As our country continues to reflect on the devastating impact of Covid-19 and the World Health Organization noted that the ‘end is in sight’ for the pandemic, we need to recognize and address the disproportionate hardships that Black and Latino communities have faced over the last two plus years. Latino communities, who experienced some of the highest infection, hospitalization, and death rates compared to other racial and ethnic groups in the U.S., were mostly forgotten and excluded when testing and vaccine efforts were planned and executed. In addition to the continued spread of the virus in our communities, there has been a shortage of programs to support families and individuals whose economic, educational, housing and nutritional needs are at risk due to the pandemic.
As new bivalent boosters have become available, and the demand for monkeypox vaccines rises, while at the same time federal funding for testing and vaccinations winds down, it is more urgent than ever to take the necessary steps to ensure the needs of Latino communities are included in future public health planning to avoid repeating mistakes that led to unnecessary suffering.
Improving visibility of Latino communities during public health crises
Throughout the Covid-19 pandemic, cases in Latino communities were undercounted and underreported, which led to skewed reporting and reduced efforts to urgently address the virus’ impact. The invisibility of Latinos was prevalent throughout the pandemic, as death rates for Latinos were 2.3 times higher than for white Americans, including younger Latinos, who were more likely to be essential workers and were therefore at higher risk for infection with 45% of adults having jobs requiring them to work outside of the home. Despite the availability of vaccines in our country, a staggering 35% of unvaccinated Latinos were fearful of immigration consequences when considering the vaccine, and 15% reported being asked for a Social Security number – which is not required by law for a vaccination.
Despite these staggering statistics, media coverage grouped Latinos in with other communities of color, and while reporters highlighted commonalities across groups, they have failed to draw attention to risk factors that specifically affected the Latino community. That includes access to healthcare services and information available in Spanish, masking and social distancing policies that were not realistic in many multigenerational Latino homes, and immigration status fears and mistrust. These inequities impacted the way the Latino community experienced the pandemic, yet little was done to offer culturally tailored solutions until it was too late.
Addressing the unique needs of the Latino community
The pandemic only shone a spotlight on what we in the public health community have been sounding the alarm about for years regarding the systemic inequities rampant in our healthcare system. In the U.S., our system and payers have failed to adapt their processes and services to meet the cultural needs of the growing number of Latinos, who are expected to make up 30% of the population by 2050.
We can no longer rely on a one-size fits all healthcare system that continues to ignore us and refuses to build trust with our Latino community. In addition to neglecting the cultural and health literacy needs of Latino patients, our community experiences medical gaslighting by providers with implicit biases about lifestyle choices and belief systems of Latinos that impact the way we think about our health. For example, a Latino patient may look to family and friends for medical advice before seeking healthcare from a physician for fear of being labeled “non-compliant” or receiving unrealistic care recommendations.
To combat this, hospitals, practices, and providers must invest in developing and implementing trainings to understand the diverse cultures that make up the U.S. Latino population. This includes the numerous protective factors like social support systems and informal networks that have provided the community much needed resources and services when the existing system excluded them. Additionally, it is imperative that providers reflect the diversity of their patients – the more we can usher in providers who come from our community and can empathize with our traditions and values, not to mention, speak our languages, the better chance we have at achieving true culturally-relevant and competent care.
A better way forward
My hope is that health equity does not become another trendy buzzword. We need to ensure everything we’ve learned over these last few years will be integrated into business objectives, ultimately becoming the fabric of our healthcare system. To do this properly, there are a handful of key elements to delivering culturally competent public health services that will set us up for success.
First, we must integrate culture into care. As our community continues to grow, we should embrace the traditions and unique characteristics that make up our identities, instead of forcing our people to hide their language, vulnerabilities, or basic needs. This goes well beyond providing translation services, which often lack cultural awareness. Offering the Latino community care teams, with providers who have a deep and personal experience with our culture, traditions, and health outlooks is the only way we will build trust back.
Additionally, addressing gaps in healthcare coverage is essential to improving access in our community. A large proportion of our community and country does not qualify for state or federal subsidies or cannot afford commercial or employer health insurance plans. This gap impacts the Latino community significantly in states that do not expand Medicaid benefits to people that have immigrated to the U.S. or states with concentrated Latino neighborhoods where domestic work is common and health benefits are often neither provided nor used. If these issues are not addressed, they will continue to play a role in the health inequities experienced by the Latino community.
New care models like direct pay primary and specialty care memberships are helping access, but there is a need to cater to broader communities besides the White and affluent. Notable players in the space have focused on developing seamless experiences for customers, but where these companies fall short is in their ability to tailor services to the communities who most need these solutions. If these primary care models are to succeed, improving access must be a part of the overall growth plan.
In addition to improving cost and accessibility, communities should be able to engage with care teams that look and sound like them while providing culturally appropriate care in their homes, neighborhood clinics, and via virtual services. These novel solutions typically rely on technology to open the door for care. We know that technology alone won’t fix the systemic issues in the healthcare system, and to be successful, technology should enhance established care relationships so that these touchpoints help patients and providers build stronger connections to drive better health outcomes. Innovative solutions can and should preserve the culture and traditions that make the Latino community strong.
We are at an inflection point as a society where we must change our perspective on what it will take to ensure that ALL patients are seen, heard, and cared for – both in everyday and dire health care scenarios. Our sisters and brothers are dying from preventive chronic conditions, and no one is doing anything about it. We must do something different. We must stop pretending that our healthcare needs, and our access is equitable. It just isn’t.
Photo: Nuthawut Somsuk, Getty Images