Not when it comes to health-policy strategies.
Kids watching one of the puppet shows that are part of the Hartford, Conn., Hispanic Health Council’s nutrition campaign might hear dialogue like this, “I come from Mexico, and I like fruits and vegetables,” says puppet No. 1. Puppet No. 2 responds, “I’ve been here a long time, and I don’t like to eat what I used to eat in Puerto Rico.”
HHC’s nutrition puppet show, says the group’s director, Jeannette DeJesus, is based on a study conducted with the populations the council serves that found that “the longer you’re in this country, the poorer your eating habits.” But the study also found that unhealthy habits differed depending on where those surveyed came from. People of Mexican origin account for only 10 percent of Hartford’s Latino population, and they are largely new immigrants. HHC’s research found that that group is more likely to have fresh produce in their diets than people from the Puerto Rican majority, a community that has been in Hartford for decades.
With Latinos now accounting for more than 15 percent of the U.S. population, there is a great deal of emphasis on health outreach to the “Hispanic community.” (Different members of the community have different preferences for using “Hispanic” and “Latino” to refer to those with backgrounds in Latin America, though generally speaking, they are interchangeable.) But the truth is, the diversity of the Hispanic population means that to be truly effective, outreach must target many different Hispanic subcommunities. Knowing that someone is “Latino” or “Hispanic” does not tell a health-care worker what language she speaks, what foods she eats, or where she was born.
The majority of Latinos (61.9 percent) were born in the United States, and their families emigrated from more than 20 countries, with distinct climates, geographies, and ethnic/racial makeups. This not only means that they have different customs, but also different genetics that may make them susceptible to different medical conditions. And in the United States, many may not even speak Spanish anymore. The broad range of Latino communities is obvious to organizations like HHC that work directly in Latino communities, says Dr. Maria Rosa of the Institute of Hispanic Health at the National Council of La Raza (NCLR). But, she says, their work is complicated by “a lack of awareness in our society in general about those differences” within the Hispanic community. “When you need the support, it’s very difficult to convince particular [donor] groups about the need for funding to provide approaches that are culturally competent and linguistically appropriate. Often they think if it’s in Spanish, it applies to all.”
Rosa’s institute, which works in communities nationwide in cooperation with 300 affiliated groups, relies on an approach that trains promotores de salud—health promoters—within the communities they serve. Before a program is implemented, NCLR works with these promoters to develop interventions that will resonate with the particular demographic with which they will be working. Dominicans know best how to speak to Dominicans, Guatemalans to Guatemalans, U.S.-born Latinos to U.S.-born Latinos. This ensures that health workers “speak the language” of the people they serve. Rosa clarifies, “When we say ‘language,’ we’re not just speaking about Spanish. We’re talking about particular words, particular habits, that [a Hispanic] subgroup might have.” It also means speaking English when appropriate: many U.S.-born Latinos are more comfortable in English, and some speak no Spanish at all.
Because most Latinos in the U.S. are of Mexican descent (almost two out of three), national health materials often contain subtle cues that make them more difficult to use in communities of different origins. Wilson Camelo, of the Hispanic marketing firm Bauza and Associates, explains, “What you tend to see with national campaigns is that they tend to skew Mexican. Those kind of nuances don’t play well in the Northeast, because [the Hispanic immigrant community there is] much more Caribbean-based.”
For example, when designing a flier for an HHC campaign to encourage the mostly Puerto Rican families they serve to sign up for food stamps, Bauza could not find an appropriate photograph involving Latino families and food. Either they were shot in fancy kitchens or they had a “kind of Mexican fiesta look.” His firm finally resorted to taking a simple shot of a mother and daughter in a high-end kitchen and erasing the background details. They hired actors with Puerto Rican accents for their radio ads, and emphasized that food stamps could be used to purchase staples of the Caribbean diet like rice and beans. Tortillas, a Mexican staple often mentioned in national nutrition campaigns, were absent.
This kind of community-specific approach, Hispanic health educators stress, is the only way to truly improve outcomes. Yet, says the HHC’s DeJesus, the funding for this vital work is increasingly difficult to secure because of a broad desire for an immediately available, “economical, efficient answer” to any problem. “The reality,” DeJesus says, “is that we’re dealing with people—lots of different people.”