Latino and Hispanic communities face hurdles to healthcare

Mariza Hardin and Erik Cardenas wanted to build a healthcare model that put families like their own first- and second-generation Mexican American families first.

Hardin and Cardenas, who met at the now-shuttered Amazon Care, connected over being “care navigators” for their families, which included helping find culturally knowledgeable providers who spoke Spanish and navigating the complexities of health insurance.

The pair founded Zócalo Health in 2021 and raised $5 million in seed funding with the goal of bringing virtual primary care services to US Latino communities. It is seeing patients in California and Texas. For a $40 monthly fee, patients have access to virtual same-day and next-day appointments (in both English and Spanish) with a physician, and support from their personal “promotores de la salud.”

The “promotores de la salud” acts as a wellness “navigator that helps you answer all the questions and helps connect them to the different resources within the community,” Hardin said.

Access to primary care can affect the “health of our patients over a lifetime,” according to Cardenas.

Still, their experiences of trying to navigate the US healthcare landscape are not unique.

Financial obstacles

Hispanic and Latino people are the second-largest racial or ethnic group in the US, making up 18.9% of the total population, according to the 2020 Census. However, they are overrepresented within the uninsured population compared to their non-Hispanic white peers.

In 2019, Latinos accounted for 37% of nonelderly uninsured people in the US, a 2021 report from the US Department of Health and Human Services found. A little more than half of Hispanic immigrants who had been in the country for a decade or less reported that they had seen a healthcare provider in the last 12 months, according to a 2022 Pew Research Center survey of 3,716 Latino adults.

Zócalo Health’s mission to “focus on bringing the Latino community back into primary care” could have more far-reaching effects.

Patients without an identified primary care provider can often seek treatment at comparatively costly urgent care centers, Gino Aisenberg, codirector of the Latino Center for Health at the University of Washington, said.

In California, an investment in primary care could lead to fewer hospital visits and annual savings of $2.4 billion in healthcare spending, according to a 2022 study of eight health plans.

Lack of “bilingual, bicultural” providers

Over a third of Hispanic adults that the Pew Research Center surveyed said they prefer to see a Spanish-speaking healthcare provider.

It’s important to have providers who speak Spanish but also understand how “cultural norms, beliefs, and traditions influence the way that we perceive and make healthcare decisions,” Cristian Alarcon, program director at MHP Salud, a national nonprofit that aims to improve healthcare and social services access for Hispanic and Latino communities, said.

In mental healthcare, for example, a lack of cultural knowledge or language barriers can lead to a risk of misinterpreting or misdiagnosing symptoms—or prescribing treatments that a patient may not prefer, Aisenberg said.

In Washington, there is “a scarcity of bilingual, bicultural providers” to meet the needs of the population, Aisenberg said. That trend may not be exclusive to the state.

Only 9% of US healthcare practitioners (and 7% of physicians and surgeons) are Hispanic, according to a 2021 Pew Research Center analysis of federal data. Even in California, Latinos make up 40% of the population but only 11% of medical school graduates, UCLA Health found.

If these trends continue, it could take up to 500 years to close the Latino physician gap in California, analysis from the UCLA Latino Policy and Politics Institute suggests.

Looking to the community for care

Community health workers can fill some of those gaps, Aisenberg said.

MHP Salud has established community health worker programs, especially along the US-Mexico border, to connect Latinos to community support resources and health education. Their programs range from helping people with insurance applications to sharing information about chronic conditions common among Latinos, Alarcon said.

“Community health workers are individuals who are from and serve the communities they live in,” Alarcon told Healthcare Brew. “That allows them to be this effective catalyst for supporting the health initiative with cultural awareness and sensitivity.”

MHP Salud reported that its cancer prevention program in Texas, Cada Paso del Camino, which ran from 2015–2018, had a return rate of $3.16 for every dollar spent on the program.

For community health programs to be successful, however, health systems should look to integrate those workers into medical practices, Aisenberg said.

“The sad thing for me is…promotores are often used by healthcare organizations to gain access to the community,” Aisenberg said. “They have insights, they have listened well to the stories and experiences of their neighbors and members of their community, but that isn’t always listened to, respected, and valued by the medical team.”

But what works in one place to meet the healthcare needs of its Hispanic and Latino population may not work in another, Alarcon said.

“We aren’t a monolith, you know. We’re a very diverse group of people,” he said.