Hispanic Heritage Month
For many Hispanic communities across the Bay Area, finding consistent, stable access to healthcare can be a challenge. Not only is healthcare expensive for many of these communities, but actually seeing healthcare providers, managing medicine, and language and culture barriers all represent obstacles faced as some Hispanic families seek the healthcare they need. To understand and gain insights into these problems, the EBI committee talked with Dr. Rakhi Singh, a doctor at Fair Oaks Health Center in San Mateo County that primarily serves Hispanic patients.
For Hispanic communities, seeking healthcare itself can be a challenge. There are many challenges that Hispanic communities face when it comes to healthcare, including less access to health insurance (in 2022, 9.6% of Latinos are uninsured, compared to 2.6% of whites) and job inflexibility, both of which make it difficult for people in these communities to get the help they need, when they need it.
“If you look at Hispanic populations, they're less likely to seek medical care for problems,” Dr. Singh, a family physician at the Fair Oaks Health Center who is involved in helping marginalized Hispanic populations in the area, says. “They get hourly wages. So for them to come to see their physician, they have to take time off work and they don't get compensated.” So they don't have sick leave. Many of my patients, they're like, I don't have sick leave...So that's an additional barrier to actually taking three hours off to go see somebody.” The working schedule of many Hispanic patients makes it very difficult for them to find time to meet with a medical professional, as it could mean losing out on some of their wage. This inaccessibility can cause some people in the Hispanic community to de-prioritize their healthcare, even though it may be clear they should be seeking it.
Language can also be a barrier when it comes to accessing health care. At Dr. Singh’s clinic, 70-75% of patients prefer their healthcare delivery in Spanish, and a majority are of Hispanic heritage. The rise of technology in medicine means that video translators can assist doctors, but “you lose some intimacy and connection with the patient when there's a third […] video person in the room that you don't know,” Dr. Singh says, and emphasizes the importance of healthcare professionals learning Spanish, at least at a basic level when working in predominantly Hispanic communities.
Many of her colleagues share a Hispanic background (Mexican or Salvadorian) with her patients, and “[patients] find such a connection with providers that are like them,” highlighting the importance of diversity in medicine.
Many struggles persist even after visiting a medical professional. As pharmaceutical prices continue to rise, attempting to buy meds without insurance can quickly become an impossible task. This is made even more challenging by an unstable income and other financial burdens.
But these challenges can extend beyond just affording medicine. Dr. Singh shared a story of a patient who struggled to afford insurance for his diabetes“...he at one point didn't have a fridge to store the way you're supposed to store some of his medications, in particular insulin. So he just felt fine. So he stopped taking his medications. And so when there's that instability of funding, where patients are worried, they sometimes just get lost to care.”
Dr. Singh highlights how income instability and other complex factors can negatively impact a patient’s ability to continue to receive the care they require, whether it’s because of budget issues, or complications regarding medicine.
Beyond medicine access, even basic nutritional and lifestyle instructions can be challenging. Lower-income areas often lack the same access to grocery stores with healthy foods, areas called “food deserts”. Lack of access to affordable nutritional foods makes maintaining a balanced diet an impossibility for many.
Additionally, exercise can be a challenge. If a doctor may encourage more exercise, many may be unable to do so. For many poorer areas, a lack of walking and running infrastructure, including parks and pedestrian-friendly sidewalks discourages exercise.
“Even the lack of nature in some of the areas that people live,” Dr. Singh says, “It's very hard to get out and go to a park, and the park may be far and very small. If you don't have the infrastructure, it's very hard to live your life. Walking 45 minutes a day is impossible if you don't feel that the area is safe or it's not set up in a way for you to do that”
Dr. Singh stresses that providers seek to understand each patient’s unique circumstances, and recognizes that this can be a blind spot for many doctors. While trying to provide food boxes to the community, her clinic neglected to survey the population on their needs and cultural context. “That was just tone deaf of us… We think we know what folks need, but I think access and partnering with them, it's probably gonna do wonders.”
Each of these individual barriers adds up, discouraging individuals from being able to prioritize their health in the face of family and work responsibilities. While these problems apply to all communities, they are particularly prominent in Hispanic populations.
Ultimately, the most significant step to improving equity in healthcare for Hispanic communities is access, Dr. Singh says. “It doesn't have to be eight to five that you have to go to a building. [...] What if we were able to go to local communities [...] and provide some basic care. What if we were doing visits in evening hours when folks weren't working or on weekends, what if we did healthcare drives knowing where the community gathers.”
The increasing availability of technology also means healthcare can be much more accessible. “The pandemic was an eye opener because we started doing more phone visits and we realized that the show rates were much higher,” explains Dr. Singh, as patients don’t have to take time off work or deal with transportation access.
