Page 55 - Cultural Competence in Health Education

Disparities in Health Among Racial and Ethnic Groups 33

diabetes, mental illness, and tuberculosis and also dental and preventive care were areas
where the disparities for Latinos were widening (Henry J. Kaiser Family Foundation,
2006). AHRQ also reported that in five out of the six categories that measured access to

care, disparities increased for Latinos even though they narrowed for other ethnic and
racial groups, including blacks, Asians, and American Indians. Questioned as to the
reason for the widening gap for Latinos, the director of AHRQ stated that perhaps a
language barrier was contributing to the problem and also suggested that illegal immi-
gration might play a role (Henry J. Kaiser Family Foundation, 2006).
A key report quantifying disparities in the use of preventive care services also
reported that racial and ethnic minorities continue to receive less preventive care than
non - Hispanic whites. The report highlighted three areas in which Hispanics use fewer
preventive services: compared to similar non - Hispanic whites, Hispanic smokers are
55 percent less likely to get assistance from a health care professional when trying to
quit smoking, Hispanic adults over the age of 50 are 39 percent less likely to be current
on screening for colorectal cancer, and Hispanic adults over 65 are 55 percent less likely
to be vaccinated against pneumococcal disease (Partnership for Prevention, 2007).

Ramsey, Wear, Labarante, and Nichman (1997) found no significant difference for
bypass surgery and marginal differences for angioplasty between Mexican Americans
and non - Hispanic whites in Corpus Christi, Texas. Other studies of Hispanics found
different results. In a study conducted at a Veterans Administration hospital, Mickelson,
Blum, and Geraci found Hispanics to be 71 percent less likely than whites to receive
thrombolytic therapy (Mayberry et al., 2002).
The health profi le of the Hispanic population in general and Mexican Americans
in particular has seriously questioned the dominant paradigm that focuses on SES and
access to medical care as the key explanatory factors for racial differences in health. In

fact, first - generation Mexican Americans are often low in SES and have low utiliza-
tion rates for health care services, insurance coverage, and preventive services but also
have rates of infant mortality, overall mortality, and chronics illness that are lower
than rates for African Americans and comparable to rates for non - Hispanic whites.
This phenomenon is referred to as the Hispanic paradox. That acculturation may play
a role is suggested by the fact that foreign - born Hispanics have a better health profi le
than their counterparts in the United States do. Rates of infant mortality, low birth
weight, cancer, high blood pressure, adolescent pregnancy, and psychiatric disorders
increase with length of stay in the United States (Vega & Amaro, 1994). Hispanic
health status is nevertheless often shaped by factors such as language and cultural bar-
riers, lack of access to preventive care, and the lack of health insurance. This is espe-
cially true in relation to length of time in the United States. As Mexican American and
other Hispanic immigrants assimilate, they take on the diets, lifestyles, and health pat-
terns of their adopted country. Their patterns of disease, mortality, morbidity, and
chronic illness begin to look more like those of other Americans, and they quickly lose
the health advantages described in the Hispanic paradox. The Centers for Disease
Control and Prevention has cited heart disease, cancer, unintentional injuries (acci-
dents), stroke, and diabetes as leading causes of illness and death among Hispanics.

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