Health Status of Latinas

At the national level, the leading causes of death among Latinas are heart disease, cancer, stroke and diabetes. Although there are variations on health indicators depending on the country of origin, it is often difficult to break down the data to clearly see the differences. For example, Mexican American women tend to have lower blood pressure than other Latinas. Puerto Rican and Mexican American women are more likely to have diabetes than white women. It is even more challenging to find data broken down to more specifics at the state level where Latinas are often lumped into the minority category. Regardless of the differences, these poor health outcomes can be lowered by making lifestyle changes and improving the use and access of preventive services. In this issue of Maternidad Latina, we address some of the barriers Latinas face in using preventive healthcare services and recommend the use of a new publication to encourage Latinas to improve their own self-care and make lifestyle changes.

Although we may make statements about Latinas as a whole, it is important to remember that Latinas come from various countries (those living in North Carolina come from at least 10 different countries), different regions within their countries and different socio-economic backgrounds. Differences based on length of residence in the United States also play a factor in what Latinas know about preventive health care and should be taken into account. Information about Mexican women and the use of health services in their home country will be presented as an illustration of differences within one country. Women from other countries may or may not have similar experiences, depending on their country and the health services available in that country.

Putting Children's Health First
It is not uncommon for Latinas to take their children for well-baby visits or for sick visits. In focus groups done by the North Carolina Healthy Start Foundation, Latinas have shared how important it is for their children to get their immunizations and that they'll do anything for their children's health. From the moment they are pregnant, most Latinas will make positive health changes not for their own health, but for the baby's health. At first glance, taking care of their own health does not seem to be a priority for many Latinas. A variety of factors can help us understand the reasons behind this lack of focus on their own health.

Is the Prevention Message New for Latinas?

Participants in focus groups addressing Latinas' health, knowledge and attitudes expressed the importance of being and feeling healthy. They knew the importance of eating well, exercising and going for preventive checkups. Knowledge, however, does not often translate into practice. Barriers mentioned by women in these focus groups include lack of time, transportation and money, as well as a culture of self-sacrifice for others. In particular, the combination of lack of money and self-sacrifice influence Latinas to put their own health last. In North Carolina, 64% of Latinas are uninsured. When money is limited it is easy to understand that Latinas will prefer to put the limited amount of money toward their children, be it to buy medicine, school supplies, etc.  (Full report available ).

Case Study: The Mexican Health System and the National Health Card

As mentioned, many Latinas already know that they should be taking care of themselves. Yet, prenatal care is often the first contact for immigrant Latinas with the healthcare system in the United States. Depending on their place of origin, Latina immigrants may also have had limited contact with the formal healthcare system. In the case of Mexican immigrants (73% of Latinos in NC are from Mexico), there is great diversity in experiences using the formal health care system in their home country depending on access to insurance coverage and availability of services. 

There are two main sources of health care in Mexico: the Mexican Institute for Social Security (IMSS—for people working in private industry) and the Institute of Social Security for State Workers (ISSSTE—for those in government jobs). About 50% of Mexicans are covered by one of these two systems and have access to clinics and hospitals run by the respective system. The other half of the population is uninsured, particularly those living in rural settings. The uninsured in Mexico may be able to obtain services at clinics run by the Ministry of Health where available. In some rural communities, the only health services available are at rural health posts staffed by medical students completing their social service before graduation. In some cases, Mexicans, even those who have government insurance, will seek the services of private doctors. This is due to lack of appointments in the public system or the perception that a private doctor will provide better care. In general though, the use of preventive services is very limited to those who have insurance and access to health clinics. 

In 2001, the Mexican government instituted a new health insurance system to cover people who are self-employed (for example, house keepers, street merchants, taxi drivers). This new plan provides coverage to an additional 15% of the population. Those covered can get care at any public healthcare facility in the country by paying a sliding-fee. In addition, under the 2001-2006 National Health Plan the government introduced the use of Cartillas Nacionales de Salud or national health cards modeled after the national immunization cards. These cards are targeted to men and women ages 20-59 and aim to help the population keep track of all of their vaccines, use of family planning, blood pressure, screening tests, and other indicators of general health. In the state of Guanajuato, from where many immigrants to NC originate, 18,000-20,000 cartillas are distributed yearly and it is believed that most women accessing services are using them.

So what does this have to do with North Carolina? A new publication by the North Carolina Healthy Start Foundation My Health Journal (Mi Diario de Salud) aims to help women in NC keep track of their health. For Mexican women familiar with the Cartilla Nacional de Salud this health journal may not be as foreign as we might think. For others who are just getting used to a healthcare system, it can be an important tool to make the best use of medical visits and begin to take care of themselves.