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Contents of Report
Pages 1-35

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From page 1...
... Ethnic minorities in the United States especially those who have high rates of poverty such as Hispanics often experience disparities in health and in accessing health care services. This is problematic because good health represents a minimum condition for full participation in most dimensions of life, including the ability to work and be steadily employed, to consistently attend school and to learn, to socialize and engage in one's
From page 2...
... The Meeting on Emerging Issues in Hispanic Health As a part of its long-standing tradition and continuing commitment to promote a national dialogue on race and diversity in the United States, the National Academies organized an expert meeting on Emerging Issues in Hispanic Health on April 10, 2002, that brought together experts in demography, public health, medicine, sociology, psychiatry, and other fields to examine key issues related to Hispanic health and well-being. Emerging Issues in Hispanic Health was a part of the National Academies' effort to develop a larger, broad-scale study of Hispanics in the United States to explore the demographic, economic, and social trends affecting the Hispanic population in the areas of health, education, labor, immigration, community development, and others.
From page 3...
... The report then reviews data on the extent to which Hispanics have access to health insurance and barriers they face as a group in obtaining insurance coverage. Finally, the report reviews three emerging issues in Hispanic health: threats to the health status of elderly Hispanics, mental health, and Tic .
From page 4...
... The heterogeneity of the Hispanic population presents significant methodological challenges in obtaining accurate population data (see Box
From page 5...
... Although presenting data on such a broad group is problematic in that it erases considerable variation and masks the fact that certain Hispanic subgroups would perform quite differently from the broad group "Hispanics" on any given measure, it does allow some useful comparisons to be made that establish signposts of relative advantage or disadvantage of Hispanics compared to other groups in the United States. Readers are encouraged to bear in mind these limitations when such data are presented
From page 6...
... Within this broad category, individuals selfidentified in the following ways: 66 percent, Mexican; over 14 percent, Central or South American; 9 percent, Puerto Rican; over 6 percent, "other Hispanic"; and 4 percent, Cuban (Therrien and Ramirez, 2001~. As a population, Hispanics are relatively younger than the general U.S.
From page 7...
... TABLE 2 Percentage of U.S. Population Living in Poverty in 2000 All Ages Under 18 Hispanics 21.2 28.0 Non-Hispanic whites 7.5 9.4 African Americans 22.1 30.9 SOURCE: Adapted from Dalaker (2001~.
From page 8...
... Cuban Americans have the same leading causes of death as non-Hispanic whites, although there were slight variations in order. Chronic liver disease and cirrhosis were unique to Mexican Americans, Puerto Ricans, and other Hispanics, suggesting perhaps an important vulnerability for these populations and raising questions about prevention.
From page 9...
... SOURCE: Workshop presentation by Elizabeth Arias, April 10, 2002. TABLE 3 Ten Leading Causes of Death in U.S.
From page 10...
... mission rates have been missed. Finally, Hispanics of Mexican descent featured two unique leading causes of death compared to other Hispanic groups: deaths due to certain conditions originating in the perinatal period and to congenital malformations, deformations, and chromosomal abnormalities.
From page 11...
... For example, as ethnic minorities Hispanics often face discrimination and prejudice, and groups such as Puerto Ricans and Mexican Americans are often in lower socioeconomic brackets. Given these types of disadvantage, it is noteworthy that a population such as Mexican Americans, who are often poor, generally have lower levels of education than non-Hispanic whites, and who often face discrimination based on their ethnicity, still has lower rates of morbidity than the most privileged demographic group (non-Hispanic whites)
From page 12...
... and non-Hispanic blacks (nearly 70 percent; Martin et al., 20021. Births to Cuban Mexican Puerto Rican Central and South American Non-Hispanic White Black 0 0.5 1 1.5 Rate 2 2.5 3 3.5 FIGURE 2 Total fertility rate for U.S.
From page 13...
... When more careful examination is given to within-group differences in fertility patterns, clear disparities between Hispanic subgroups emerge. In general, Cuban Americans closely resemble non-Hispanic whites, whereas Puerto Ricans and Mexican Americans tend to mirror non-Hispanic blacks.
From page 14...
... SOURCE: Workshop presentation by Elizabeth Arias, April 10, 2002. Cuban Mexican Puerto Rican Central and South American Other Hispanic Non-Hispanic White Black 0 2 4 6 Percent 8 10 12 14 FIGURE 4 Percentage of low-birthweight babies for U.S.
From page 15...
... . Puerto Ricans also have the highest infant mortality rates, about 8 infant deaths per 1,000 live births.
From page 16...
... These experiences create a complex set of social determinants that affect health and appear to yield both positive and negative health outcomes. This section reviews several key concepts of research on the social determinants of health, including the epidemiological paradox as it relates to positive infant outcomes, selective migration, beneficial health behaviors stemming from adherence to the cultural practices of one's country of origin, and processes of assimilation.
From page 17...
... Women's orientation toward motherhood appears to be a particularly important aspect of why traditional gender roles might exert a protective effect on infant outcomes. Guendelman's research has shown that Mexican-born women have a very strong orientation toward motherhood, viewing parenting and taking care of the household as their primary responsibilities even if they also work outside the home.
From page 18...
... Like Mexican-born women in the United States, these immigrants demonstrate a similar adherence to traditional gender roles and are disadvantaged compared to native-born women, yet they have positive infant outcomes compared to more advantaged native-born women, suggesting the possibility of capitalizing on cultural values as a way to promote healthy birth outcomes (Guendelman et al., 20011. Nevertheless, adherence to traditional gender roles does carry certain risks for women and children.
From page 19...
... In contrast, Puerto Ricans are heavily exposed to American culture while still living in Puerto Rico and assimilate to American mainland culture rapidly without retaining their old protective factors. Although a number of factors influence infant outcomes, these differences in assimilation patterns may explain part of the reason why Mexican Americans have better infant health outcomes compared to Puerto Rican women who have spent a similar length of time on the U.S.
From page 20...
... , an increase in negative health behaviors, and higher rates of infant mortality (Landale et al., 20001. In terms of behaviors that directly affect health, early migrants were more than twice as likely to smoke or drink as late migrants: more than 7 percent of late migrants smoked and more than 2 percent drank alcohol compared to over 16 percent and almost 7 percent of early migrants, and more than 17 percent and over 4 percent, respectively, of mainland-born Puerto Ricans (Landale et al., 20001.
From page 21...
... Furthermore, such barriers as not being offered employment-based insurance benefits, language barriers to the election process, and negative perceptions about health care services also may reduce coverage among Hispanics. De7This section draws heavily on meeting presentations by E
From page 22...
... Hispanics are the least likely ethnic group to have health insurance: 35 percent of Hispanics ages O to 64 are uninsured, compared to 1 1 percent of non-Hispanic whites and 20 percent of African Americans (see Figure 61. These high rates of being uninsured persist among Hispanics despite having higher rates of Medicaid and State Children's Health Insurance ProMedicaid Job-based insurance Uninsured _ 44~/ Non-Hispanic Hispanic White African American Nonelderly Persons Ages 0-64, US Asian American and Pacific Islander FIGURE 6 Uninsured rates among nonelderly (ages 0 to 64)
From page 23...
... Access to health insurance coverage also varies by national origin. Mexican Americans and Hispanics of Central and South American descent have very low rates of employment-based insurance coverage, and both groups have the highest rates of uninsurance (37 percent; see Figure 7~.
From page 24...
... This may suggest changes in a person's eligibility status as well as changes in Hispanics' ability to navigate the process of electing health care. Language barriers and newness to the cumbersome process of electing health insurance may prevent many recent immigrants from taking advantage of available health care benefits.
From page 25...
... · Language barriers encumbered the process of electing health care coverage and of finding a physician in a convenient location. Efforts to improve awareness among Hispanic communities of eligibility for various insurance programs, to increase the accessibility of the insurance election process and the availability of health care services, and to reduce some of the concerns Hispanics have about health insurance could increase insurance coverage in this population.
From page 26...
... Elderly Hispanics have low rates of institutionalization despite higher rates of disability, suggesting either that they have better-than-average social support mechanisms to draw on or that many elderly Hispanics may 8This section draws heavily on the meeting presentation by Kyriakos Markides of the University of Texas Medical Branch.
From page 27...
... Although elderly Hispanics currently make up a small percentage of the overall Hispanic population, these emerging patterns of morbidity offer important insights regarding the health challenges likely to affect a growing number of aging Hispanics. High rates of diabetes and hypertension are likely to continue to be prevalent.
From page 28...
... Acculturation is one possible explanation for the negative changes observed in mental health status. Social support and traditional values tend to erode with greater exposure to American society, and risk factors such as increases in marital instability, low educational attainment, increased experimentation with drugs and alcohol, and changes in emotional support structures and gender roles all become more prevalent among Hispanics as they spend more time in the United States and begin to assimilate to American culture.
From page 29...
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From page 30...
... For example, although Hispanic youth are overrepresented in the juvenile justice system, they are less likely to receive therapeutic services than are non-Hispanic whites. Like the challenges to the physical health of elderly Hispanics, rates of mental health problems are currently favorable for the Hispanic population.
From page 31...
... Guerra's first strategy to facilitate the identification of newly emerging health problems in communities like San Antonio was to familiarize health 10This section draws heavily on the meeting presentation by Fernando Guerra of the San Antonio Metropolitan Health District.
From page 32...
... In this way, communities like San Antonio may act as a sentinel for health issues for Hispanics in similar urban centers. SUMMARY THOUGHTS The meeting on Emerging Issues in Hispanic Health brought together a group of researchers with a diverse set of expertise.
From page 33...
... Guerra, April 10, 2002. 1999 Asthma Inpatient Hospital Visits All Age 75 to 99 50 to 74 25 to 49 1 to 24 none 1999 Asthma Inpatient Hospital Visits <18 Age 80 to 90 60to79 40to59 20to39 1 to19 none ~ _ ~~ J: FIGURE 9 Examples of GIS population and epidemiological mapping: Hospital visits for asthma for all ages and minors in the San Antonio area by census tract.
From page 34...
... Not only does this group compose a significant proportion of the total Hispanic population, their ability to achieve long-term social and economic success and stability will be of significance as they age and become either a more vulnerable or successful group. Finally, planning for the emerging health care needs of elderly Hispanic will be of great significance in ensuring that this group remains healthy and vital.
From page 35...
... SUMMARY OFA WORKSHOP 35 continues to change rapidly. Hispanics now make up over 12 percent of the country's population and by 2050 are likely to constitute 25 percent (Day, 19961.


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