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Social Determinants of Hispanic/Latino Health...

Social Determinants of Hispanic/Latino Health

Daniel Santibanez, MPH, RD, University of North Florida

September 23, 2005 - UNF Hispanic Health Issues Seminars

This is part 8 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of the Duval County Health Department.

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Aetna Presentation Social Determinants of Latino Health Aetna Presentation Social Determinants of Latino Health Presentation Transcript

  • Social Determinants of Hispanic/Latino Health Daniel Santibañez, MPH, RD Department of Public Health University of North Florida This is part 8 of an 8 part series of seminars on Hispanic Health Issues brought to you by the University of North Florida’s Dept. of Public Health, College of Health, a grant from AETNA, and the cooperation of the Duval County Health Department.
  •  
  • While education plays a valuable role…
    • It is important not to “blame the victim” by focusing strictly on lifestyle choices
    • Addressing the social and physical environment that influences behavioral choices is an essential element of a strategy to change behavioral patterns
  • SES is central to eliminating health disparities
    • It is closely tied to health and longevity
    • At all income levels, people with higher SES have better health than those at the level below them
    • SES is also a strong force behind differences in health among racial and ethnic groups
    • People die younger in societies with greater inequalities in income
  • Social Determinants of Health
    • The socioeconomic and racial disparities in health in the United States today require public health professionals to critically examine the scope and focus of public health research and practice
    Healthy People 2010 Goals: Goal 1: Increase quality and years of healthy life Goal 2: Eliminate health disparities
  • Social Determinants of Health
    • Income inequality
    • Social exclusion
    • Job insecurity
    • Poor working conditions
    • Food insecurity
    • Inadequate housing
    • Language
    • Access to care
  • People affected by health disparities more frequently live in environments with:
    • Toxic conditions
    • Inadequate access to affordable nutritious food, places to play and exercise, effective transportation systems, and accurate, relevant health information
    • Violence
    • Joblessness, poverty
    • Targeted marketing and excessive outlets for unhealthy products
    • Community norms that do not support protective environments
  • Focusing only on individual responsibility for lifestyle changes ignores larger environmental factors that can work against the educational message
    • For example, limited education may mean less exposure to info about risk, but the same people may live in neighborhoods with poor recreational facilities, fewer stores selling fresh produce, and more advertising for tobacco and alcohol
  • Hispanic young people were exposed to more alcohol advertising in English-language media than non-Hispanic young people
  • Key Community Factors for Reducing Health Disparities
    • Built Environment Factors
    • Social Capital Factors
    • Services and Institutions
    • Structural Factors
  • Built Environment Factors
    • Activity-Promoting Environment
    • Nutrition-Promoting Environment
    • Housing
    • Transportation
    • Environment Quality
    • Product Availability
    • Aesthetic/Ambiance
    • Number of play areas
    • Supermarket access
    • Housing quality and asthma
    • Psychological stress
  • Social Capital Factors
    • Social Cohesion and Trust
    • Collective Efficacy
    • Civic Participation and Engagement
    • Social and Behavioral Norms
    • Gender Norms
    • Connections and trust
    • Improved mental health and trauma outcomes
    • Securing community resources
    • Voting and volunteering
    • Lower addiction rates and violence
  • Resilience and responses to stress affect health
    • Researchers have found that people who experience discrimination are far more likely than others to develop HTN and other stress-induced health effects
    • Biological effects of repeated stress affect immunity, health, and life expectancy
    Minority women and “kinwork” of family and friends
  • Social Connections within a community are important
    • Children are healthier in neighborhoods were adults talk to each other
    • High levels of social support and a number of positive health benefits among Latinos
    Social networks enforce social sanctions and controls to diminish negative behaviors. Reduce incidence of crime, juvenile delinquency, and access to firearms within communities
  • Residential Segregation
    • Hispanics and Blacks are more likely than poor white families to live in areas of concentrated poverty
    • Research has shown that living in neighborhoods where some residents have higher incomes and more education is healthier
  • Services and Institutions
    • Public Health, Health, and Human Services
    • Public Safety
    • Education and Literacy
    • Community-Based Organizations
    • Cultural and Artistic Opportunities
    • Availability and access to high quality services
    • Community coalitions and perceived safety
    • Community-based health promotion
    • Gardens, murals, and music promote healing
  • Quality of health care can cause problems
    • Research has found that higher SES does not protect minorities from poor health outcomes
    Medical professionals should be trained to understand social causes in patients’ lives so that they can improve the quality of care
  • Improving Quality of Care
    • Cultural competency training
    • Recruiting minorities in healthcare
    • Even w/insurance coverage and higher SES, disparities in prevention and screening exists
    • Quality = Equity in health care
    “ Racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients’ insurance status and income, are controlled.” -Unequal Treatment, Institute of Medicine
  • Educational Opportunity
    • Because the quality of schools is partially determined by community resources, people in poor communities get poor quality education
    As a result, they have fewer opportunities for good jobs and incomes. In addition, they face the effects of lowered expectations.
  •  
  • Structural Factors
    • Economic Capital
    • Media and Marketing
    • Ethnic, Racial, and Intergroup Relations
    • Employment opportunities
    • Adequate living wage
    • Job training
    • Local ownership of business and homes
    • Access to loans
    • Media perceptions
  • Economic pressures exact a toll on minorities
    • Hispanics, African-Americans, Native Americans and some Asian groups are more likely than other groups to be poor
    • Poverty affects health by limiting access to needed resources
    • Other elements of SES, including education, residence, and occupation, also affect people’s quality of life, including their health
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  • Occupational Opportunities
    • Having to work more than one job, lacking health benefits, having little control over one’s schedule or pace of work, and being unable to take time off work when needed can cause chronic stress and damage self-esteem.
  •  
  • Disparities go beyond SES
    • To plan and develop interventions that will truly help the community, public health professionals must capture the contextual reality of racial and ethnic communities
    • By understanding race and ethnicity in terms of community, we can grapple with their complexity and take note of the differences between poor communities
    • It is a holistic approach that does not exclude poor people but rather looks at them within the communities where they live
  • Poder es Salud/ Power for Health
    • Many public health practitioners and researchers have identified greater community involvement and increased social capital as ways to reduce inequities related to income, race, gender, ethnicity, and geographic location.
    A more empowered and competent community is a healthier community
  • Poder es Salud/ Power for Health
    • Social capital is characterized by a sense of trust, shared norms and values, and interconnectedness
    • It has both an informal aspect related to social networks and a more formal aspect related to our social development programs
    • Social cohesion, “civicness” and participation in society and governance
  • Poder es Salud/ Power for Health
    • The project builds on existing social capital to expand ties between the African American and Latino communities and expand access to social and economic resources
    Community-based research works with existing units of identity that share an emotional connection, values and norms, common interests, and a commitment to meeting shared needs.
  • Poder es Salud/ Power for Health
    • 3 core strategies to enhance community-level social capital:
      • Community-based participatory research
      • Popular education
      • Community health workers
  • Poder es Salud/ Power for Health
    • 3 African-Am faith based organizations
    • A coalition of 5 evangelical congregations in the Latino community
    • A geographically defined community consisting of 4 apartment complexes
    Steering committees formed
  • Poder es Salud/ Power for Health
    • Public safety committee
    • Community health fair
    • Diabetes support and information group
    • Homework club
    • Photovoice Project
      • Led residents to develop a campaign to remove trash and illegally-dumped materials from area
  • Poder es Salud/ Power for Health
    • Created a cooperative to provide members with insurance, small-business loans, and job opportunities
    • In response to community members prioritizing 3 social determinants of health:
    • Lack of health insurance
    • Lack of self-employment and business knowledge
    • Lack of jobs and employment security
  • Poder es Salud/ Power for Health
    • Peace Campaign initiated and implemented to address the increase in gang violence and repeated police use of lethal force against unarmed citizens
    • Peace Campaign Goals:
    • Explore violence as a public health issue
    • To build lasting relationships between young people and police officers
    • To help youths learn nonviolent techniques that they can use with peers and adults
  • Poder es Salud/ Power for Health
    • Youth advisory council
    • Youth gang task force
    • Creation of a community-based initiative created to prevent crime and revitalize the community - Weed and Seed
    • Included police cadets in the coalitions
    Peace Campaign has involved coalition members in design, implementation, and evaluation
  • Community Action Model
  • “ No epidemic has even been resolved by attention to the affected individual” - Dr. George Albee
  • Migrant Farmworker Health
    • There are over 3 million MSFW in the U.S.
    • 81% foreign born
    • 95% born in Mexico, 2% Latin America, 1% Asia, 1% other
    • 80% Male and 84% Spanish-speaking
    • Nearly ¾ of U.S. farmworkers earned less than $10,000 per year
    • 3 out of 5 families had incomes below poverty level
  • Migrant Farmworker Health
    • The health needs of farmworkers have been ignored by the public health research community
    • Most agricultural studies have focused on farm owners/operators
  • Migrant Farmworker Health
    • Of the farmworkers who go to health clinics, at least 40% present with multiple and complex health problems including infectious and chronic diseases, making diagnosis and treatment that much more difficult
  • Migrant Farmworker Health
    • Dental
    • Environmental/Occupational health
    • Mental health and substance abuse
    • Domestic violence
    • Disaster relief
    • Housing
    • Child labor
  • Migrant Farmworker Health
    • The poor level of oral health for farmworkers was generally found to correspond with lack of access to information that could help prevent oral health problems and lack of access to preventive care and restorative services
    Dental disease ranks as one of the top 5 health problems for farmworkers aged 5-29 and among the top 20 health problems for all other ages presenting for care
  • Migrant Farmworker Health
    • Environmental/Occupational health issues include:
      • Disability and death Traumatic injuries
      • Respiratory problems
      • Dermatitis
      • Infectious diseases
      • Cancer
      • Eye problems
  • Migrant Farmworker Health
    • Although there are field sanitation guidelines for farmworkers developed by OSHA, these are seldom enforced by OSHA or compiled with by employers
    Tuberculosis and parasitic diseases are attributable to deficient sanitation both at work and at residence sites, poor quality drinking water and failure to provide uncontaminated washing and drinking water
  • Migrant Farmworker Health
    • High levels of depression are associated with high acculturative stress, low self-esteem, discrimination, low religiosity, lower income, physical health problems, and lack of child care
    Because Mexican culture emphasizes familism , collectivist values, and affiliation, Mexican migrants may be particularly vulnerable to depression when they lack support from family and friends
  • Mental Health Stressors:
    • Language
    • Unpredictable nature of work and housing
    • Being away from family and friends
    • Difficult workload and structure
    • Socialization of children
    • Lack of daycare and supervision
    • Poverty and poor housing conditions
    • Isolation and discrimination
  • Migrant Farmworker Health
    • Approximately 13% drink 6 or 7 days a week an average of 21 drinks weekly
    • Alcohol and drug abuse create safety and health hazards
    Social isolation is the primary risk factor for elevated alcohol consumption
  • Migrant Farmworker Health
    • Estimated 20% of women experienced physical abuse and 10% reported forced sexual activity in one year
    • Women whose partners used drugs and/or alcohol were 6 times more likely to be abused
    Research on domestic violence among this population continues to progress at a slow pace and much is still unknown
  • Migrant Farmworker Health
    • When faced with a natural disaster, migrant community health centers find themselves restricted by emergency relief vehicles that are financially limited and unable to respond the needs of the areas that they serve
    The costs of serving this population are in many ways already extraordinary. Add to this situation a natural disaster, and most migrant health centers simply do not have the additional resources to adequately address these difficult circumstances
  • Migrant Farmworker Health
    • Overcrowded and substandard housing can contribute to the contraction and spread of disease, as well as injury through household accidents
    • Many farmworkers crowd units to limit the cost impact of housing on their low incomes
    Although they toil to bring a bounteous harvest to our tables, farmworkers are often faced with some of the poorest living conditions in their communities
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  • Migrant Farmworker Health
    • Exposure to pesticides, transportation accidents, tractor rollovers, unguarded machinery, open irrigation ditches, and animals are among the serious hazards faced by child laborers
    • Large numbers of youth are suffering fatal and non-fatal agricultural injuries
    Few legal protections exist to safeguard the health and well-being of young farmworkers.
  • Child Labor: 2 groups
    • Unaccompanied and those who work alongside their parents
    • Approx. 55,000 unaccompanied
    • Of these, 44,000 are foreign-born males
    • Median annual income $1,000 - $2,500
    There is no limit under federal law to the number of hours per day or per week that children may work in agriculture. As a result, the hours worked are often long and affects health and education.
  • Migrant Farmworker Outreach
    • Over 100 migrant health centers, along with a dozen migrant “voucher” and other special programs exist
    • Federally assisted migrant health services reach only about 15% - 20% of the nation’s MSFW population
    In migrant health, the challenge of making real breakthrough during the coming decade in improving access and reducing health disparities for MSFWs depends on investing adequately in lay health outreach
    • Questions ?
    • Thank you
    • Daniel Santibanez
    • [email_address]