Key Takeaways

•  Language and cultural barriers are causing trauma for Americans who are already disproportionately putting up with the pandemic. A report further highlighted that the language barrier in administering healthcare will continue long after the pandemic resolves as the proportion of Spanish-speaking physicians in the country is below 6% compared to the projections by the U.S. Census Bureau that Hispanics will make approximately 25% of the U.S. population by 2045.

•  Judith Flores, M.D., chair of the National Hispanic Medical Association’s board of directors, opined that the lack of trust in the health care system among the Spanish-American community emanates from the under-representation in health care professions and immigration challenges.

• One of the methods being adopted by healthcare providers is to employ more Spanish-Speaking physicians. Emergency bilingual teams were employed at Boston Medical Center, Brigham and Women's Hospital, and Johns Hopkins Hospital in Baltimore to help with treating Covid-19 patients.
• Another remedy adopted towards providing access to healthcare for Hispanics is the Affordable Care Act of 2016, which worked towards bridging the health insurance gap among Latinos. Some of the areas of focus tackled by the act include expanding Medicaid, therapy for all, Promotores de Salud (community health workers), healthcare for undocumented immigrants, and national tax on sugary drinks.

Introduction

• The research provides insights into the challenges encountered by healthcare systems and hospitals when catering to the Hispanic community, specifically Spanish-speakers, and the remedy they adopt towards mitigating these challenges, including where they're falling short.

Language Barrier

• According to an article by US News, Language and cultural barriers are causing trauma for Americans who are already disproportionately putting up with the pandemic.
• The report further highlighted that the language barrier in administering healthcare will continue long after the pandemic resolves as the proportion of Spanish-speaking physicians in the country is below 6% compared to the projections by the U.S. Census Bureau that Hispanics will make approximately 25% of the U.S. population by 2045.
• According to William Calo, a Pennsylvania State University researcher who studies Hispanics and public health, “We are struggling with providing good information in English — just imagine adding a second language (Spanish language).”
• While a growing number of fact-checking organizations are trying to identify and correct false claims spreading online, very few publish their work in Spanish.
• Hospitals such as the Massachusetts General Hospital experienced a surge in Spanish-speaking patients from 10% to over 50% in April 2020.
• The patients frequently were unable to communicate with their largely white, monolingual care teams.
• To worsen the matter, the patients were more isolated due to the inability of family members to visit.
• A study from Northern California revealed that "patients whose doctors were not fluent in their spoken language were more likely to have out-of-control diabetes."
• Some data suggest that the best medical care is given by culturally and linguistically congruent providers and the inability of physicians to communicate with their patients results in a two-tiered system of health care.

Lack of Trust

• A publication by NBC News revealed many Latinos in the US have less access to medical care, a higher level of distrust in government, and sometimes need to be reached by Spanish-language public health resources.
• In the case of the pandemic, "false claims and conspiracy theories, ranging from bogus cures to the idea that the virus is a hoax, have dogged efforts to control the pandemic from the beginning."
• This barrier is said to be a dangerous mix capable of discouraging people from taking precautions, helping with contact-tracing efforts, or seeking treatment.
•  Judith Flores, M.D., chair of the National Hispanic Medical Association’s board of directors, opined that the lack of trust in the health care system among the Spanish-American community emanates from the under-representation in health care professions and immigration challenges.
• A survey by BMC Public Health showed that "Barriers to dissemination and adoption of precision medicine (PM) included lack of health insurance, financial burden, participants’ immigration status, distrust of government, limited English proficiency, low literacy levels, cultural norms, fear about genetic testing results, lack of transportation, the newness of PM, and lack of information about PM."

Immigration Status/Insurance Challenges

• Another challenge faced by Spanish-speaking Americans towards accessing quality healthcare is because they can not afford it (insurance) and sometimes because of their immigration status.
• For many, the unwillingness to get tested or seek treatment comes from the fear of deportation in a community that has a reasonable number of immigrants.
• The New York State Sen. Gustavo Rivera, a Democrat who represents a largely Hispanic district in the Bronx, opined that the past US president promised to round up both illegal and legal immigration thereby, painting immigrants as posing a public health and safety danger.
• A survey of Spanish-speaking respondents showed that 67% reported social determinants of health healthcare access barriers of being uninsured.
• One of the participants in the survey, a husband, described his inability to secure an appointment for his wife for a mammogram from a program for the uninsured.
• According to the 67-year-old respondent, “I called twice…He (the person answering the phone) asked what kind of insurance she had and I told him that she doesn’t have any kind of insurance. Then I told him I was under the impression that in this case, these services are free. He tells me, “Yes, it is true, but we need to know what insurance she has.” Then I tell him, “She doesn’t have any insurance.” He says, “Wait a moment.” Two or three minutes pass, he returns to the phone and says, “Ah, we are really sorry, but the machine is broken. We don’t have any machines available at this moment.”

Remedy Adopted By Hospitals/Shortcomings

Employing Interpreters

• The Affordable Care Act in 2016 worked towards bridging the health insurance gap among Latinos and directed that hospitals must employ qualified interpreters.
• Some of the areas of focus tackled by the act include expanding Medicaid, therapy for all, Promotores de Salud (community health workers), healthcare for undocumented immigrants, and national tax on sugary drinks.
• Notwithstanding the efforts by The Affordable Care Act, Latinos are still about 3 times more likely to be uninsured than non-Hispanic whites.
• The progress made by the Act in expanding health insurance coverage for Latinos is said to be at risk due to the disproportionate impact on Latino workers caused by the COVID-19 economic recessions.
• Abriendo Puertas/Latino Decisions survey revealed that 37% of Latinos have had someone in their household lose their employer-provided health insurance benefits during the recession.
• Also, cultural barriers, such as that nearly one-third of Latinos are not fluent in English, make the healthcare system less accessible to those who often need it the most.

Adopting Foreign-Trained Physicians

• One of the methods being adopted by healthcare providers is to employ more Spanish-Speaking physicians.

•  Emergency bilingual teams were employed at Boston Medical Center, Brigham and Women's Hospital, and Johns Hopkins Hospital in Baltimore to help with treating Covid-19 patients.
• According to US News, employing interpreters to help communicate with patients is a good pandemic model, but it's not sustainable.
• In the US, foreign-trained physicians must take multiple exams and redo their residency, leading to delayed and very expensive licensing and certification.
• The source opined that a better solution would be to provide an emergency credential to Spanish-speaking physicians who obtained their degree in countries other than the U.S.
• The process is onerous and unnecessary as the European Union makes it easier for physicians to move between countries.
• The source further opined that medical school should be free for bilingual applicants to encourage more financially challenged students.
• For 2019-2020, Hispanic medical school applicants in the U.S. were 3,350 out of over 53,000 applicants.
• Also, the current bilingual healthcare providers need to be better compensated as they are helping the system save money by obviating the need to hire an interpreter.

Healthcare for Undocumented Immigrants

• A publication by Brooklyn University opined that 50% of all foreign-born, non-citizen Latinos lack health insurance.
• The first COVID-19 stimulus bill passed in March notably did not expand Medicaid eligibility to undocumented immigrants, excluding many of them from COVID-19 testing and treatment options, even as many puts themselves at risk working essential jobs.
• The source recommends that future COVID-19 bills should expand Medicaid eligibility to cover the medical needs of undocumented citizens (the Democrats’ HEROES Act does this).
• More generally, bills like the HEAL Act should be passed to expand immigrants’ access to Medicaid.
• About 77% of all undocumented immigrants are from Latin America, these policies are largely a Latino health issue.

Research Strategy