As the recent presidential election illustrated once again, Hispanics and Latinos are a major U.S. demographic group, transforming not only our political landscape but major institutions like health care. In 2000, Hispanics/Latinos became the largest group of people of color in the United States, passing African Americans 10 years ahead of projections. At over 52 million, Hispanics/Latinos now comprise nearly 17 percent of the total population, an increase of 43 percent between 2000 and 2010. Contrary to popular belief, this growth is due to a higher birthrate than the national average and not immigration, which has been declining steadily to now 20 percent of its height in 2000.
More than half of Hispanics/Latinos were born in the United States, which is why their median age of 27 is much lower than other groups, and more than half of all children in California today are Hispanic/Latino.
Despite these trends, the question of who Hispanics/Latinos are and what they need from health care still remains for many organizations. There are three basic concepts that can get health care organizations on the right track to serving this growing population in an effective, safe, cost-effective manner.
The first concept is that terminology matters. There is no one term that all Hispanics/Latinos — most commonly understood as people with cultural and/or ethnic origins in a Spanish-speaking country of Latin America — use to refer to themselves. This is a complex and contentious issue driven by multiple factors such as nation of origin, age, political orientation, and geographic location. For example, "Latino" tends to be preferred in California, in urban areas, and among younger people and liberals. "Hispanic" is often preferred in New Mexico and Texas, and by older individuals, and conservatives. "Mexican American" is often used by people of Mexican descent in the west and southwest, and "Spanish" is common among Hispanics of northern New Mexico. "Chicano" is a term of political and ethnic pride adopted by many individuals of Mexican descent with strong leanings toward the political left, while "Boricua" has a similar political flavor for Puerto Ricans. Many Hispanics, particularly those whose families emigrated in the last generation or two, may identify most with their country of origin — Salvadoran or salvadoreño, cubano (Cuban), or mexicano, for instance.
An additional complexity is that Hispanics/Latinos may identify with more than one label depending on the context. A young male college student in south Texas whose grandparents emigrated to the United States in the early 1900s during the Mexican Revolution may identify as a Hispanic in national political conversations or travels, as Mexican American in her hometown, and as Mexican or mexicano when around other Hispanics or traveling close to the U.S.-Mexico border. In general, "Hispanic" and/or "Latino" are the most commonly preferred terms by the largest number, but it’s always a good idea to ask the patient or local community their preference and honor that preference.
The second basic concept is that Hispanics/Latinos are extremely diverse. Lumping together millions of people that come from 20 different countries located across two continents with vastly different geographies and millennia of advanced civilizations, invasions, and colonization and calling them by one name is about as absurd as lumping together all Europeans. However, the common history of colonization by Spain and the resulting shared Spanish language and Catholic faith have resulted in some cultural similarities. Those include a group-oriented, family-based value system, priority given to relationships over tasks or time, and (for most groups) familiarity with hierarchies, and clear norms for interacting across power differences. But, while 63 percent of Hispanics/Latinos in the United States are of Mexican origin, 37 percent come from other countries with widely different cuisines, geographies, histories, language, and customs — and Mexicans are quite diverse too.
Hispanics/Latinos are also a multiracial ethnic group, not a race. An attempt to better capture the racial diversity of this population was one reason behind the U.S. Census separating race from ethnicity starting in 2000. A Hispanic from the Dominican Republic is likely of African origin and may identify racially as black. Many Peruvians are of Japanese descent and may identify racially as Asian. Argentinians are of mostly Italian, Spanish, and German descent, and may identify racially as white. An indigenous Mexican or Bolivian may identify racially as Native American. However, for most Hispanics, the race question is a strange and complicated one since most identify more with their nationality or Hispanic/Latino ethnicity than a racial group (partly because they are typically multiracial and partly because most Latin American countries don’t collect race data and some — like Mexico — have a strong ideology about being mixed European and Indian/Native American). This is why Hispanics have a high tendency to mark "decline to state", "some other race" or "White" on census forms and patient forms.
Finally, despite the cultural similarities that Hispanics/Latinos may share, and the common bonds we all share across our common humanity, the third basic concept is Hispanics/Latinos are different. Any effective, "culturally competent" model of patient care or attempt to reduce disparities needs to treat them appropriately and differently. Besides the cultural tendencies described above, Hispanics/Latinos tend to be younger, less formally educated, and less financially well-off than other groups. They tend to get certain diseases and cancers at higher rates or present with higher acuity — more due to social and economic stressors and cultural factors than genetics. However, they often have better health than other U.S. residents, especially if they are recent immigrants (this is called the "Hispanic Paradox").
Providing this growing population with excellent care means taking time, building a relationship, involving the entire family, paying attention to gender roles, building trust, proactively connecting with the community, noticing nonverbal communication, demonstrating respect, providing materials in Spanish (even for bilingual patients) and language interpreters, learning about traditional healing practices, smiling, listening to understand, and noticing that Hispanic patients may not always be assertive in asking questions or raising concerns, especially if trust and relationship have not yet been built. In short, the basics of providing excellent patient care require emotional intelligence and remembering that this "Sleeping Giant" is not going away, nor is he going back to sleep!
Susana Rinderle, M.A., is a trainer, consultant and coach in diversity, equity and inclusion who has worked broadly and published widely on the U.S. Hispanic/Latino population. She was the co-founder and former manager of diversity, equity & inclusion at the University of New Mexico Hospital. See www.susanarinderle.com for more information.
