Office of Minority Health

Latino/Hispanic Culture & Health

The purpose of this handout is to help you understand some of the features of Hispanic/Latino American culture and issues surrounding Hispanic/Latino American health by presenting a broad picture of cultural facts and experiences. Please keep in mind, when referring to this information, that every person is an individual, who is both influenced by his or her culture and is also a unique being. The information below should not be used to over-generalize or characterize all members of a cultural or ethnic group as alike. There are many factors that impact on a person’s identity, behavior, and beliefs, including: individual characteristics; socioeconomic status; education; religion; age; sex; particular migration experiences; and whether the family lived in a rural, urban, or suburban area.

Population Information

• By the year 2000, it is estimated that Hispanics will be the largest minority group in the US. There are 59,745 Hispanics in RI, making them the largest and most diverse minority group in the state. Hispanics make up almost 6% of the RI population, but were nearly 15% of the population in Providence in 1990, and are a significantly higher percentage today.
• 98% of Hispanics live in urban areas, mainly Providence, Pawtucket, and Central Falls.
• Hispanics have Indian, European, and African roots; they are very racially diverse.
• The majority of Hispanics in RI come from Puerto Rico, the Dominican Republic, and Colombia. Other major groups are from Guatemala, Cuba, and Central/South America.
• Puerto Ricans are US citizens. "Operation Bootstrap" established yearly migration of thousands of Puerto Ricans to agricultural farmlands in the Northeast, including Rhode Island. From 1970-1990 many Hispanics returned to PR due to a declining US economy; reliance on federal social programs increased. Many in lower socioeconomic strata migrate back and forth to PR, which can be stressful to families and disruptive of health care services. This travel back and forth has also resulted in reinforcement of PR culture and development of bicultural identity.
• Colombians have been coming to the US since 1950’s fairly steadily, mainly for economic reasons. Many originally worked in RI textile mills. Some also have come in the past 10 years for political reasons.
• Dominicans have been migrating to the US since the 1960’s, when the US supported a military coup in their country.
• Many Guatemalans and other Central Americans came to RI fleeing political persecution.
• The general US population is aging, but the Hispanic population is increasingly youthful.
• While 29% of the Hispanic population lives below the poverty level, compared to 6.8% of the state’s overall population, this also means that over 70% of Hispanics in RI do not live in poverty. Hispanics have the lowest median family income in RI ($20,516 vs. $39,172). The unemployment rate for Hispanics is almost twice as high as the general population’s rate (13.5% vs. 7.5%).
• Less than half of adults age 25 or older have graduated high school, compared to 72% of the general population.
• About 78% of Hispanics in RI over age 5 speak Spanish at home. About 37% say they speak English poorly or not at all.
• Nationally, Hispanics are four to six times more likely than the general US population to read English below the fourth grade level; many have low literacy in Spanish as well. An individual’s literacy level depends on the person’s socioeconomic background and education.

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Names

• Children are often named after relatives or religious figures. The middle name is followed by the father’s last name, which is followed by the mother’s last name. Traditionally, wives keep their maiden names and add on their husband’s names in the following form: maiden name, followed by "of" (de), followed by husband’s last name.
• Some Hispanic surnames are not Spanish. The founding father of Chile was named O’Higgins, and the presidents of Peru, Argentina and Chile have been Fujimori (Japanese), Menem (Syrian) and Aylwin (Welsh).

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Family Structures

• Familismo – Hispanics/Latinos tend to view the family as a primary source of support. Families are broadly defined, close knit, and emotionally and financially supportive. Family often includes non-blood-related persons, including compadrazgos (when a couple baptizes the child of another). Some non-Hispanics interpret these family characteristics negatively as over-involvement or dependence.
• The eldest male is typically the authority figure, and gender roles are traditional.
• Important decisions are made by the whole family, not the individual.
• Elders often provide childcare so that children and spouses can work.
• In traditional Colombian families, children are highly protected and very dependent on their parents. They are expected to live with their parents until they marry. Punishment is often emphasized over positive rewards. Children are taught to avoid confrontations with their parents and older persons, and to be obedient, respectful, and shy.

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Communication and Social Interaction

• Personalismo – This refers to the tendency of Hispanics to place utmost value on individuals as opposed to institutions. They tend to trust and cooperate with individuals they know personally, and many dislike impersonal and formal structures. Hispanic customers may identify a health worker by name rather than by job title or institution. In a professional situation, many expect formality in address (Mrs. X), but also personalismo (how are your kids doing in school?). The quality of a social interaction is often seen as more important than length.
• Respeto - The special consideration and respect that should be shown to elders and authority figures within the community. When speaking Spanish, elders should be addressed as usted, not tu.
• Simpatía - This describes many Hispanics’ preference for smooth social relations based on politeness and respect, as well as avoidance of confrontation and criticism. Overt disagreement is not considered appropriate behavior. Some expect offers of gifts or food to follow a pattern of offer, refusal, insistence, and final acceptance, so receivers do not appear greedy or givers insincere.
• Many Hispanics are characterized by warm, friendly, and affectionate relationships. Personal space is close and frequently shared with family members or close friends.
• Some Hispanics may get agitated or emotional when nervous or frightened. They may communicate intense emotion and appear quite animated in conversations – a behavior that is sometimes misperceived by non-Hispanics as being "out of control". Latinos’ voice pitch and inflections are sometimes misinterpreted as confrontational. Many are very loud and outspoken in expressing pain.
• Many Hispanics, particularly if they were not raised in the US, may avoid direct eye contact with authority figures or in awkward situations.
• Many will nod affirmatively but not necessarily mean agreement. Silence may mean failure to understand and embarrassment about asking or disagreeing.
• Many may understand English better than they can speak it, especially under stress.
• Modesty and privacy are important. Stigmatized health issues should be discussed through an interpreter and not family members. When a family member is used as interpreter, if the issue is personal, try to use a family member of the same gender. Sexuality issues are hard to discuss. Often the word for sex (sexo) is not even used - tener relaciones (to have relations) is used instead.

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Time Orientation

• Time and punctuality may be flexible. Social gatherings are often expected to start later than the announced time.
• Many Hispanics are averse to a hurried pace, especially given the expectation of personalismo.

Health Beliefs and Practices

Concept of Health

• Health is generally viewed as: being and looking clean; being able to rest and sleep well; feeling good and happy; having the ability to perform in one’s expected role as mother/father, worker, etc. In Puerto Rico, the phrase llenitos y limpios (clean and not too thin) is used.
• A person’s sense of bienestar (well-being) is thought to depend upon a balance in emotional, physical, and social arenas. Imbalance may produce disease or illness. Some attribute physical illness to "los nervios", believing illness results from having experienced a strong emotional state. Thus, they try to prevent illness by avoiding intense rage, sadness, and other emotions. Depression is not talked about openly; a person may say, "I am sad" (triste).
• Eating well and drinking fruit juices are common health promotion practices. Exercise is often not perceived as a health promotion practice and is discouraged during illness. As with other issues, this will vary by educational level.
• Individuals may not seek help until they are very sick.
• Hispanic cultures view illnesses, treatments, and foods as having "hot" or "cold" properties, although how these are ascribed may vary by country. Some consider health as the product of balance among four body humors (blood and yellow bile are "hot", phlegm and black bile are "cold"). One would balance a hot illness with cold medications and foods, etc. This might result in not following a doctor’s advice to drink lots of fluids for a common cold, if one believes such drinks add more coldness to body. Instead, hot liquids (teas, soups, broth) could be recommended. Colombians often use meat broth instead of chicken soup when sick; also drink agua de panela (unprocessed sugar and water) for respiratory/flu symptoms.
• Prevention strategies could build on this concern for balance – e.g., adopt a balanced diet to prevent diabetes and other diseases associated with overweight.
• Some common illnesses and their accepted causes:

Ataque – severe expression of shock, anxiety, sadness

Bilis – vomiting , diarrhea, headaches, dizziness, migraine, nightmares, loss of appetite, inability to urinate, brought on by livid rage and revenge fantasies. Believed to stem from bile pouring into bloodstream in response to strong emotion.

Empacho – lack of appetite, stomachache, diarrhea, vomiting, caused by poorly digested or uncooked food. Treated by massaging the stomach and drinking purgative tea, or by azarcon or greta, medicine that has been implicated in some cases of lead poisoning.

Mal de ojo (evil eye) – Vomiting, fever, crying, restlessness, brought on by an admiring or covetous look from a person with an evil eye. Children susceptible. Preventable by wearing particular jewelry.

Pasmo – tonic spasm of voluntary muscle; chronic cough or stomach pain; arrest of child’s growth and development, all brought by exposure to cold air when body is overheated.

Susto (fright) – anorexia, insomnia, hallucinations, weakness, painful sensations, brought on by traumatic experiences. Treatment may include a barrida (spiritualistic cleansing by sweeping body with eggs, lemons, bay leaves), herb tea, prayer.

Asthma may be called fatiga by Puerto Ricans.

Health promotion, prevention, and treatment

• Preventative medicine is not a norm for most Hispanics. This behavior may be related to the Hispanic "here and now" orientation, as opposed to a future-planning orientation.
• Some commonly known Hispanic sayings suggest that events in one’s life result from luck, fate, or other powers beyond an individual’s control.

Que será, será (What will be will be);

Que sea lo que Dios quiera (It’s in God’s hands);

Esta enfermedad es una prueba de Dios (This illness is a test of God);

De algo se tiene que morir uno (You have to die of something).

• Persons with acute or chronic illness may regard themselves as innocent victims of malevolent forces. Severe illness may be attributed to God’s design or bad behavior or punishment. Genetic defects in child may be attributed to parents’ actions.
• Family and friends may indulge patients, allowing them to be passive – a stance that may conflict with the view that active participation is required to prevent or heal much disease.
• Other Hispanic sayings support health promotion, and illustrate the considerable status given to health and prevention:

La salud es todo o casi todo (Health is everything, or almost everything);

Es mejor prevenir que curar (An ounce of prevention is worth a pound of cure);

Ayúdate que Dios te ayudará (Help yourself and God will help you).

• "Helping yourself" may lead to placing responsibility for cure with the entire family. The challenge for health professionals is to assess the amount of control patients believe they have over their health and to design interventions that build on traditional support systems.
• Vaccination is very important and adhered to for children.
• Western medicine is expected and preferred in case of severe illness, but some Hispanics may also use native healers. Curanderos utilize prayers, massage, and herbs to treat physical, spiritual, and emotional ailments. Espiritistas are believed to have spiritual or psychic powers to cure illness by communicating with dead souls.
• A "botanica" is a resource store for herbs and other traditional remedies. Some Hispanics may go there before going to a physician or clinic. In many Latin American countries, pharmacists prescribe medications, and a wider range of medications is available over the counter. People may share medicines, or write home for relatives to send them medications. Individuals may discontinue medication if doesn’t immediately alleviate symptoms, or after their symptoms abate. Many believe taking too much medicine is harmful.
• Due to history, some Hispanics may distrust the health system (many Puerto Rican women experienced involuntary sterilization, or were adversely affected by birth control pill trials), or view it as an extension of a repressive government (Central Americans), or fear it as a point of contact with immigration authorities. Some may confuse public health programs with welfare and avoid them due to stigma.

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Health Status

• The five leading causes of death for Hispanics in Rhode Island are: cancer, heart disease, homicide, AIDS, and unintentional injuries. For the general population they are: heart disease, cancer, stroke, chronic lung diseases, pneumonia and influenza.
• Nationally, Hispanics are about twice as likely to have non-insulin dependent diabetes than are non-Hispanic whites, and are more likely to have undiagnosed diabetes.
• Hispanic men are more likely to have undiagnosed, untreated, or uncontrolled hypertension than the national average.
• Incidence of AIDS among Hispanics was 4 times more likely in RI than among the general population. Cases of gonorrhea were 2 times more prevalent.
• The incidence of tuberculosis for Hispanics in RI was 5 times greater than for the general population (17.5% vs. 3.5). Some patients may mistake the tuberculin test for a vaccine, and not realize the importance of medical follow-up. Some authorities recommend arranging for the reading of results of the test at work or school, for the client’s convenience. Also, the use of the Bacillus Calmette-Guerin (BCG) vaccine in many Latin American countries may complicate the clinical detection of tuberculosis infection among Hispanics.

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Behavioral Health Risk Factors

• Hispanics are less likely than the general RI population to smoke (20.3% vs. 22.4%). Some authorities attribute this to the low incidence of smoking among Hispanic women. One researcher states that Hispanics are more likely to smoke in social settings rather than in response to "need" or nicotine addiction.
• Hispanic Rhode Islanders are less likely than the general population to be overweight, but more likely to be obese.
• Hispanic Rhode Islanders are a third less likely than all Rhode Islanders to exercise regularly (30.4% vs. 45%), and engage in less leisure-time physical activity. One researcher notes that a high percentage of Hispanics work in manual labor that does not contribute to aerobic fitness.
• Hispanics were more likely than other Rhode Islanders to eat 5 servings of fruits and vegetables per day (29% vs. 24%).
• Hispanic Rhode Islanders are nearly 50% less likely to drink alcohol than the general population.
• Hispanic Rhode Islanders are more likely than the general population to use safety belts or child safety restraint (81% vs. 76%).

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Health Screening

• Women participate in more screening activities than men. Women’s breast and pelvic cancer screening procedures may be seen as intrusive and embarrassing, thus may be delayed or not done. In Rhode Island, the percentage of women ages 40 and over screened for breast cancer and the percentage of women screened for cervical cancer is higher in the Hispanic population than in the general state population.
• Many Hispanic men are resistant to the concept of health screening. Wives may be very influential in men’s screening decisions. Elderly might be influenced by children. Health screening recommendations for children are generally followed.

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Maternal and Child Health

• The birth rate of Hispanics in RI is about twice as high as for the general population (116.4 vs. 57.5 per 1000 women ages 15-44).
• A greater percentage of Hispanic mothers than all mothers in RI delivered babies without prenatal care in the first trimester. (14.8% vs. 10.3%). Yet the rate of low birth weight babies was only slightly higher in the Hispanic population in RI (6.8% vs. 6.3%)
• Hispanic teenagers ages 14-18 were over 3 times as likely to give birth than all teenagers in the state.
• Hispanic babies are over 3 times as likely to be born into poverty (78.1% vs. 25.5% for general population).
• Breast feeding is less common among Hispanic women than among non-Hispanic whites. Many Latin American women believe colostrum is harmful for babies. In Colombia, breast feeding is expected in low to middle socioeconomic groups.

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Diet and Food Practices

• The typical diet is high in fiber, relying heavily on beans and grains (rice) rather than on meats for protein.
• Leafy green vegetables not a usual part of the diet.
• Relatively little intake of dairy products. Milk is consumed in coffee.
• Generally eat a lot of tropical fruits, fruit juices, and starchy root vegetables (e.g., potatoes, cassava, plaintains). Sofrito (blend of spices) is used to season stews.
• Puerto Ricans do not typically eat tortillas. More than 100 varieties of herbal teas are used to treat illness and promote health. For colds, flu and viruses, many use a mixture of honey, lemon and rum as an expectorant and antitussive. Egg yolk, sugar, and milk, malta, or fruit juices may be used as nutritional support for illness.

Sources: Culture & Nursing Care: A Pocket Guide, edited by Juliene G. Lipson, Suzanne L. Dibble, and Pamela A. Minarik, University of California at San Francisco, School of Nursing Press, 1996. Call (415)476-4992. Minority Health Facts: Hispanics/Latinos in Rhode Island, Office of Minority Health, RI Department of Health. Basic Cultural Competence Training Curriculum, South Carolina Department of Health and Environmental Control; Delivering Preventive Health Care to Hispanics: A Manual for Providers, National Coalition of Hispanic Health and Human Services Organizations, 1990; Multicultural Information & Resources, Children’s Hospital; Community Health Education and Promotion: A Guide to Program Design and Evaluation, by Aspen Reference Group, Aspen Publishers, Inc., 1997; Latino Values and Implications for Intervention, by Nicolás Parkhurst Carballeira, ND, MPH, and José Paré-Avila, MA, Latino Health Institute, Boston, MA (617) 350-6900.

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