Daily Archives: Aug 19, 2019

    Raul Vasquez leads Urban Family Practice and related companies that have become a model for how the social determinants of health can be addressed in a medical setting

    By: Edwin Martinez

    Recent discussions at the University of Buffalo brings to light healthcare disparities among the Latino/ Hispanic community in Buffalo and Western New York according to Dr. Raul Vazquez of Urban Family Practice.

    Both subtle and significant differences in food habits, cultural mores and lifestyles exist among Cubans, Mexicans, Puerto Ricans, and Central and South Americans. These subsets of Hispanic populations reside in the United States but tend to be lumped under the larger umbrella of Hispanics who are often referred to as Latinos, the largest and fastest growing minority group in the US. Their inherent diversity, however, becomes important to the healthcare system, healthcare decision makers in public and private sectors, and clinicians since it impacts their risks of getting all diseases, particularly cancer and blood disorders.

    One study explains that most cancer data in the US are reported for Hispanics as an aggregate group, masking important differences between sub-populations according to nativity status (i.e., those who are foreign born versus those who are US born), degree of acculturation, and country of origin. For example, a report found that US cancer death rates in Mexicans are 12% lower than those among mainland Puerto Ricans.

    When it comes to healthcare disparity for those with blood diseases, one example is the study that determined that black and Hispanic patients with acute myeloid leukemia (AML) had increased risk of death by 12% and 6%, respectively, compared with non-Hispanic whites. These disparities existed despite a higher prevalence of favorable cytogenetics and a younger age at diagnosis in these minority groups. Some studies have demonstrated relatively poor adherence to medications and follow-up care among African Americans, Hispanics and other minority groups.

    However, cancer remains the leading cause of death among all Hispanics, accounting for 21% of deaths. While Hispanic people are less likely than non-Hispanic white Americans to be diagnosed with the most common cancers – lung, colorectal, breast and prostate – they have a higher risk for cancers associated with infectious agents, such as liver, stomach and cervix.

    In fact, one study found that Mexican American and Puerto Rican American males die at twice the rate of non-Hispanic whites from stomach and liver cancers – the two most troubling cancers for Hispanic Americans. Furthermore, liver cancer mortality rates are increasing for males and females of all Hispanic groups.

    However, there is much variation in the cancer burden among Hispanic populations by nativity, which is difficult to capture – as noted earlier – because most data are reported for this heterogeneous population in aggregate.

    Latinos: A Robust Mix

    According to the US Census Bureau, the majority of Latinos are of Mexican national origin (64.3%), followed by Puerto Rican (9.5%), Salvadorean (3.7%), Cuban (3.7%), and Dominican (3.1%), with the rest coming from other Central and South American countries. Overall, about 60% of these individuals are US-born, with the remaining 40% born in Mexico (64%), Puerto Rico (9%), and other Latin American countries.

    Their distinct lifestyle and dietary choices reflect their countries of origin as well as the degree to which they are assimilated to the US lifestyle, coupled with a wide spectrum of socio-demographic characteristics. The degree to which individuals have assimilated to the US and their socioeconomic status (SES) strongly influences behavioral patterns related to cancer prevention, diagnosis, and treatment.

    What is relevant to this discussion is that data show that across the major cancers – breast, colorectal, prostate, lung, and liver – US-born Latinos have higher incidence and worse survival than foreign-born, and those with low-socioeconomic (SES) status have the lowest incidence. Puerto Rican and Cuban Latinos have higher incidence rates than Mexican Latinos.

    As with other racial/ethnic populations in the US, differences in cancer determinants across US Latinos are in part due to substantial variation within this population in the prevalence of well-established cancer risk factors such as smoking, low quality diet, and physical inactivity. In addition, limited access to health care and financial constraints among US Latinos has been associated with lower cancer screening rates which makes treatment more challenging and complex.

    Furthermore, both genetic ancestry and nativity correlate with known cancer determinants. For example, there are differences in trends for body mass index (BMI) by nativity among US Latinos, with US-born Mexican and Puerto Ricans having greater annual increases in BMI than US-born Cubans and foreign-borns. Also, Latinos of higher IA or African ancestry are more likely to have a lower SES than those with higher European ancestry.

    Accounting for Diversity in Evaluating Cancer Risk

    These heterogenious factors present a unique opportunity for all US healthcare stakeholders to unravel the complex role of SES, culture, lifestyle and genetics as potential determinants of cancer risk in Latinos and other populations. To date, most of the epidemiological studies have largely ignored this diversity and have grouped Hispanics/Latinos as a single ethnic group.

    What is needed is a better and more specific understanding of the heterogeneity that exists within Hispanic and Latino populations, and the identification of important clues that contribute to key cancer determinants. Identifying cancer characteristics in the subsets of this population will help to achieve the goal of personalized medicine in this fast-growing minority group and respond more appropriately to their defined needs for prevention and treatment.

    Effective strategies for decreasing cancer rates among the Hispanic/Latino populations should include the use of culturally appropriate patient advisors and targeted, community‐based intervention programs to increase screening rates and encourage healthy lifestyle behaviors.

    Key Challenges in Basic Care for Hispanics

    Regardless of the subset, the challenges for detecting cancer and other chronic, complex diseases among Hispanic and Latinos remains a serious challenge. One significant issue is compromised access to primary care, the point of care at which many diseases are first detected, diagnosed and often prevented. At least one-fourth of Hispanic adults in the U.S. don’t have a primary healthcare provider which may result from the fact that only seven percent of U.S. physicians are of Hispanic origin.

    Hispanic health disparity is also shaped by cultural/language barriers, lack of health insurance and financial constraints: Thirty-one percent of Hispanic people in the U.S. state that they are not fluent in English, while 22.6% of Hispanic people in the U.S. in comparison to 10.4% of non-Hispanic whites were living at the poverty level.

    Thankfully, this situation is changing. A high level of technology adoption among Hispanics presents an opportunity to provide access to healthcare for this ever-growing population, with new programs designed specifically to meet their cultural and medical needs. In fact, 84% of all Hispanic people are online and Hispanic community internet smartphone usage is 25% higher than the national average.

    Leveraging Technology to Battle Healthcare Disparity

    Proven technology is being used to leverage decades of health industry knowledge and to speed access to care, particularly within Spanish-speaking communities. Innovative technology solutions that are bilingual and culturally relevant have been designed to provide opportunities for underserved populations to access affordable care, prescription drugs, chronic condition management programs and telehealth/virtual medical consultations.

    As more research is done to address the disparities in treatment for cancer, blood diseases and other serious, chronic conditions – including diabetes, heart disease and others — these technology solutions represent the first step in closing gaps in care for Hispanic and other underserved populations in the United States. By drastically simplifying access, delivering quality health and wellness products and services, and enabling individuals to learn about their health, individuals with compromised access are now better able to determine their wellness needs, more readily purchase critical medications, manage chronic conditions and engage in behavior change that empowers them to lead healthier, more productive lives.

    While beating cancer is a challenge for every American family, Hispanics and Latinos clearly face extra hurdles. Recognizing the obstacles, providing improved access to primary care and ensuring affordability of products and services are the key steps to meeting and overcoming these barriers.

      NEW YORK (Reuters) – U.S. President Donald Trump’s anti-immigrant rhetoric and focus on the grievances of white voters helped him win the 2016 election. But a Reuters analysis of public opinion over the last four years suggests that Trump’s brand of white identity politics may be less effective in the 2020 election campaign.

      The analysis comes amid widespread criticism of Trump’s racially charged comments about four minority women lawmakers and the fallout from a mass shooting of Hispanics in El Paso, Texas, that many Democratic presidential candidates swiftly blamed on the president’s rhetoric.

      Reuters/Ipsos polling of 4,436 U.S. adults in July showed that people who rejected racial stereotypes were more interested in voting in the 2020 general election than those who expressed stronger levels of anti-black or anti-Hispanic biases.

      In 2016, it was the reverse. The Reuters analysis shows that Trump’s narrow win came at a time when Americans with strong anti-black opinions were the more politically engaged group. While Reuters did not measure anti-Hispanic biases in 2016, political scientists say that people who express them closely overlap with those who are biased against other racial minorities.

      This year’s poll found that among Americans who feel that blacks and whites are equal, or that blacks are superior to whites, 82% expressed a strong interest in voting in 2020. That was 7 percentage points higher than people who feel strongly that whites are superior to blacks.

      “There is some indication that racial liberals are more energized than the racially intolerant,” said University of Michigan political scientist Vincent Hutchings, who reviewed Reuters’ findings. “That would seem to be good news for the Democrats and bad news for the Republicans.”

      The July poll did have a silver lining for Trump. Most white Republicans approve of his performance in office. And over the past four years they have become increasingly supportive of his signature issue: expanding the wall along the U.S.-Mexico border. Some 82% now support it compared to 75% last year.

      Trump is clearly still as popular as ever with conservatives who dominate the predominantly white, working-class communities that helped him win in 2016, said Duke University political scientist Ashley Jardina, who also reviewed the poll findings.

      n his 2016 campaign, Trump focused on the grievances of white voters who feared the global economy was leaving them behind and who wanted more restrictions on immigration. He employed put-downs of Latino immigrants and inner-city, typically black, residents.

      He said then that Mexicans were “murderers” and “rapists,” and as recently as last year, Trump labeled illegal immigration to the United States an “invasion.”

      Trump has asserted repeatedly that his words are not meant to be racially divisive. “I think my rhetoric … brings people together,” he said earlier this month.

      Responding to the Reuters polling analysis, a spokesman for Trump’s reelection campaign, Daniel Bucheli, said the president “enjoys broad support from diverse groups of Americans, and this coalition of supporters, to include minorities and first time voters, continues to grow daily.”

      “If there is something we’ve come to learn about President Trump is that he calls it like it is,” Bucheli said, when asked about Trump’s recent comments about the lawmakers and others.

      The White House did not respond to a request for comment on the poll findings.

      DECLINING ANXIETY

      The Reuters analysis also found that Americans were less likely to express feelings of racial anxiety this year, and they were more likely to empathize with African Americans. This was also true for white Americans and whites without a college degree, who largely backed Trump in 2016.

      White Americans are also 19 percentage points more supportive of a path to citizenship for illegal immigrants and 4 points less supportive of increased deportations, when their responses from the July poll were compared with a Reuters/Ipsos poll in January 2015.

      The July 17-22 poll also found that 29% of whites agreed that “America must protect and preserve its White European heritage,” down 7 points from a Reuters/Ipsos poll conducted in August 2017 and 9 points down from another Reuters/Ipsos poll in August 2018.

      The poll also found that 17% of whites and 26% of white Republicans said they strongly agree that “white people are currently under attack in this country, a drop of about 6 points and 8 points respectively from 2017.

      Paula Ioanide, an expert in American race relations at Ithaca College, said the poll findings were consistent with her research that racial anxieties among whites peaked during the presidency of Barack Obama.

      Some white Americans “are not feeling as under attack as they did in 2016,” Ioanide said. With Trump in the White House, “they’ve seen a kind of endorsement of the kinds of things that they wanted: A restoration of a white identity that they previously had felt was under attack.”

      Reuters and its polling partner, Ipsos, developed its race poll with political scientists at the University of Michigan and Duke University, asking a series of questions that measured respondents’ perceptions of people from different racial backgrounds, the treatment of blacks and whites in America and their interest in voting in 2020.

      WIDENING DEMOCRAT VS REPUBLICAN GAP

      Among whites who dominate the American electorate, the poll showed a widening gap between the way Democrats and Republicans view race.

      Some 28% of white Democrats said in the latest poll that “black people are treated less fairly than white people” in the workplace, compared with 5% of white Republicans. Some 59% of white Democrats said blacks were treated less fairly by police, while 22% of white Republicans agreed.

      The number of Democrats who said blacks were treated unfairly in the workplace and by police grew by 8 points and 11 points, respectively since 2016. There was almost no change, however, among white Republicans.

      White independents were more empathetic toward blacks than white Republicans, but less empathetic than Democrats.

      Michael Tesler, a political scientist at the University of California, Irvine, said Trump may be influencing many Democrats and Democrat-leaning independents in their views on race.

      “They may not care that much about race initially, and then they see Trump pushing on race so hard on race,” he said. “And so they push back.”

      Samantha Burkes, 36, of Bullhead City, Arizona said she was doing just that when she rated blacks well above whites in terms of intelligence, work ethic, manners, peacefulness and lawfulness in the Reuters/Ipsos poll.

      “I just wanted to express that I don’t think black people are worse than white people,” said Burkes, a white Democrat who plans to vote against Trump in 2020. “I’m just lashing out, really.”

      Political polling

      Reuters/Ipsos polled thousands of Americans about race and political engagement in 2016 and 2019.

      Reuters and Ipsos drew connections between the way people feel about raceand their political engagement with a series of questions asking respondents to rate white people on a variety of personality traits, such as intelligence, work ethic, lawfulness, manners and peacefulness. It then asked respondents to rate black people on the same scale. Ipsos then analyzed each respondent’s answers to determine if they tended to rate everyone equally, if they generally rated whites as superior to blacks (anti-black) or if they rated blacks as superior to whites (pro-black).

       

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