Latino Health Issues

HISPANIC CULTURES

In popular usage, terms such as Hispanic and Latino are often a descriptive umbrella to refer to any American whose ancestry includes people of Spanish, Mexican, or Central or South American origin. Although, the "Hispanic" label can be found in the literature going back at least twenty centuries, its official introduction to the modern lexicon has come in recent decades. According to the U.S. Department of Health and Human Services, the term refers to anyone with linguistic or cultural antecedents in Latin America or Spain.

Hispanics are commonly considered a monolithic group of Americans, but this notion could not be further from the truth. This population is more accurately referred to as a mosaic of cultures. In reality, the various Hispanic subgroups reflect profound differences in ethnicity, culture, and origin, and they have remarkably few characteristics in common. For example, this population covers the racial spectrum. Hispanics can be white, African American, Asian or Pacific Islander, or Native American. Moreover, the diversity extends to nationality, customs, heritage, lifestyles, and socioeconomic status. While similarities among the groups do exist, particularly in language (Spanish) and religion (Catholic), deeply embedded dissimilarities among the different groups in background and life experiences will influence health. This means caution should be taken in making broad generalizations about the Hispanic/Latino population.

HISTORY OF THE HISPANIC AMERICANS

The ancestors of today's Hispanics arrived at the New World's shores through various routes. Christopher Columbus first landed on the island later named Puerto Rico over five centuries ago. The European colonization of North America began with Spanish settlements in Mexico and what is now the South and Southwestern United States. Today, although U.S. Hispanics are concentrated in the West, Southwest, and New York, New Jersey, Massachusetts, Illinois, Florida, and Puerto Rico, they have become an integral element of state populations nationwide. Of the total U.S. Hispanic population, the majority are Mexican American, followed in size by Central and South Americans, Puerto Ricans, and Cuban Americans.

Due to its relative youth and rapid growth, the Hispanic population in the early twenty-first century will become the largest ethnic minority in the United States supplanting African Americans for that distinction. This growth has been particularly rapid since 1950, when the Hispanic population, totaling 2.3 million, represented only 1.5 percent of the overall U.S. population. By the year 2000, Hispanics numbered about 32.5 million and comprised 11.8 percent of the population. It is projected that by 2050 the Hispanic population will reach 98.2 million, or almost one-quarter of the country's population. In Canada, the portion of the population classified as Latin American in 1996 numbered 176,975.

Mexican Americans. After its independence from Spain in 1821, Mexico continued active colonization of its northern territory, which ranged from California to Texas and as far north as southern Wyoming. Following the Mexican War in 1847, the United States obtained most of the present-day Southwest, and residents of Mexico in this region found themselves living in U.S. territory. Over the past 150 years, Mexico has been a major departure site for immigration to the United States. In 1999, Mexican Americans comprised about two-thirds of all Hispanics in the U.S. population.

Central and South Americans. Since the 1960s, immigration from countries neighboring Mexico and from South America has increased dramatically, primarily as a result of political, civil and/or economic turmoil and hardship in countries such as the Dominican Republic, Guatemala, El Salvador, and Nicaragua. Central and South Americans have settled in numerous locations across the United States, most notably in California, New York, Washington, D.C., New Jersey, and Florida. These ethnic subgroups reflect a strong diversity of culture, background, and educational and socioeconomic levels. Central and South Americans represented 14.3 percent of the U.S. Hispanic population in 1999.

Puerto Ricans. Another major source of Hispanic Americans over the past century is Puerto Rico, which was ceded to the United States following the Spanish-American War in 1898. Puerto Ricans were granted U.S. citizenship as a result of the Jones Act of Congress in 1917. The end of World War II marked the beginning of a significant migration of Puerto Ricans to the mainland, primarily to New York. The open migration between the island of Puerto Rico and the mainland has presented an assimilation process that is unique among Hispanic Americans, because Puerto Ricans freely operate in two divergent societies. Individuals from Puerto Rico comprised 9.6 percent of the U.S. Hispanic population in 1999.

Cuban Americans. While small Cuban settlements in the Tampa area of Florida and in New York date back to the early 1900s, the major migration from this island came as a result of Fidel Castro's rise to power in 1959. The large majority of immigrants settled in Miami, creating an urban sector known as Little Havana. The Cuban arrivals during this period represented the upper and middle classes, which afforded them a very different immigration experience from those who came from Mexico and Puerto Rico. However, the next major exodus, of 125,000 people in 1980, came primarily from the working classes of Cuba. About 4 percent of the 1999 U.S. Hispanic population were Cuban Americans.

SOCIODEMOGRAPHIC INFLUENCES ON HEALTH

Among the most striking demographic influences is the relative youth of the Hispanic population. Overall, the median age of Hispanic Americans in 1999 was 26.1 as compared to 36 for the general population. Closer inspection, however, reveals some wide variations in age among Hispanic population groups. The median ages of Mexican Americans (24.2) and Puerto Ricans were the lowest(27.5), while that of Cuban Americans was much higher (41.3). Not surprisingly, the proportion of the Cuban-American population over age 65(17.8%) was considerably higher than the percentage found in Mexican Americans (4.4%) and Puerto Ricans (6.5%). Such age structure differential among the ethnic groups explains variations in the prevalence of chronic diseases seen more in the elderly, including cancer, diabetes, and cardiovascular disease. Since the age profile of the Cuban-American population more closely resembles that of non-Hispanic whites, the rates of major diseases for these populations are similar.

Among Hispanic in general, lower socioeconomic and education levels provide additional influences on health status. For example, economic status directly relates to the availability of health insurance and access to care. In 1998 the median income for Hispanic households was $28,330, considerable lower than the $42,439 median income for their non-Hispanic white counterparts, and poverty rates among Hispanics were over three times higher (25.6% versus 8.2%). Education levels, which are associated with economic levels and health status, are also lower among Hispanics than other populations. In 1999, 56.1 percent of Hispanics age twenty-five and older had finished high school, compared to 87.7 percent of non-Hispanic white adults.

CHRONIC DISEASES AMONG HISPANICS

Disease mortality rates are lower overall for Hispanics than for non-Hispanics, and considerably lower for the two major killers, cardiovascular disease and cancer. Diabetes, however, claims more lives among the Hispanic population.

Cardiovascular Disease. Although cardiovascular disease among Hispanics is increasing, rates of death for this disease are substantially lower for Hispanics than for non-Hispanics. Few studies include Puerto Ricans and Cuban Americans, and most of the Hispanic cardiovascular disease statistical data reflect findings in studies of Mexican Americans. These studies show lower heart disease mortality rates among Mexican-American men than among non-Hispanic white males.

Cancer. Compared with non-Hispanics, cancer rates are lower overall and lower for the major sites—lung, breast, prostate, and colorectal— among Hispanics. For lung cancer, the reduced incidence and mortality (60 to 80% lower than for non-Hispanics) extends to each of the major Hispanic ethnic groups. Breast cancer incidence is 30 to 50 percent lower among Hispanic women. Among Hispanic males, the frequency of prostrate cancer is significantly lower only in Mexican Americans; incidence rates for Puerto Ricans and Cuban Americans are comparable to those of non-Hispanic white men. Colorectal cancer rates are also lower for all of the Hispanic ethnic groups. Hispanics are at greater risk for cancers of the cervix, stomach, gallbladder, and liver. Among Mexican-American and Puerto Rican women, cervical cancer incidence is tow to three times higher than in non-Hispanic white women.

Diabetes. Diabetes is a primary health concern for Hispanics. This has been particularly documented among studies involving Mexican Americans, in which the risk of type II diabetes mellitus is two to three times higher than those of non-Hispanic whites. While risk appears to vary among Hispanic groups in different areas of North, Central, and South America, the greatest risk is apparently associated with an increased proportion of Native American genetic admixture. Among Mexican-American adults in Texas, about 15 percent have type II diabetes mellitus. The comparatively high level of undiagnosed diabetes among Hispanics is particularly disturbing because diabetes is one of the major killer diseases for this population.

A DIVERSE POPULATION

The diversity of the Hispanic population in terms of background, culture, and sociodemographic characteristics renders broad generalizations difficult and, in many cases, meaningless. This diversity impacts the health of the Hispanic groups, which is reflected in wide-ranging incidence and mortality rates for the major chronic diseases. In addition, the implications for knowledge, attitudes, and behaviors with regard to the broad spectrum of health issues are profound. For the Hispanic population in general, and for the ethnic subgroups in particular, public health needs include improved data collection, increased population and chronic disease research, and greater emphasis on training culturally sensitive health care providers.

AMELIE G. RAMIREZ

LUCINA SUAREZ

(SEE ALSO: Cultural Appropriateness; Cultural Identity; Ethnocentrism; and articles on specific diseases mentioned herein)

BIBLIOGRAPHY

Haffner, S. M. (1998). "Epidemiology of Type 2 Diabetes: Risk Factors." Diabetes Care 21:Supp. 3.

Miller, B. A.; Kolonel, L. N.; and Bernstein, L. et al., eds. (1996). Racial/Ethnic Patterns of Cancer in the United States. 1988–1992. Bethesda, MD: National Cancer Institute. NIH Pub. No. 96–4104. Available at http://www-seer.oms.nci.nih.gov/Publications/REPoC/.

Mitchell, B. D.; Almasy, L. A.; Rainwater, D. L.; Schneider, J. L.; Blangero, I.; Stern, M. P.; and MacCluer, J. W.(1999). "Diabetes and Hypertension in Mexican American Families: Relation to Cardiovascular Risk." American Journal of Epidemiology 149(11):1047–1056.

Romero-Barcelo, C. H. R. 856—United States—Puerto Rico Political Status Act. Available at http://www.puertorico51.org/reference/analysis.htm.