The Facts Behind Common Illnesses in Latinos
Story By: Eliana Osborn
The medical field is constantly in flux as new treatments are devised and research opens doors to better understanding disease. Certain conditions are more common in Latinos, due to both genetic predisposition and environmental factors. These three health care professionals are combining their culture and expertise to advance access and understanding of the complexities involved in modern medicine.
Aida L. Maisonet Giachello has always been interested in one-on-one research: talking to individuals to collect data through interviews. That passion for people has taken her to the head of the field, working on the sociological aspects of health and illness, especially in the Latino community.
Aida earned her PhD in medical sociology at the University of Chicago in 1988. She is currently a Research Professor of Preventative Medicine at the Feinberg School of Medicine at Northwestern University. She’s on the Board of Directors of the American Diabetes Association and a member of the Center for Diabetes and Metabolism. In 2005, TIME magazine named her one of the “25 Most Influential Hispanics in America” for her work as a health activist.
Diabetes is a growing medical crisis around the world, including in the United States. Twenty-six million Americans have diabetes or are at risk, with an estimated 5 million who are undiagnosed. In the Latino community, as many as 25 to 30 percent of the population has the condition, depending on where they live. Female Latinos are more likely to be afflicted, and more than one-third of those over age 65 have diabetes.
Giachello points to a number of reasons that diabetes is so prevalent in Hispanics: obesity, poverty, genetic predisposition and avoidance of medical care. The problem isn’t just in the U.S., either — she says diabetes is the number one cause of death in Mexico City.
“People don’t die of diabetes,” Giachello says. “They die of complications.” Untreated diabetes means not keeping blood sugar levels under control. That can lead to blindness, heart disease, kidney failure, stroke, amputation and other serious issues. With such scary conditions on the table, dealing with diabetes can seem overwhelming. But there’s strong evidence of strategies that can help individuals and communities manage diabetes and live long, healthy lives.
It used to be primarily older people who would be diagnosed, but now diabetes is increasing in teens and young adults. The culprit? Body weight. This is especially true in Latinos; one-third of the U.S. population is overweight or obese, while 75 percent of Latinos are in the same category. And Latino children are becoming obese at higher rates, too. That’s why prevention and delaying the onset of diabetes is so crucial. Even with genetic factors that make diabetes more likely, a healthy lifestyle can decrease your likelihood of developing the disease until later in life. Giachello has focused much of her work on community health workers, getting them trained to spread education and facts about diabetes from those living with the disease.
When Giachello started in health research in the late 1960s, services for Spanish speakers were few and far between. Add to that cultural differences about preventative medical care and insurance, and it meant that Latinos were not getting information about how to prevent and manage chronic conditions. She began working on policy with the Commissioner of Health in Chicago and was able to impact the 44 community health clinics.
Policy changes include making neighborhoods healthier: when fast food is more accessible than fruits and vegetables, busy families eat poorly. Broken sidewalks make walking more difficult, and worries about violence can keep people inside. And the stress of immigration, work, and family can increase sugar levels. How do we handle stress? Lots of us eat more or smoke, which is doubly dangerous if you are diabetic.
Giachello believes that early prevention is key to changing the diabetes problem. That means getting pregnant when you are at a healthy weight and keeping active while pregnant. Gestational diabetes can lead to large babies with a higher chance of diabetes themselves. Wellness checkups for kids — and adults — mean doctors can keep track of weight and blood sugar before serious problems arise.
Giachello founded the Midwest Latino Health Research, Training and Policy Center at the University of Illinois at Chicago. Through the center, education on what causes diabetes and how to treat it, in culturally sensitive ways, has been crucial. Giachello believes that knowledge is the key to preventing complications of diabetes and erasing the myths that surround it. “You have to be in control and empower yourself to be on top of [your disease],” she says.
For too long, being bilingual and bicultural has been seen as a negative. Psychologist Xavier Cagigas of UCLA is part of a growing contingent of researchers who sees things differently. The more we learn, the more scientists see how hybrid identities can actually protect brains and communities.
Cagigas is the director of the Cultural Neuropsychology Initiative at UCLA, an innovative psychology program focused on providing services for Spanish speakers and bilingual Spanish-English speakers. He holds a PhD in clinical psychology from UCSD and is an assistant clinical professor at UCLA.
Why is language so important in mental health? Cagigas says that we think differently in our first and second language. If an assessment is done in just one language, a doctor will get different results. “Usually your first language is more emotional,” he explains. “So if you only ask questions in a second language, you may not get those kind of answers,” which are crucial to making a correct diagnosis.
As the United States is becoming more and more diverse, issues in culturally competent diagnosis and treatment are getting more attention in the medical field. Those who donate extensively to research organizations like the National Institutes of Health (NIH) are making sure research is more inclusive. Otherwise, science findings don’t match up with real world populations. And that means poor outcomes or missed opportunities to help those who are suffering.
Many elements of Latin culture are what Cagigas calls “mentally protective.” That is, these practices are good for us — they help us handle stress and live balanced lives. Things like being community-oriented instead of individualistic, social involvement, lots of physical contact — all of these things are good for mental health. Latinos have struggled when they’ve rejected traditional culture, especially when immigrating. The strain of a “hybrid identity” when you try to assimilate can be psychologically harmful.
So the shift in society and medicine, seeing the benefits of bilingual and biculturalism, is welcome, Cagigas says. Bilingual brains functions differently, organizing and building more connections. The research shows that “bilingual people have healthier brains,” Cagigas notes. His work with the CNI aims for better treatment of mental health issues by using culture in a positive way.
“We need to reclaim and celebrate cultural practice instead of apologize for them,” says Cagigas. “As a group, then Latinos will be healthier and healthier.” Interdependence —being part of a family and community — helps people weather the storms of life. Trying to fit in to the dominant culture and feeling negative about your heritage can lead to stress.
Many mental health challenges are the result of dissonance. Trying to fit in and reject things important to you is especially damaging. Acculturation is a natural process, but it is one Latinos and others need to be mindful of. A solid psychological state is built on understanding what you value in everyday life. Cagigas says that mood — and people’s immune systems — are strengthened when they work to retain some of the collectivism of Latino culture.
Business and science are finally recognizing the benefits of bilingualism. In the medical field, a bilingual provider is more efficient and cost effective. In children, bilingualism means better executive function — planning and organizing, thinking about the future, that sort of thing. There are real, measurable benefits of bilingualism in things like Alzheimer’s disease. While knowing two languages won’t prevent Alzheimer’s, Cagigas says serious symptoms typically develop four to six years later for bilinguals.
Brains are complex systems, where genetics and environmental factors work together. Cagigas and others in the psychology field are diligently working to make sure language and culture are understood in terms of how they impact mental health. By meeting patients where they are — in all their linguistic and cultural complexity — doctors can provide the best care possible.
Fernando Garcia received his medical training at the Universidad Peruana Cayetano Heredia Medical School in Lima, Peru, before heading to the United States for his residency. He completed a residency in pathology at the University of Kansas, followed by a fellowship in surgical pathology and infectious diseases at Vanderbilt University in Tennessee. He has served on the faculty at the University of Kansas and Hahnemann University Hospital in Philadelphia, and currently serves as a pathologist at Cancer Treatment Centers of America®.
Pathologists are behind the scenes of cancer care, working with their microscopes to analyze tumors and cells. With an oncologist, the pathologist provides the information necessary to determine treatment based on the specific DNA profile of a particular cancer. Garcia explains how the field of cancer care is changing, thanks to advances in pathology.
“Cancer not a single disease within each organ; there are multiple subtypes of cancers,” he says. “It has become a very complicated state of affairs. By understanding the DNA of cells, we now can offer patients individual therapies that are tailored to that particular cancer.”
Recent research has found genetic issues in Latinos throughout Mexico, Latin America, and the United States predispose people to obesity. Garcia notes that obesity increases the risk for certain types of cancers, especially breast and prostate. That means Latinos need to be more careful about their food choices if they want to protect themselves. “A good initiative would be to educate young people about healthy eating habits,” Garcia says, noting that there are ways to serve lighter versions of traditional foods.
Another problem in the Latino community is an attitude that cancer won’t happen to you if you don’t have a family history, smoke or are overweight. According to Garcia, research finds that “the majority of cancers occur by bad luck.” That means that most people who get cancer have no control over the situation.
We do know that Hispanics with cancer usually are diagnosed at later stages, when the disease is more advanced and harder to treat. Why? They haven’t gone to the doctor for regular checkups and screening. There is a myriad of issues involved, including access to health care and socioeconomics. But Garcia says that men in particular don’t go to the doctor until their health problems are serious. “If we could figure out ways to utilize more visiting nurses or medical professionals that the Latino community feels comfortable with, that would definitely help,” he explains.
Knowing what care you need and how to get it can be overwhelming, especially if you have to worry about language barriers or how to pay for it. “Being a patient is a daunting task if you don’t have access to education,” Garcia says. Access to information is an area where a lot of change is needed. But each of us has to take responsibility and be in charge of our own health.
Garcia’s main recommendation would be to “understand that body weight is involved in many diseases.” That fact needs to be explained and the focus on education needs to be more robust, as it is one of the main areas individuals have control over. Eating, drinking and exercise can all be managed in ways that fit within your own lifestyle.
For Latinos to improve their health outcomes, Garcia says there needs to be a shift in how they view medical care. Preventative care like cancer screenings and wellness visits can catch problems early — that’s when cutting edge personalized treatments can make the most difference. Cancer isn’t a one-size-fits-all disease that you have to be afraid of. Garcia and others on the forefront of cancer research are learning more every day. To take advantage of these advances, the Latino community should stay informed and go see their doctors.