Latino immigrants to the U.S. say the quality and affordability of health care is better in the U.S. than the country they come from, according to the latest survey by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health. But many report having health care problems.
In the last 12 months, 31 percent say they had a serious problem with having enough money to pay for health insurance. About one in four had a serious problem affording doctor and hospital bills and prescription medicines.
When it comes to the health issue that concerns Latinos most about their own and their families’ health, diabetes tops the list — whether they were born in the U.S. or immigrated here.When asked in a poll last year what the biggest health problem facing the nation was, they had a different answer: “cancer.”
This split may reflect the high prevalence of type 2 diabetes in Hispanic populations. About 10 percent of Latino adults have been diagnosed with it or are in a stage that is often silent called “prediabetes.”
One important factor: Latinos may be genetically predisposed to the disease. And this risk can be aggravated by the environment and diet.
The Diabetes ‘Plague’
Take the example of East Los Angeles, an area heavily populated by Mexican-Americans.
Like many of her friends and family members, Rebecca Martinez-Rocha says she struggles with her weight. At one point, she weighed over 320 pounds.
“I don’t think I realized it at the time, whether it was denial or I stopped getting on a scale,” she says, “but I was morbidly obese.”
And, as it turns out Martinez-Rocha was prediabetic, a diagnosis she received at a local health clinic.
“I wasn’t aware of the fact that I was ill; I figured that I was relatively young, in my 20s and early 30s, she says. “It was kind of one of those ‘ah-ha’ moments in life, where you look at it and put it all together and you think, ‘How did I get here?’”
The doctor who diagnosed Martinez-Rocha’s condition was Anne Peters, a diabetes specialist and professor of medicine at the Keck School of Medicine at the University of Southern California, and director of the Comprehensive Diabetes Center at the Roybal Community Medical Center.
Peters says type 2 diabetes is the “plague” of the Latino community she treats. “Individuals here are getting diabetes at rates we’ve not seen before.”
About 12 percent of the Latino population she sees has diabetes. Peters projects that number will climb to nearly 30 percent over the next few decades if nothing changes in the environment or diet of local residents.
Peters told Martinez-Rocha she was on her way to getting insulin-dependent type 2 diabetes. Martinez-Rocha says she got very scared and made major changes. She lost 160 pounds.
But many patients don’t do that, in large part, because prediabetes is often “silent.” If people don’t go to a doctor and get their blood sugar measured, they’ll never know they have it.
And that’s a shame, Peters says, because pre-diabetes can be turned around. “If somebody has pre-diabetes, they need to lose weight, not a lot of weight, maybe only ten to fifteen pounds,” she says.
They “don’t have to become skinny” to benefit, she adds. Studies show just moderate weight loss can reduce diabetes risk by half.
Losing weight is hard for many people. But Martinez-Rocha says it’s even harder when you live in a neighborhood that offers lots of high-fat, high-salt and high-sugar food.
“If you drive around my neighborhood, every corner you’ll see a taco stand, a fast-food restaurant, a sweet-bread store, places selling tamales, or fried food,” Martinez-Rocha says.
In our poll with the Robert Wood Johnson Foundation and Harvard School of Public Health, we found that one in five Mexican-Americans also rate the availability of fresh fruits and vegetables in their neighborhood as fair or poor.
Alex Ortega is a public health researcher and professor of public health at UCLA. He calls neighborhoods like this “food swamps,” where healthy food is hard to come by.
Just walk into the typical corner market, he says, and the first thing you’ll see are signs for liquor and lottery tickets, cigarettes, soda and chips. “They might sell some fruits and vegetables, but they’re typically in the back of the store and in very poor quality,” Ortega says.
Our survey found that Latino immigrants generally do not perceive their diets as less healthy in the U.S. About 4 in 10 (38 percent) of immigrants see their diet as healthier in the United States, and about the same number (39 percent) see their diet as about as healthy. Only 1 in 5 (21 percent) see their diet as less healthy.
Prior studies have shown that obesity rates among immigrants increase as their duration of residence in the U.S. increases. They suggest that this may be attributable in part to changes in lifestyle, including unhealthy diet.
Will Converting Stores Lower Obesity?
Ortega is committed to turning the Latino diet around. As director of the UCLA-USC Center for Population Health and Health Disparities, Ortega is heading a project to convert corner stores in low income neighborhoods.
About a month ago, Ortega, along with community activists, local high school students and store owner, Maria Avila, transformed the Euclid Market in the Boyle Heights section of East Los Angeles. They added windows, a new paint job, re-arranged and organized shelving. But most importantly, Ortega says, they added healthy foods.
The newly converted store opened to the public in December 2013. Today, when you walk in the door, the first thing you see isn’t cigarettes and junk food, it’s fresh fruits and vegetables.
This is the fourth corner store in the area to be converted. Ortega is still collecting data, but anecdotally, he says store owners tell him they have more customers, they’re selling more fruits and vegetables and they’re making more money.
But the big question is whether the availability of fresh fruits and vegetables will make a difference in the health of the neighborhood and the epidemic of diabetes.
Better Options, Better Diet
For DeeDee Barba it has made a difference.
Barba is a college freshman who’s taken part in the store conversion project for two years. Not only has she learned about marketing and sales, she’s also learned about nutrition. As a result, she says, her family now eats more healthfully. Part of that includes no dressing on salads.
“We now eat our salads with olive oil and lemon and it’s actually good!” she says. “We eat a lot of fish and chicken; we rarely eat red meat. We eat rice, but we have whole wheat rice. We don’t drink soda anymore — we drink mostly water.”
Seventeen-year-old high school senior Steven Cardona worked with the store conversion project for the past year. Learning about nutrition, he says, has changed his family’s diet dramatically.
“Before we would eat lots of fast food, but now we eat mostly steamed vegetables, rice, chicken and lean meats,” he says. Family members have lost a lot of weight and everybody reports feeling “better,” he says.
Ortega says that’s exactly what’s hoped for: that the availability of healthy food in low income neighborhoods like this will make a difference in what residents buy, cook and eat. And that it will mean changing diets and reducing the high rates of obesity and diabetes in the Latino community in East L.A.