By Lori Gonzalez (2021)
Although older Latinos and Whites are equally as likely to be living with one or more chronic conditions, older Latinos report poorer health, lower access to health care providers, and less satisfaction with health care providers. Older Latinos face several barriers when engaging with the health care system including a lack of culturally competent care. This issue brief describes the role of Community Health Workers in improving care for the Latino community.
The Community Health Worker (CHW) program began in China in the 1930s to provide health care to migrant farmers and spread to many other parts of the world including the U.S. by the 1960s (MHP_Salud_landscape, 2021; Perry 2013). The CHW program empowers CHWs who are often members of the communities in which they serve—uniquely positioning them to bridge the gap created by the social determinants of health. Although CHWs may have some formal training or credentialing, most are not medical professionals. CHWs provide culturally competent health education, advocacy, social support, counseling, and care coordination that is cost effective and health promoting (MHP_Salud_landscapes, 2021). This brief describes the role of Community Health Workers (CHWs) in mediating healthcare disparities among older Latinos.
While older Latinos and Whites have similar proportions living with one or more chronic conditions, Latinos are less likely to visit physicians and other doctors, are less satisfied with their health care experiences, are less likely to be insured, more likely to report fair or poor health, and report being less likely to obtain medical care (Georgetown University Health Policy Institute, 2021). Compared to Whites, Latinos are one and one-half times more likely to be living with Alzheimer’s and other dementias (Alzheimer’s Association 2016). Latinos experience greater exposure to health hazards, increased lifetime prevalence of disease and disability, mistrust of and lower quality relationships with health care practitioners, and a lower adherence to treatment regimens (see Hall et al. 2015 for a review). These barriers to health and healthcare can be reduced with effective programming that’s culturally competent.
Research has shown that CHWs have been successful in helping the older Latino community manage diabetes, increase physical activity and healthy eating, lowering blood pressure, improving mental health, increasing health screenings, and reducing costly emergency department visits by reducing the impact of the social determinants of health (NIH, 2021; Shah et al., 2015 Trump et al., 2017; Chang et al., 2018; Verhagen, 2014). The social determinants of health include nativity, migration, citizenship, socioeconomic status (SES), the physical environment in which people live, access to health services, access to healthy foods, transportation issues, and other social and political factors (MHP_Salud 2021; Naik et al., 2019). As one example of the social determinants of health, Hispanics whose preferred or first language is Spanish, may have difficulty communicating with traditional medical professionals and other health care workers and understanding/navigating the health care system (White, Haas, and Williams 2012). In a recent survey, for example, 16 percent of Hispanics reported feeling that nursing homes could not provide for cultural needs, including preferred spoken and written language (AP-NORC 2017). Regarding social and political determinants, there is a concern about the lack of racial, ethnic, and cultural diversity among health care providers. Medical professionals have been found to hold negative racial stereotypes about Latinos (Bean et al. 2013; Blair et al. 2013; Sabin, Rivara, and Greenwald 2008). SES also has a determinant effect on health studies have found that Hispanics’ lower self-reported health status is largely attributable to lower SES and in particular, wealth (e.g., Pollack, Page, and LaMontagne 2013). While 7 percent of Whites aged 65 and older live in poverty, the percentage of older Hispanics living in poverty is much higher (20 percent; Cubanski et al. 2018). With regard to wealth, the median wealth of White families in 2011 was $111,146, compared to $8,368 for Hispanic households (Traub et al. 2016). Finally, research has found that the social determinants of health vary within Latino subgroups with some experiencing greater disadvantage, depending on the particular determinant being considered (see Penman-Aguilar et al., 2016).
CHWs have the potential to reduce costs associated with formal care education and by bridging the gap of the social determinants of health, reduce the potential for costly health outcomes. However, the current Medicare reimbursement system rules disqualifies, undervalues, and provides narrow eligibility requirements for CHW reimbursement (Humphrey and Kieman, 2019). Over 30 states reimburse CHW services via Medicaid, however, rates are low (CDC.gov, 2021). Expanding the program will require greater recognition of CHWs, improved education opportunities, planning to integrate CHWs into care teams, and higher reimbursement rates (CDC.gov, 2021; Humphrey and Kieman, 2019). Investing in the program would improve health care outcomes and quality of care for older Latinos by providing culturally competent health care education and potentially reduce health care costs.