Latinx #HealthEquity in California: Facing Disparities and Building for the Future

A Report by Hispanics in Philanthropy and the University of California - San Francisco

What is Health Equity? Why focus on Latinx community ?

The goal of health equity is to reduce—and, ultimately, eliminate—disparities in health among socially and/or economically disadvantaged groups, including people of color; people with low incomes; lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) people; and people with disabilities.

To achieve health equity and social justice, health equity work must examine health through a holistic and cultural lens that is focused on the social determinants of health, such as income, education, and housing.

Disparities Remain

Despite decades of government and community efforts to improve health equity in Latinx communities in California, vast disparities remain. Latinxs are the group least likely to be insured or to report having a doctor.

What are the most important issues impacting Latinx health equity in California? To find out, we spoke with 10 leaders in the field, and conducted comprehensive research.

Dots indicate geographic location of organizations currently engaging in health equity work in California

This is what we discovered with our partners on the ground.

What are the key health equity issues affecting the Latinx community?

1. Social Determinants of Health

It is critical to understand the various social determinants of health—the general socio-economic, environmental, and cultural conditions that influence a person’s health and well-being—that impact Latinx communities throughout California. This includes factors like the employment and educational opportunities available in a community, social networks, and exposure to environmental toxins, among others.

As a result of institutionalized racism, government agencies, foundations, and businesses have underinvested in Latinx communities, leading to disparities in economic prospects, education, and housing.

“...now they call it social determinants, but for 18 years, we have been calling it issues of sobrevivencia, issues that deal with our survival, wellbeing, our family, so everything from jobs to school grounds...every environment affects our health in both physical and emotional [ways].”

Promising Strategy: Many organizations and communities throughout California are already directly addressing the social determinants of health. For example, one leader working in the Central Valley discussed a community health improvement program that brings together multi-sector partners to collaborate on issues from diabetes to land use to improve health outcomes among underserved communities.

2. Immigration

Health disparities are often elevated among undocumented and/or recent immigrants, including lack of access to services and mental health. Many of the leaders we spoke to were concerned about the psychological impacts of immigration, particularly the issue of deportation, on individuals and families.

One healthcare expert noted that families with mixed immigration statuses are hesitant to access healthcare services…because they’re afraid they’re going to get picked up. Every time there’s a rumor in the community about an ICE agent being somewhere close by, our census plummets.”

Promising Strategy: Many organizations and communities throughout California are already directly addressing the social determinants of health. For example, one leader working in the Central Valley discussed a community health improvement program that brings together multi-sector partners to collaborate on issues from diabetes to land use to improve health outcomes among underserved communities.

3. ACCESS TO HEALTHCARE SERVICES

Health disparities are often elevated among undocumented and/or recent immigrants, including lack of access to services and mental health. Many of the leaders we spoke to were concerned about the psychological impacts of immigration, particularly the issue of deportation, on individuals and families.

“The ugliest thing that ever happened in my career, dealing with persons who don’t speak English or are migrants ....we had a mom come in and she brought her child. And the child was limp as a dishrag with a 105 fever, and this child had been sick for 3 days. This child had meningitis. ‘Why didn’t you bring him before?,’ we asked. She said she had no money. That child died."

Promising Strategy: One Latinx-serving community clinic partners with nursing students to coordinate home visits as a way to provide in-home services and improve continuity of care for patients who might otherwise face difficulties accessing services. The program has specifically focused on Latinx populations who frequently have transportation challenges or jobs that preclude them from seeking care during normal clinic hours (9 am -5 pm).

4. Quality of Care

In many areas of California, access to clinicians who provide quality, culturally competent care can be challenging. Individuals may face providers’ explicit discrimination, implicit bias (also known as unconscious bias), cultural barriers, and a lack of culturally competent care.

While explicit bias by providers against Latinx people still occurs, implicit, or unconscious, biases are more common and can be manifested in subtle ways such as being condescending and judgmental toward non-white patients, making assumptions about treatment adherence, and being less thorough when it comes to diagnosing an illness.

Promising Strategy: Create a culturally competent care plan. Strategies include: acknowledging potential language barriers by extending appointment times for those with limited English proficiency, ensuring all written information is also available in Spanish and indigenous languages at an appropriate reading level, hiring bilingual staff who are sensitive to cultural norms and values and ideally reflect the community being served, accommodating the work schedules of low-income patients by offering evening hours and drop-in appointments, and providing culturally specific treatment plans.

5. Mental Health

Along with the stresses of poverty and environmental factors, mental health issues for Latinxs may be exacerbated by factors including racism, criminalization, fears of deportation, and the stress of acculturation and assimilation. The current socio-political climate, coupled with a general lack of culturally sensitive or trauma-informed services, has brought a renewed focused on mental health needs among health equity leaders in California.

A Promising Strategy:"Nothing about us, without us." To address mental health needs among Latinxs, as well as other communities of color and the LGBTQIA community, the Office of Health Equity (within the California Department of Public Health) launched the California Reducing Disparities Project (CDRP). This project prioritizes “community-defined evidence and population-specific strategies for reducing disparities in mental health."

6. Sexual and Reproductive Health

While gains have been made in the field of sexual and reproductive health, substantial disparities still remain by income, race/ethnicity, and immigration status.

Access to contraception services is important, but culturally appropriate counseling—such as understanding that a young Latina may need extra support to comply with her contraceptive use to fulfill her dreams of being the first to go to college in her family—and comprehensive sex education that addresses the specific concerns of Latinx teens, are also needed to dispel misinformation and myths about contraceptive use.

In California, Latinas remain the group with the highest teenage pregnancy in the state, reflecting both challenges in seeking care and the impact of persistent poverty and more limited educational opportunities, particularly in rural parts of the state.

Promising Strategy: Initiatives such as the state of California’s Family Planning Access Care and Treatment program (FPACT) have helped Latinx people access reproductive health services by offering free reproductive health services to low income women up to 200% of poverty, regardless of legal status.

The Path Forward: The Critical Role of Funders

Promising Strategy: Initiatives such as the state of California’s Family Planning Access Care and Treatment program (FPACT) have helped Latinx people access reproductive health services by offering free reproductive health services to low income women up to 200% of poverty, regardless of legal status.

Organizations, particularly small ones, struggle to apply for and receive funding, constrained by restrictive funding streams and lengthy applications processes. Many organizations face challenges trying to continue needed services, when funding streams dry up or funders move to the next issue of interest.

So how can funders step up?

Download the full report and find out

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