Sarah Polk|Olivia Carter?Pokras|George J. Dover|Tina L. Cheng
A Call to Improve the Health and Healthcare of Latino Children
Johns Hopkins University|University of Maryland, College Park|Johns Hopkins University|Johns Hopkins University
face us changing seen children 2050 1 5 americans immigrant 35 us children latino1passel js cohn us population projections 20052050 pew research centers pew hispanic center february 11 2008 available httpwwwpewhispanicorgfilesreports85pdf accessed november 30 2012google scholar lifecourse research revealed powerful influence early child health experiences adult health need address child health disparities order promote population health2cheng tl jenkins r dreyer b introduction child health disparities health literacypediatrics 2009 124 s161s162crossref pubmed scopus 36 google scholar ample research demonstrates health healthcare disparities exist latino children children whose parents limited english proficiency lep poor children3berry jg bloom foley palfrey js health inequity children youth chronic health conditionspediatrics 2010 126 s111s119crossref pubmed scopus 105 google scholar 4mcquaid el vasquez j canino g fritz gk ortega colon et albeliefs barriers medication use parents latino children asthmapediatr pulmonol 2009 sep 44 892898crossref pubmed scopus 50 google scholar 5mandell ds wiggins ld carpenter la daniels j diguiseppi c durkin ms et alracialethnic disparities identification children autism spectrum disordersam j public health 2009 99 493498crossref pubmed scopus 459 google scholar preventable health conditions disproportionately affect latino children include obesity dental caries6guarnizoherreo cc wehby gl explaining racialethnic disparities childrens dental health decomposition analysisam j public health 2012 102 859866crossref pubmed scopus 64 google scholar 7rossen lm schoendorf kc measuring health disparities trends racialethnic socioeconomic disparities obesity among 2 18yearold youth united states 20012010ann epidemiol 2012 22 698704abstract full text full text pdf pubmed scopus 100 google scholar additionally latino children risk delayed diagnosis conditions effective treatments exist autism spectrum disorder attention deficit hyperactivity disorder3berry jg bloom foley palfrey js health inequity children youth chronic health conditionspediatrics 2010 126 s111s119crossref pubmed scopus 105 google scholar 5mandell ds wiggins ld carpenter la daniels j diguiseppi c durkin ms et alracialethnic disparities identification children autism spectrum disordersam j public health 2009 99 493498crossref pubmed scopus 459 google scholar although 9 10 us latino children us citizens 16 live households headed adults lep ie speak english less well8motel statistical portrait hispanics united states 2010 pew research centers pew hispanic center february 21 2012 available httpwwwpewhispanicorgfiles201202statisticalportraitofhispanicsintheunitedstates2010apr3pdf accessed november 30 2012google scholar patients lep face challenges accessing care care often difficulties explaining illness understanding clinicians recommendations participating fully development treatment plan language barriers associated wide range negative patient safety quality outcomes inadequate treatment pain prescription fewer medications well medical errors overdoses9flores g fuentesafflick e barbot carterpokras claudio l mclaurin ja et althe health latino children urgent priorities unanswered questions research agendajama 2002 288 8289crossref pubmed scopus 381 google scholar limited health literacy often cooccurs lep thought important mediator healthcare utilization health outcomes lep poverty also cooccur increase risk health disparities thirtyfive percent us children living poverty latino8motel statistical portrait hispanics united states 2010 pew research centers pew hispanic center february 21 2012 available httpwwwpewhispanicorgfiles201202statisticalportraitofhispanicsintheunitedstates2010apr3pdf accessed november 30 2012google scholar limited health literacy difficulty navigating us healthcare system challenges unique latinos must addressed order reduce health disparities healthcare system must linguistically culturally competent well accessible areas improvement detailed include community engagement interpreter availability workforce diversity healthcare access inclusiveness research efforts initiatives described require collaboration among pediatric clinicians community members health system administrators insurers first clinicians healthcare delivery systems policy makers must engage community members including patientsfamilies lep limited health literacy design implementation evaluation health information services example hospital clinic advisory board representatives patients served provide critical insight local outreach efforts build trust increase cultural awareness required bridge gap availability utilization second interpreter services must universally accessible clinical settings use trained professional interpreters mitigates negative effects language barriers patient safety healthcare quality10flores g impact medical interpreter services quality health care systematic reviewmed care res rev 2005 62 255299crossref pubmed scopus 798 google scholar appropriate language services associated improved patient satisfaction fewer errors communication better adherence medications improved clinical outcomes9flores g fuentesafflick e barbot carterpokras claudio l mclaurin ja et althe health latino children urgent priorities unanswered questions research agendajama 2002 288 8289crossref pubmed scopus 381 google scholar title vi mandates fund adequate language services medicaid medicare recipients11title vi available httpwwwjusticegovcrtaboutcorcoordtitlevistatphp accessed may 23 2013google scholar time advocate thirdpartypayers reimburse interpreter services 38 states interpretation remains unfunded mandate tracking patient satisfaction interpreter utilization rates conjunction patient demographic information necessary assure adequate utilization quality tangible demonstrations linguistic competence proper multilingual signage phone access appropriate documentation patients lep status preferred healthcare language availability use welltranslated versions commonly used materials discharge paperwork consent forms educational materials third clinical care improvements require culturally competent inclusive workforce enhancing workforce diversity could speed healthcare improvements clinicians currently representative patient population12hayesbautista de hsu p hayesbautista stein rm dowling p beltran r et allatino physician supply california sources locations projectionsacad med 2000 75 727736crossref pubmed scopus 15 google scholar latino children able pursue higher education help reduce disparity improvements however must delayed children join professional ranks especially given 2010 latinos highest high school dropout rate racialethnic group 58 native born 181 foreign born latinos leaving high school without diploma raises concern pace diversification professional workforce8motel statistical portrait hispanics united states 2010 pew research centers pew hispanic center february 21 2012 available httpwwwpewhispanicorgfiles201202statisticalportraitofhispanicsintheunitedstates2010apr3pdf accessed november 30 2012google scholar regardless pursuit improved healthcare quality responsibility clinicians policy makers latino nonlatino alike lessons cultural competence cultural humility included training healthcare employees team members physicians nurses receptionists security staff one example workforce diversity initiative program medical education latino community university california irvine designed train physicians culturally sensitive linguistically competent address specific needs californias latinos13program medical education latino community university california irvine available httpwwwmededucieduprimelc accessed may 30 2013google scholar 14manetta stephens f rea j vega c addressing health care needs latino community one medical schools approachacad med 2007 82 11451151crossref pubmed scopus 20 google scholar fourth culturally linguistically competent healthcare system address disparities also accessible healthcare system15eisenberg jm power ej transforming insurance coverage quality health care voltage drops potential delivered qualityjama 2000 284 21002107crossref pubmed scopus 119 google scholar seen implementation childrens insurance program enrolling insurance reliably result receiving care studies show among children eligible public health insurance latino children likely uninsured16crocetti ghazarian sr myles ogbuoji cheng tl characteristics children eligible public health insurance uninsured data 2007 national survey childrens healthmatern child health j 2012 16 s61s69crossref pubmed scopus 7 google scholar study barriers care maryland latinos knowing go care second ability pay17zambrana carterpokras improving health insurance coverage latino children review barriers challenges state strategiesj natl med assoc 2004 96 508523pubmed google scholar outreach services may required enroll people care well insurance related note wellbeing children depends health caretakers affordable care act comprehensive solution latino population legally us less 5 years may eligible public health insurance undocumented cannot buy exchanges even able pay full premium18andrulis dp siddiqui nj health reform holds risks rewards safetynet providers racially ethnically diverse patientshealth aff millwood 2011 30 18301836crossref pubmed scopus 47 google scholar mixed status families may reluctant participate order avoid unwanted attention17zambrana carterpokras improving health insurance coverage latino children review barriers challenges state strategiesj natl med assoc 2004 96 508523pubmed google scholar continued efforts needed ensure access health insurance health care children families finally participation ongoing child family health research needs better reflect us population many clinical trials include diverse racial ethnic populations individuals lep children19brown sd lee k schoffman de king ac crawley lm kiernan minority recruitment clinical trials experimental findings practical implicationscontemp clin trials 2012 33 620623abstract full text full text pdf pubmed scopus 56 google scholar similarly many research instruments tested across diverse racial ethnic groups languages english attention development validation measures well translational research specifically andor inclusive latinos needed investigators make reasonable accommodations include participants lep particularly persons lep constitute sizeable portion sample population institutional review boards monitor discourage reflexive exclusion nonenglish speakers increased use appropriate interpreter services providing clinical care may make clinician scientists comfortable recruiting nonenglish speakers research ten years ago journal american medical association published health latino children urgent priorities unanswered questions research agenda9flores g fuentesafflick e barbot carterpokras claudio l mclaurin ja et althe health latino children urgent priorities unanswered questions research agendajama 2002 288 8289crossref pubmed scopus 381 google scholar decade later greater urgency address longer considered unanswered questions rather unmet responsibilities time set course towards healthier future us children