Data highlight health gaps for Hispanic kids

Hispanic children continue to do worse than whites on a number of key health indicators, according to a new report jointly issued by a collection of federal agencies.

Eighty-eight percent of white, non-Hispanic children were reported to be in very good or excellent health, but only 74% of Hispanic children were reported to be in these categories, according to "America's Children: Key National Indicators of Well-Being 2005," released in July by the Federal Interagency Forum on Child and Family Statistics. Hispanic children also trailed white children by five percentage points -- 84% to 79% -- on the rate at which they received the combined immunization series.

Mexican-Americans -- who make up two-thirds of the U.S. Hispanic population -- are the most likely to be overweight. According to the report, 27% of Mexican-American boys are overweight, compared to 15% of white boys.

The Hispanic teen birth rate is also the highest of any racial or ethnic group, with 50 out of every 1,000 Hispanic girls ages 15-17 giving birth, compared to 39 for blacks and 12 for whites.

Explaining the disparities

In 2002 the U.S. Census Bureau tallied Hispanics at 37.4 million, or 13.3% of the total population, but they account for 36% of all uninsured children, according to the Agency for Healthcare Research and Quality's 2004 Medical Expenditure Panel Survey.

The move by several states to cut or freeze State Children's Health Insurance Program enrollment to plug budget holes has had a disproportionate impact on Hispanics, 25% of whom rely solely on taxpayer-provided health care, according to AHRQ's August report.

Elena Rios, MD, MSPH, said the disparities are also due in part to linguistic and cultural barriers that impede Hispanics' access to care. "Most Hispanic patients are not seeing Hispanic doctors," said Dr. Rios, who is president and CEO of the National Hispanic Medical Assn. "Right away the patient may not feel comfortable, or may not feel the doctor really understands what they're trying to say about their symptoms. "

The Census Bureau estimates that there are 36,000 licensed Hispanic physicians in the country, about 5% of the total.

Dr. Rios said that medical, dental and nursing schools should hire more minority faculty and change to a more "comprehensive" admissions process with a greater eye to diversity. She also said it should be easier for international medical graduates to become licensed in the United States.

For many Hispanics whose English is limited, language is still a barrier to care.

"If other family members are more versed in English, the doctor might talk to the family member, and the patient is almost nonexistent," said Wilma Alvarado-Little, a medical interpreter and program manager of the Center for the Elimination of Minority Health Disparities at the University at Albany, State University of New York. "It's not patient-empowering."

In June, the AMA's House of Delegates adopted an opinion from the AMA Council on Ethical and Judicial Affairs on racial and ethnic health care disparities. The opinion calls on physicians to strive for equal treatment of all patients, beware of stereotypes, help diversify the work force and help increase awareness of health care disparities. The opinion also says, "physicians should recognize and take into account linguistic factors that affect patients' understanding of medical information" and that "language barriers should be minimized."

Regina Benjamin, MD, is the founder of a rural health clinic in Bayou La Batre, Ala., and about 30% of her patients are of Laotian, Cambodian or Vietnamese descent and speak limited or no English.

"There's a lot of discussion out there about requiring or not requiring interpreters," said Dr. Benjamin, a member of the AMA Council on Ethical and Judicial Affairs. "It certainly helps you communicate with the patient and you deliver much better care if you have an interpreter."

Many physicians object to the idea of having to pay for translation services for their patients. The AMA is on record as objecting to a federal requirement that any practice or facility that accepts reimbursement from Medicaid provide a certified medical interpreter because it is an unfunded mandate.

AMA policy says, "Physicians cannot be expected to provide and fund these translation services for their patients."

Dr. Benjamin said that while the Medicaid requirement is well-intended, "Doctors can't afford to hire interpreters. It would be great if someone would make interpreters available through a telephone line at a low cost. It would be really helpful for folks like us out here."

Most certified medical interpreters charge $20 to $25 an hour, and telephone and video-conference interpreting is available for $2 to $3 a minute, but Medicaid pays only $30 per office visit.

"Health care disparities is an issue we don't like to think about," Dr. Benjamin said. "You hear a lot about it, but actually doing something about it is a little different. To come out and support the CEJA report is a big move in the right direction. ... [T]hese disparities are unacceptable and have to be addressed head-on, and that's what the AMA is trying to do."