Combating Diabetes Disparities Among The Hispanic Population
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On July 26, 2021, David G. Marrero, PhD, director of the University of Arizona Center for Border Health Disparities, presented at the “Diabetes through a Health Equity Lens” symposium at the ADA’s 81st Scientific Sessions. His presentation focused on the prevalence of diabetes in Hispanic communities and how integrating culturally-tailored care can inform health outcomes and tackle diabetes disparities among the Hispanic population.
Marrero started off the presentation by stating that the term Hispanic encompasses many different ethnic groups. “Many people treat Hispanics as a homogeneous group of people and that’s not really the case,” said Marrero.
The prevalence of diabetes varies by ethnic group:
- 10.2 percent in South Americans
- 13.4 percent in Cubans
- 17.7 percent in Central Americans
- 18.0 percent in Dominicans and Puerto Ricans
- 18.3 percent in Mexicans
What Drives Diabetes Disparities Among Hispanic Communities?
Unfortunately, a complex interplay of factors contribute to diabetes disparities observed within the Hispanic community. Food insecurity is one of those issues. In 2014, 22.4 percent of Hispanic households were food insecure. Food insecurity was much more prevalent among Hispanic adults living in households led by single women with children and with incomes below the federal poverty line, or 30.7 percent.
“In Arizona, one in four Latino households are considered food insecure, versus 11 percent of white households in the same region,” Marrero says. He adds that Latino households spend a third of their income on food, a majority of which is calorie dense, low in fiber, and high in fat, sodium and carbohydrates. Too much carbohydrates can cause blood sugar levels to rise and foods high in fat contribute to obesity, a leading risk factor for type 2 diabetes.
Language barriers also drive diabetes disparities. “We know that there’s a language discordance that many people come here and they do not speak English, which makes it much more difficult to negotiate social systems, particularly the health care system in the United States,” Marrero explains.
Coupled with an individual’s immigration status, Marrero says that being undocumented can further limit a person’s ability to access optimal or even adequate health care. Forty-five percent of undocumented immigrants were uninsured compared to less than one in ten citizens.
Being undocumented means being barred from having affordable health insurance such as Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Affordable Care Act (ACA) marketplaces. Research findings show that there is a direct association between access to care and glycemic control, highlighting the need for accessible and culturally tailored care.
Reducing Health Disparities
Marrero shares that in order to decrease health disparities, it starts with accessible health insurance. “Health care that’s available to everybody, regardless of their ethnicity, their country of origin, their economic status, or their immigration status.”
Additionally, Marrero calls on the need for culturally tailored education. “So this goes beyond simply translating things that we’ve used for English speaking people into Spanish,” Marrero explains. “We need to consider cultural concepts when trying to engage Hispanics in health interventions.”
For example, common cultural concepts in the Mexican culture include:
- Machismo: an adherence to Hispanic male-bound hyper masculinity. Representative behaviors can include power seeking, dominance, and emotional disconnectedness.
- Familismo: perceived obligations for helping family members; reliance on support from family.
- Caballerismo: behaviors associated with honor, respect, dignity, social responsibility, care for family and emotional connectedness
Marrero says understanding these cultural concepts can help providers understand certain behavioral decisions and engage Hispanic people in lifestyle changes.
Reducing health disparities will also require solutions that consider location for delivery and time of delivery. “Many Mexican origin families in Tucson really can’t take time off from work. They don’t have the ability to carve off part of their day economically, and go to a medical center,” says Marrero. “They need to be able to access information that doesn’t require that they change their life pattern for that day, week, or year.”
The Use of Promatoras To Increase Health Equity
Interventions would not be possible without the support of community health workers, also known as, promatoras de salud. “They are neighbors, moms, dads, children, youth and members of communities who believe in helping and including others to be part of the solution to create a healthier place for all,” Marrero explains.
Promatoras not only embody the spirit of their community and culture, but they serve to create relationships and build trust. “As a result, participants do more than learn about managing their diabetes. They understand problems, they understand the issues that are of concern. They understand the barriers that exist and can help people circumvent that,” says Marrero.
By integrating community health workers and cultural concepts into the fold of health care, Marrero says that it will revolutionize models of care delivery to better serve and combat diabetes disparities among the Hispanic population.
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