JAMA commentary urges uplifting US Latinos to improve health and our nation

University of Texas Health Science Center at San Antonio

It is essential to lift the nation's Latino population from obscurity to the forefront of health care, public health intervention and societal presence, three professors from The University of Texas Health Science Center at San Antonio argue in a powerful commentary published Aug. 17 by the Journal of the American Medical Association (JAMA).

The authors are Amelie G. Ramirez, DrPH; Rita Lepe, MD; and Francisco G. Cigarroa, MD, from the health science center's Joe R. and Teresa Lozano Long School of Medicine.

Despite accounting for more than 18% of the U.S. population, "the Latino community has not benefited from having 'presence' in the U.S. health care workforce through meaningful and influential administrative and governance positions," they wrote.

Amelie G. Ramirez, DrPH, National Academy of Medicine member

This limits Latinos' ability to drive needed change in health care policy or make improvements in the social determinants of health, such as insurance, housing, employment and income, that impact care access and health outcomes.

"How else is it possible to account for more than 100,000 deaths from COVID-19 among U.S. Latino individuals?" the authors asked. "This ethnic group continues to experience the same systemic health inequalities that were causing widespread health disparities long before the surge of coronavirus – inequities that remain largely ignored by the mainstream media amid the pandemic."

Latino individuals died from COVID-19 at more than twice the rate of White individuals during the pandemic, the authors wrote, citing a report. Reduction in life expectancy is projected to be fourfold greater in U.S. Latinos (3.05 years) than in Whites (0.68 years), the authors said, citing a second source.

Social determinants

"Latino individuals have the lowest rate of health insurance coverage among racial and ethnic groups, and often lack a primary care clinician," Drs. Ramirez, Lepe and Cigarroa wrote. Lower median household incomes, higher housing cost burdens, longer work commutes, less access to safe green spaces for physical activity, greater mental health stresses and more discrimination at many levels are also characteristic.

Rita Lepe, MD

"This yields a wide variety of chronic disease disparities between the Latino population and the White population," the authors said. "Latino individuals are more likely to have obesity, diabetes, liver disease and poorly controlled high blood pressure; have higher risks of stomach, cervical and liver cancers; and are more likely to be diagnosed at later disease stages due to being left out of screening programs, clinical trials and preventative care."

The COVID-19 pandemic intensified all of these inequalities and made them blatantly more apparent, the authors said.

Virus and vaccine misinformation

"One of the reasons for such a high mortality rate for the Latino community was the lack of clear information about COVID-19," the authors wrote. "Mainstream media rarely explained to the public the disparities related to COVID-19 occurring among the U.S. Latino population; only 1.9% of news stories on COVID-19 featured the terms Latino, Hispanic or Latinx between January 1, 2020, and May 31, 2021."

Although many federal, state and local agencies tried to provide culturally sensitive information in Spanish and Spanish-language broadcast outlets tried to educate the Latino public about the virus and vaccination, misinformation persisted. "This was primarily driven by social media, where the Latino community often turned to for news," Drs. Ramirez, Lepe and Cigarroa wrote.

Francisco G. Cigarroa, MD, National Academy of Medicine member

As of June 27, 2021, the authors noted, only 26.3% of the Latino vaccination was fully vaccinated, the second-lowest percentage among U.S. racial and ethnic groups, according to the U.S. Centers for Disease Control and Prevention.

Latino health care professionals needed

When Latino patients are admitted to hospitals, they don't see many Latino health care providers. Only 5.7% of nurses and 6.3% of physicians are Latino, whereas 73.5% of nurses and 67% of physicians are White, the authors said, citing data from the U.S. Health Resources and Services Administration.

Meanwhile, only 6.7% of U.S. medical school enrollees during the 2020-2021 school year identified as Latino, they stated, citing another report. As the U.S. Latino population increases, the pipeline of Latino physicians and nurses will not be able to keep up, the authors concluded.

What can be done?

The authors wrote these strategic calls to action:

  • "Boards of trustees and executive leadership must be held accountable for improving the diversity of their students, professional workforce and administrative leadership teams because other interventions have not achieved their desired results."
  • "Diversity within institutions and industry must be fostered. Training and toolkits are emerging to spread awareness of implicit bias in health care. These resources can help individuals and health care professionals identify preconceived notions or stereotypes that have adversely affected their understanding of and decision-making toward others; encourage speaking out against acts of racism and discrimination; and organizationally declare racism a public health crisis and commit to systemic change. This will require investment in and amplification of these tools and resources."
  • "Access to education and educational attainment for Latino individuals must be increased. … A first-generation graduate from college will change a family's trajectory for generations and will certainly help family members navigate the complex health care system they encounter every day."
  • "Enhancing educational opportunities and attainment is the key to admitting diverse medical students into medical school. The debt burden to all undergraduate and medical students should be alleviated so that pursuing an academic career in medicine and science is achievable."
  • "It is incumbent on the U.S. to give 'presence' to Latino and other racial and ethnic minority groups in all facets of society. This is vital to the nation's future success. The changing demographics demand embracing diversity, equity and inclusiveness to better navigate the future, and importantly, mandate improving the social determinants of health for ensuring overall public health. Not doing so will threaten the collective national well-being and prevent the U.S. from reaching its full human potential and success."

Amelie G. Ramirez, DrPH, is with the Institute for Health Promotion Research, the Department of Population Health Sciences and the Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center. Rita Lepe, MD, is with the Texas Liver Institute in San Antonio and the UT Health San Antonio Transplant Center. Francisco G. Cigarroa, MD, is with the UT Health San Antonio Transplant Center.

Dr. Cigarroa, chairman of the board of the Ford Foundation, was invited to join David Satcher, MD, PhD, and Howard Koh, MD, MPH, as panelists on the JAMA Network podcast, "Addressing Diversity, Equity and Inclusion in Health Care and Medicine," hosted by Ebony Boulware, MD, MPH.

The University of Texas Health Science Center at San Antonio, also referred to as UT Health San Antonio, is one of the country's leading health sciences universities and is designated as a Hispanic-Serving Institution by the U.S. Department of Education. With missions of teaching, research, patient care and community engagement, its schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have graduated 39,700 alumni who are leading change, advancing their fields, and renewing hope for patients and their families throughout South Texas and the world. To learn about the many ways "We make lives better®," visit www.uthscsa.edu.

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