Latinos Lives and Health, a poll released last month by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health, found diabetes is the top health concern of Latinos.
With 19 percent of Latinos reporting diabetes as the foremost health concern facing their families, it far outranks the next most reported health issue, cancer, which ranked number one by 5 percent of Latinos. The results of the survey show the significant differences among diverse populations in this country and can help nurses address the specific needs and concerns of their Latino and Hispanic patients.
As is always the case, healthcare tensions involve much more than just physical ailments. The poll also reported significant amounts of stress around healthcare costs and employment issues. More than one in two Latinos are concerned that if a major illness struck, they wouldn’t have the funds or health insurance to cover the resulting bills. And in many Latino and Hispanic cultures, family comes first which can have significant impact on treatment adherence. There could be a very real reluctance among patients to take money from the family funds to pay for their own healthcare or to set aside time to care for themselves, even if it can improve their health.
According to the Office of Minority Health, rates of diabetes in Hispanic and Latino populations are high, so families have a right to be concerned. Hispanics and Latinos over the age of 18 are diagnosed at a rate of 13.2 percent compared to 7.6 percent of non-Hispanic whites. They also die of diabetes complications at a higher rate than non-Hispanic whites, so clear health information about diabetes management is essential.
As a nurse, one of the most important things is to make patients aware of diabetes as a serious disease with potentially life-threatening, and certainly life-altering, complications. Follow through on medications and lifestyle changes are essential, but when you are talking about changes and treatment, you must take cultural expectations into account, too. Various traditions around family dynamics, food, and celebrations can wreak havoc on trying to control diabetes, so making yourself familiar with some patient expectations can lead to positive treatment and care outcomes.
The Agency for Healthcare Research and Quality listed a few suggestions in their Diabetes Disparities Among Racial and Ethnic Minorities report. Involving the family in new approaches to diabetes management with medication, eating, and exercising helps. Show patients how to read labels and what to watch for. Exercise can be a family walk after dinner.
Above all else, listen to the patient and the family to see what approaches they might have and then try to work within that framework.
Angelica P. Herrera, DrPH, MPH,an Assistant Professor in the Center for Aging Studies at the University of Maryland Baltimore County, knows all too well the havoc that diabetes plays in the Hispanic community. Among her current projects is the refinement of a home-based intervention for family caregivers of older Latinos with poorly controlled type-2 diabetes.
Q. What are the most important issues concerning diabetes in the Hispanic population?
A: Diabetes is an area of considerable concern among Hispanics, particularly for older adults, and an area of research I’ve been heavily involved in as of late. The high obesity rate among Latinos is one of the most obvious culprits. Latinos are also less likely to seek early diagnoses and treatment for diabetes, and when diagnosed are less likely to follow through on recommended dietary changes and medication therapy.
Limited access to care because of non-insurance or underinsurance only makes matters worse in this community. There is also a strong multi-generational component, which I believe involves not solely the transference of genetics, but also sharing of poor dietary habit and lifestyles.
Poverty, which is only compounded by awful numbers in educational attainment, coupled with discrimination and neighborhood segregation make matters worse for Latinos, leading to high stress levels. There is growing research supporting the relationship between stress and diet.
Q: How did things get so bad?
A: There are many factors associated with the prevalence of diabetes in the Hispanic population, including overall population growth, under-utilization of healthcare resources, the increased number of elderly, and cultural factors that make it difficult for Hispanics to understand or follow advice surrounding diabetes. There is certainly a genetic component not well understood.
Q: Is there hope for a reduction in diagnosis, better health outcomes for diabetics, or even a cure?
A: To curb the rise in diabetes, there needs to be major public policy change that promotes healthful lifestyles, more research into culturally and linguistically appropriate interventions for this community, and increased coverage and incentives in the health care system to screen and treat the disease early on.
There is no easy solution for diabetes and the rate of diabetes is likely to continue to increase given the projected growth of the Hispanic population.
Q: What’s been effective in educating Hispanic diabetics, and helping them lead healthier lives?
A: The most effective approach to educating Hispanic diabetics has been culturally sensitive education that focuses on the specific challenges that the population faces, and looks at finding the best ways to support diabetes management in Hispanics. This includes using Hispanic community health workers who can present information in Spanish and understand the perspectives of the Hispanic culture.
Q: What does Hispanic Heritage Month mean to you personally?
A: Hispanic Heritage Month is an important time to reflect on the issues that are currently facing the Hispanic population and what the best ways to move forward.
Jebra Turner is a health reporter and former H.R. director, where she oversaw workplace health and safety training programs for staff and clients. She lives in Portland, Oregon, but you can visit her online at www.jebra.com.
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