Los Angeles County suffers from an acute shortage of culturally competent doctors to treat the area's Latino community, compounding the problems Latinos experience accessing medical care due to the fact that they have the highest percentage of adults lacking health insurance, according to a UCLA study.
On the plus side, however, Latinos are becoming more physically active and have decreased their tobacco use in recent years, and continue to have lower rates of heart disease, cancer and stroke, according to the study from the UCLA Center for the Study of Latino Health and Culture. The long term threat to this healthy Latino profile is an ominous increase in overweight and obese youth and adults.
The findings are part of the "2006 Latino Scorecard: Road to Action," a five-part report sponsored by the United Way of Greater Los Angeles that also examines housing, education, economic development and public safety.
"Similar to previous years, Latinos do their part as individuals to ameliorate the overall health of L.A., such as giving birth to healthy babies." said David Hayes-Bautista, director of the center. "However, the healthcare system continues failing to respond by opening the doors to access to care. In fact, Latino access to care is eroding."
The county's Latino population continues to grow and now stands at 46 percent of the population, up from 44.6 percent in 2003, when the last scorecard was issued. Yet Latino communities suffer from shortages of doctors who are both culturally competent and speak Spanish.
"Considerable improvements need to be made in various areas that affect the health of the soon-to-be Latino majority," said Iya Kahramanian, co-author of the study.
The researchers used five indicators and one aggregate measure to gauge Los Angeles County Latinos' health. The indicators were health insurance, tobacco use, overweight or obesity, physical inactivity, and first-year medical school enrollments. The aggregate measure, termed a "health-promoting behavior" measure, is the sum of the average percentages from 2002 to 2003 of tobacco use, overweight or obesity, and physical inactivity.
Unlike the prior scorecard, however, this year's report does not include Latinos' positive health outcomes in order to focus attention on the other, more troubling trends that are likely to erode Latinos' overall health if they are not reversed.
The scorecard assigned "A" through "F" grades to three of the variables. Health insurance enrollment received a "D," health-promoting behaviors received a "D" and first-year medical school enrollments received an "F." The grading is based on a straight scale - for instance, if 90 percent of adults or youth had health insurance, they would get an "A."
An updated scorecard will be issued in 2007.
The researchers found that the county's Latino adults have the highest percentage of uninsured persons - 34.1 percent, compared with 15.1 percent for Asians/Asian Pacific Islanders, 14.3 percent for non-Hispanic blacks and 8.5 percent for non-Hispanic whites.
Access to health insurance is a key to a healthy population because those with coverage are likelier to receive preventative health services that diagnose and treat illnesses before they turn more serious. Also, those who have coverage are encouraged to engage in health-promoting behaviors.
On average, 15.3 percent of Latino adults indicated they were current smokers, though it appears that this has decreased over time. By contrast, non-Hispanic whites and non-Hispanic blacks had higher averages (17.1 percent and 23 percent, respectively). Asians/Asian Pacific Islanders had the lower average at 14.2 percent. A hopeful sign among Latinos in this category, however, is that the 2003 scorecard showed that an average 17.6 percent indicated they were current smokers, so the numbers appear to be declining.
The percentage of overweight or obese adults remained highest among Latinos at 67.5 percent. Non-Hispanic blacks ran second at an average 66.3 percent, followed by non Hispanic whites (53.3 percent) and Asians/Asian Pacific Islanders (33.1 percent).
But Latinos also appear to be more physically active than before, with an average 34.2 percent of the Latino population being physically inactive compared with 42 percent in the 2003 scorecard. Still, Latino adults were the most physically inactive group, compared with non-Hispanic blacks (33.1 percent), Asians/Asian Pacific Islanders (23.1 percent) and non Hispanic whites (17.6 percent).
Among the Los Angeles County population ages 12-17 in 2003, Latinos had the highest percentage of overweight or obese youth at 18.4 percent, an increase from previous years when, for example, the 2001 California Health Interview Survey indicated that 16.5 percent of Latino youth were overweight or obese. The latest data also showed that 7.0 percent of non-Hispanic black youths, 6.2 percent of non-Hispanic whites and 1.7 percent of Asians/Asian Pacific Islanders were overweight or obese.
Some 5.9 percent of Latino youths were current smokers, slightly lower than the 6.1 percent among non-Hispanic whites.
On the health-promoting behaviors index (tobacco use, physical inactivity, overweight/obese) for adults, 60 percent of the county's Latino community fell into the "good" category. Non-Hispanic blacks came in slightly lower in that category at 58.8 percent, while higher percentages of Asians/Asian Pacific Islanders and non-Hispanic whites fell into that category at 76.3 percent and 70.7 percent, respectively.
"The lack of health insurance, increases in obesity and lack of physical activity all threaten to drastically affect the growing Latino population," Kahramanian said. "It is imperative to work with the Latino community to achieve improvements."
Finally, the researchers found that enrollment of Latino students in medical schools in Los Angeles County was disturbingly low, with only 42 Latinos enrolled out of 306 seats in 2003, only 13.7 percent.
"This is not an affirmative action issue - a resident of Bell has 99 percent fewer physicians available when seeking care than a resident of Beverly Hills," Hayes-Bautista said. "The simple fact is that Latino physicians are over 30 times more likely to speak Spanish and practice in a heavily Latino area. The most efficient, cost-effective way to increase access to physicians in cities such as Bell is to increase the number of Latino medical students. An additional dividend to doing this is that Latino physicians are far more likely to understand and work with the cultural dynamics that create a surprisingly healthy Latino population."
Data pertaining to adult tobacco use, overweight or obesity, and physical inactivity came from the Centers for Disease Control, Selected Metropolitan/Micropolitan Area Risk Trends (SMART) from 2002-03. Data pertaining to adult health insurance, youth overweight or obesity, and current smoking status came from the California Health Interview Survey, 2003. First-year medical school enrollment, examined to gauge the current physician shortage in the Latino community in Los Angeles County and statewide, came from data from the medical schools at UCLA, the University of Southern California and Drew Medical.
Since 1992 the UCLA Center for the Study of Latino Health and Culture has been a resource for cutting-edge research, education and public information about Latinos, their health and their role in California. Under the leadership of Hayes-Bautista, the center has been the lead institution to explode myths and stereotypes about Latinos in California society, provide reliable data on Latino health, emphasize the positive contributions of Latinos to the state's economy and society, and inform the public about the important emerging Latino medical market.
United Way of Greater Los Angeles is a nonprofit organization that helps nearly 3 million people each year in Los Angeles County. By examining community trends with volunteers and donors, United Way has shaped a vision for moving the working poor out of poverty and improving the quality of life for all of Los Angeles. Investing in programs that promote learning, empowering and caring, United Way and its donors are bridging the gap in our community. For more information, visit http://www.unitedwayla.org/.