Closing the Diabetes Treatment Gap in Hispanic Communities
Diabetes is a national health crisis. The average adult in the U.S. has a 40% chance of developing type 2 diabetes during his or her lifetime. But among adults in Hispanic and Latinx communities in this country, that risk is even greater—more than half are at risk for developing this chronic disease, where the body can no longer regulate and use glucose properly, resulting in too much sugar circulating in the bloodstream.
Many Factors Are at Play
When you consider actual rates of this disease, currently 17% of Hispanic/Latinx adults in the U.S. are diagnosed with type 2 diabetes, as opposed to 8% of non-Hispanic whites. Why? It’s complicated. “There are many factors involved in leading to people being undiagnosed and unaware,” says Lenny López, M.D., associate professor at the University of California San Francisco School of Medicine. Here, let’s unpack the many potential reasons for this health disparity.
Socioeconomic Status Affects Care
Health insurance isn’t a given in the U.S.—and 8.7% of Hispanic/Latinx people over 16 were unemployed at the end of 2020, according to the Bureau of Labor Statistics. Part-time workers may also have trouble getting coverage, says Francisco Prieto, M.D., chair of the American Diabetes Association’s National Advocacy Committee. “If you’re an essential worker and uninsured, then the chances that you’re going to have access to good comprehensive care for your diabetes, or any other chronic condition, are much less," he says.
The Rural/Urban Divide Is Real
Access to quality care is a big issue. Hispanics comprise the largest minority group living in rural America, which often means they live hours from a diabetes clinic or specialist. “People who have a consistent source of healthcare—a regular doctor or clinic they can go to whenever they have a health issue—are much more likely to have their health issues under control,” Dr. Prieto says. “That’s especially true for a condition like diabetes that requires education about diet, a regimen of physical activity, and medications that can be expensive.”
Access to Quality Food Matters
Those who can’t access a doctor may also struggle to find and consume healthy food, a key component of a diabetes treatment and prevention plan. “If you live in a ‘food desert,’ where the only convenient place to get food is in a minimart you can walk to ... you’re probably not going to get fresh vegetables and fruit,” Dr. Prieto says. This emphasizes the need for more health resources in rural and small-town areas—as well as in big cities where large supermarket chains are often scarce.
Cultural Traditions Only Go So Far
While it's true that traditional Hispanic/Latinx fare is big on fruits and vegetables—a good thing, no matter how you slice it—cultural traditions and reality are two separate things. “If your parents are working two jobs, then they’re probably not home cooking you a meal and teaching you how to cook for yourself," says Dr. Prieto. Lower income and poor nutrition often go hand in hand, which may be why some doctors notice lower nutritional quality among some of their Hispanic/Latinx patients. “Whether that’s an education thing or an access thing—both could be present,” Dr. López adds.
Systemic Bias Should Be Considered
A study in the Journal of the National Medical Association reported that at least 42% of Latina immigrants have faced discrimination in a healthcare setting. Men experience it on a wide scale, too, says Dr. Prieto. This can be anything from outright prejudice to unconscious assumptions, and it discourages Latinx Americans from seeking care. “Racism isn’t just bigotry,” he says. “Racism is also making assumptions or pre-judging people because of their background. A lot of that is unconscious.” If someone has felt minimized or talked down to by their doctor, they may be resistant to going back.
Family History May Be a Component
According to Dr. Prieto, genetics may play a role. “It’s not up to us what genes we inherit, and that’s not something you can control,” he says, explaining that some Hispanic groups, like Puerto Ricans, Mexicans, and Dominicans, have notably higher diabetes rates than others. But Dr. López counters that this might be due to a lack of data from places with lower rates, like Guatemala and El Salvador. “I'd guess if we had better cohorts of people being followed, [groups in Latin American countries] probably wouldn’t lag too far behind [in terms of diabetes risk].”
Language Barriers Are Roadblocks
For those who've learned English as a second language, not being able to decipher a doctor's orders, or even figure out how to get to a doctor, can be a huge barrier to care. Almost 40 million Americans speak Spanish as their primary language at home, according to U.S. Census Bureau data, and not all of them speak fluent English. “Many folks may not have full command of English, so they’re limited language-proficient patients,” Dr. López explains. And while some places (especially clinics in urban areas) have Spanish-speaking diabetes programs, not everyone has access to this type of care.
Bridging the Diabetes Divide
Dr. Prieto says primary care doctors are disproportionally absent from underserved, minority communities—exactly what's needed to combat this health disparity. Culturally and linguistically sensitive education is needed, too. The medical community "can help by reaching people where they are, asking them, ‘What do you understand about diabetes?’" he says. Dr. Lopez would like to see structural and policy changes made to address access to good food and quality healthcare.
People Are Not Numbers
“These factors around obesity and diabetes are not destiny,” Dr. López insists. “We don’t have any evidence that suggests that for type 2 diabetes there are such strong genetic factors that nothing else could moderate that.” He adds that for Hispanic and Latinx communities in the U.S., what matters most is that they have access to the education, support, and resources they need to be healthy. “It’s really that they need the life support and the right settings to have success in managing their diabetes. Or better yet, preventing it.”
Latinx Americans Diabetes Statistics: Centers for Disease Control and Prevention. (n.d.) “Hispanic/Latino Americans and Type 2 Diabetes.” cdc.gov/diabetes/library/features/hispanic-diabetes.html
U.S. Unemployment Rate: U.S. Bureau of Labor Statistics. (2021.) “Labor Force Statistics from the Current Population Survey.” bls.gov/web/empsit/cpsee_e16.htm
Hispanic Populations in Rural Areas: Housing Assistance Council. (2012.) “Rural Research Brief: Race & Ethnicity in Rural America.” ruralhome.org/storage/research_notes/rrn-race-and-ethnicity-web.pdf
Discrimination by Healthcare Providers: Journal of the National Medical Association. (2016.) “An Examination of Factors Associated with Healthcare Discrimination in Latina Immigrants: The Role of Healthcare Relationships and Language.” ncbi.nlm.nih.gov/pmc/articles/PMC4838486/
Languages Spoken at Home: U.S. Census Bureau. (2015.) “Detailed Languages Spoken at Home and Ability to Speak English for the Population 5 Years and Over: 2009-2013.” census.gov/data/tables/2013/demo/2009-2013-lang-tables.html
Geographic Distribution of Primary Care Doctors: Journal of Health Care for the Poor and Underserved. (2018.) “The Racial and Ethnic Composition and Distribution of Primary Care Physicians.” ncbi.nlm.nih.gov/pmc/articles/PMC5871929/