Health Promotion Among Diverse Populations
The Latino population in the United States is expected to increase from 31 million (11% of the population) to 59 million (18% of the population) by 2025. (Betancourt, Carrillo, Green, & Maina, 2004, p. 16) The term Latino refers to a very broad group with distinct nationalities, religions, degrees of naturalization and socioeconomic status. This ethnic group includes any person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. According to the 2012 U.S. Census Bureau population estimate, there are almost 53 million Hispanics living in the United States. This group represents 16.9 percent of the U.S. total population. Another significant point is that in 2012, 33.2 percent of Hispanics were under the age 18 in comparison to 19.7 percent of non-Hispanic Whites. ("Hispanic/Latino Profile," 2015, para. 1)
The health disparities faced by many Latino’s are a result of a number of complex interrelated factors: Insurance, Language Fluency, and Educational Level. Latinos have the highest uninsured rates of any racial or ethnic group within the United States. One quarter of the nation’s 44 million uninsured are Latinos. Of these 44 million, 9 million have at least one family member who is employed. (Betancourt et al., 2004, p. 17) In the past five years, Medi-Cal has changed their criteria for application and approval process. The county’s insurance ACE has also followed suit and imposed less rigid criteria in order to qualify for coverage. The undocumented migrant Latino population, in years prior, was severely affected by the inability to qualify for insurance and faced great difficulty maneuvering through a complex and intricate health care system, further adding challenges to health promotion and disease prevention for this population. Many wait until the illness supersedes the fear of deportation and ultimately seek medical help when the disease is advanced, requiring more medical care at a much higher cost. Medi-Cal has since changed requirements and offers emergency Medi-Cal for a year for any undocumented patients. The Affordable Care ACT is working in terms of affordability, access and quality for Latino families including Latinos families who were previously uninsured and Latinos who had insurance that didn’t provide them with adequate coverage and financial security. Latino families have more security, and many of those who already had insurance now have better coverage.
English language fluency varies among Latinos who reside in United States. Census 2012 data shows that 74 percent of Hispanics speak a language other than English at home. 33 percent of Hispanics state that they are not fluent in English. ("Hispanic/Latino Profile," 2015, para. 2) Latino patients often receive care from physicians who may not speak their language, understand their cultural beliefs, or socio-economic situation. These barriers produce outcomes such as patient dissatisfaction, poor compliance with medical treatments, and poor communication between patient and healthcare team occur. 85 percent of the patient population at our hospital consists of Latinos. As the culture in healthcare changes and patients are playing an ever-active role in the direction of their care, communication plays a vital role in wellness. Great lengths are taken to ensure that non-speaking English patients have all their care translated in their primary language. This is essential in assuring medications are taken how and when they should be taken. Behavioral and lifestyle changes are implemented, and compliance with follow-up care is adhered to. In spite of these efforts, we are still unable to reach a high percentage of patients due to language barriers. Some feel learning how to speak English is conceding to a culture and country not their own. As physicians are in a position of authority, Latinos believe physicians should learn their language, leaving the responsibility to the professional to insure accountability in communicating.
According to a 2012 U.S. Census Bureau report, 64 percent of Hispanics in comparison to 92 percent non-Hispanic Whites have a high school diploma. 13.8 percent of Hispanics in comparison to 32.5 percent of non-Hispanic whites have a bachelor's degree or higher. ("Hispanic/Latino Profile," 2015, para. 3) In 2012, 23.3 percent of elementary and high school students were Latinos, but only 6.8 percent of college students were Latinos. (“Hispanic or Latino Populations,” 2015) A high labor participation rate among Hispanic immigrants and employment concentrated in low-skill, low-wage jobs make it more difficult to bear the high opportunity costs associated with pursuing further education, particularly in traditional settings. Knowledge of existing scholarships, grants and other forms of financial aid are essential funding sources for students. This shared knowledge increases access for Latinos and facilitates success for this community.
Today, outreach programs and task forces provide services in underserved Latino communities. Collaborative efforts and strategies are implemented to identity barriers; provide healthcare, and target high-risk families and individuals connecting them with available resources. Many of these outreach workers have liaisons to community colleges, facilitating the bridge to educational services. Mobile clinic services render care in migrant worker areas offering services such as well baby checks, immunizations, adult physicals, and STD/HIV testing. There is a focus in these areas for outreach prevention and education of disease such as hypertension, diabetes, and heart disease. Teaching is done on site with groups in the hopes that disease processes are understood and identification of disease occurs before symptoms begin. By investing a continued multidisciplinary approach that addresses barriers specific to the Latino community, can we ensure the elimination of ethnic disparities and improve the attainment of high quality healthcare, not only for this community but also for all others.

References
Betancourt, MD, MPH, J. R., Carrillo, MD, MPH, J. E., Green, MD, A. R., & Maina, BS, A. (2004). Barriers to Health Promotion and Disease Prevention in the Latino Population. Clinical Cornerstone, 6, 3. Retrieved from https://uvagicases.files.wordpress.com/2013/10/barriers-to-health-promotion-and-disease-prevention-in-the-latino-population2.pdf
Minority Health. (2015). Retrieved from http://www.cdc.gov/minorityhealth/populations/REMP/hispanic.html
Minority Population Profiles. (2015). Retrieved from http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64