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Putting Prevention First

While Congress looks at whittling health care costs through spending cuts, it also seeks to encourage prevention.

When Vicenta Castellano, 72, was diagnosed with diabetes 14 years ago, she took charge of her health and changed her life. The San Antonio resident quit eating fried foods and drinking sodas, cut down on red meat, and increased her consumption of fruits and vegetables. She feels much better, and her checkups show that her diabetes is under control, she says. Now Castellano is an advocate for healthful eating and encourages her church friends to follow her lead. “Some of them pay attention, but most say it’s too hard,” says the Mexican American. “It’s difficult to change lifetime habits.”

What is changing is the overall state of Hispanics’ health—and it’s not for the better. “Things are getting worse,” says Jose Luis Perez, M.D., who runs community health centers in Los Angeles and Orange County, California. “The Hispanic community is getting older, it has less and less access to health insurance, and it doesn’t have access to good clinics, healthy food, and areas where people can safely exercise.” 

The need for preventive measures—checkups, screenings, better diets, and more exercise—has never been greater, health advocates say. But the broken economy and resulting job losses are keeping many Latinos from putting prevention first.

Among measures being considered in the current health care reform debate are those to make insurance coverage more affordable to low-income families and employees of small businesses. Having insurance would allow individuals to access primary and preventive care. President Obama has also outlined other prevention efforts he wants to see in a reform plan, among them requiring insurance companies to cover, at no charge, regular check-ups and tests that can help control or detect health problems early, such as mammograms and eye and foot exams for diabetics.

Looking for a Health Care “Cure”

One of the biggest obstacles to good health, Perez says, is lack of health insurance. More and more uninsured patients are coming through his clinics’ doors, he says. Statistics back him up. The percentage of Latinos who were uninsured for at least part of the year rose from 29.4 percent in 2007 to nearly 36 percent in 2008, according to the Centers for Disease Control and Prevention, compared to 21.4 percent for all other Americans. Perez and others suspect those rates are still rising.

As health care reform measures wend their way through Congress, U.S. Rep. Charlie Gonzalez, a Democrat who represents Castellano’s hometown of San Antonio, says that if passed, the reform his party is championing will become part of the “cure” for uninsured Latinos. The plan’s primary goal—to give Americans better access to health insurance through more federal aid to community clinics and subsidies to low-income people and small businesses—will be “a tremendous benefit to Latinos,” Gonzalez says. “It will be incalculable. It will be huge.”

Hispanics, he says, often develop chronic diseases, such as diabetes, while they are uninsured and unable to afford treatment. By the time they become eligible for health care under Medicare at age 65, Gonzalez says, it’s too late for preventive measures.

On the other side of the aisle, Republican opponents of the President’s and Democrats’ health care overhaul proposal say it’s too expensive and would strip Americans of their choice of doctors and health plans. Detractors also oppose a measure to raise taxes on the wealthy to help pay for the plan. In addition, questions exist as to whether preventive measures actually do save money. A study by the Congressional Budget Office, for example, found that preventive efforts such as stop-smoking programs failed to produce any overall savings. And Dr. Barry Kramer, associate director of the Office of Disease Prevention at the National Institutes of Health, has said, “In the field of prevention, few areas save a lot of lives and money.”

Despite their differences, both parties agree on one thing: prevention is key to a healthier population.

Prevention Awareness

Get sick. See a doctor. Get well. That’s one way to approach health care.

Another is to prevent illness in the first place by adopting good health habits. Unfortunately, many Latinos know little about preventive measures, says Dr. Elena Rios, president and CEO of the National Hispanic Medical Association. Most obstacles to that knowledge are socioeconomic.

“[Hispanics] often have low incomes, are poorly educated, have limited English proficiency, and live in areas that are marginalized and have few health services,” she says. “They lack awareness of healthy lifestyles.” And working two or more jobs to make ends meet, as many Hispanics do, leaves little time to take care of themselves or their families.

Rios emphasizes the language barrier. If Latinos get to a doctor, they might not understand an English-speaking physician well enough to follow the medical instructions they’re given. So, she says, the community needs more Hispanic doctors and nurses who can better communicate with Latinos. While about 15 percent of the U.S. population is Hispanic, only 5 percent of the nation’s doctors and 2 percent of its nurses are, according to the Sullivan Commission’s “Report on Health Professions Diversity.”

“I would like to see more students go into the health care professions,” says Rios, adding that any successful health care reform should include incentive grants for more students to go into primary care medicine and for the promotion of preventive measures.

And one more obstacle: “There’s also a culture of fatalism in the Hispanic community,” Rios says. “There’s often an attitude of ‘Well, if God wants me to get cancer, then that’s my fate.’” That sense of having no control leads many to ignore doctor visits and other preventive health habits, she says.

In an ironic twist, most recent immigrants from Latin America actually start out with healthier lifestyles than those born in the United States or here for a long time, according to Adolph Falcón, senior vice president of the National Alliance for Hispanic Health. Initially, immigrants exercise more, eat more healthfully, and smoke less. But as Latinos adapt to the U.S. lifestyle, they acquire bad health habits, Falcón says. Moving away from homeland meals based on grains, beans, and vegetables to high-fat processed foods has led to high rates of diabetes and obesity among Hispanics.

The Alliance wants to change that pattern through ¡Vive tu Vida!, a series of events this year in ten U.S. cities aimed at motivating second- and third-generation Hispanics to exercise. The events will feature exercise and sports activities and clinics, healthy snacks, and free health screenings. “This is a critical point in terms of our community,” Falcon says. “Our challenge now is: how do we reinforce our positive health practices and get Latinos to learn new ones?”

Another example of organizations that promote prevention efforts among Latinos is the Chicago Hispanic Health Coalition. Its projects are as diverse as the Door to Door Outreach Program, which provides intensive outreach to underserved and immigrant families, to a nutrition and exercise program for Hispanic women, to a guide listing preventive health services in the community.

And while such programs continue their work, other health care advocates and doctors who treat Latino patients are hoping that reform of the nation’s health care system makes it easier for patients like Vicenta Castellano to prevent chronic diseases such as diabetes and, if they do get sick, to adopt healthier livestyles to prevent further complications and obtain treatment earlier.

For Rios, health reform that makes Latinos healthier is also a bargain. Hispanics are a growing segment of the U.S. workforce, she says, and “the health of Hispanics is related to the economic well being of the nation.”

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