Frequently, we see questions regarding demographic information in different surveys or forms, including race and ethnicity. Asking the respondent to mark whether they identify as Hispanic or Latino is a regular practice.
But what do the terms Hispanic or Latino mean?
According to the Office of Management and Budget (OMB), the office that sets the standards for the U.S. Census Bureau, Hispanic or Latino is “a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.” But this definition is limited compared to the array of identities, ethnicities and languages encompassed. To be clear: Hispanic/ Latino/a/e/x are non-equivalent social constructs, one referring to a geographic location (Latin America) and the other to a language (Hispanic/Spanish).
We often hear terms such as Latin American, Latin culture, Latino (male term used in Spanish, often the default when referring to males and females), Latina (female term used in Spanish), Latinx (non-binary term used in English), Latine (non-binary term used in Spanish) and Hispanic. These terms represent a diverse group of nationalities, such as Mexican-American, and races like Afro-Latino/a/e/x, Indigenous Latino/a/e/x, White- Latino/a/e/x and Asian Latino/a/e/x. The term Latino/a/e/x also refers to non-Hispanic Latin American countries, such as Brazil.
Efforts to encompass a wide range of identities within the Hispanic or Latino/a/e/x group help to better reflect the diversity within it. Hispanic/Latino/a/e/x physician advocates in the U.S. and the Latino Medical Student Association (LMSA) can use the term “LHS+,” where ‘L’ would stand for Latino/a/e/x, ‘H’ for Hispanics, ’S’ for Spanish origin, and the + sign would refer to additional intersecting identities
Another example is the recent debate around a project presented by the U.S. Census Bureau that intends to label “Hispanic/Latino” as a category for race instead of ethnicity. To capture the racial diversity within “Hispanic” or “Latino” is complex. On the one hand, those coalitions in favor of using Hispanic/Latino as a race say that the objective is to collect data in a more inclusive way. The literature indicates that many Hispanic/Latino/a/e/x individuals do not self-identify with the races offered in demographic questions; therefore, some individuals may either check a random answer for race or skip this question if they can. On the other hand, groups that oppose this initiative argue that a combined race and ethnicity question may fail to recognize the racial diversity within the “Hispanic/Latino” group, which would further marginalize Latino subgroups such as Afro-Latino/a/e/x.
As complicated as it may seem, it is crucial that in health care we recognize that diversity exists among racial and ethnic groups.
But why is it important to learn about races or ethnicities in the medical practice?
According to the Institute of Medicine’s Unequal Treatment Report, access to preventive health care services and lifesaving technologies varies according to patients’ racial and ethnic characteristics. Hispanics/Latinos appear among the most marginalized groups. Furthermore, a strong body of literature demonstrates that Hispanics/Latinos suffer from higher rates of chronic health conditions than other racial groups. This is consistent with what was experienced during the COVID-19 pandemic, where the incidence and mortality during the most critical times of the pandemic were also higher among this group.
Sara Hurtado Bares, MD, associate professor of infectious Diseases, said:
“As an infectious diseases provider, it’s important for me to know if my patients are of Hispanic or Latino origin, because being aware of my patient’s background and language preferences can help me provide more personalized care. That said, the label is less important than learning about my patient’s culture – the environment my patient inhabits, the food they eat and the activities they engage in – as these cultural backgrounds inevitably help inform my differential diagnoses as well as my treatment plans.
“Demographic information, including race and ethnicity, is also important for public health reporting and monitoring. Health disparities became widely apparent during the COVID-19 epidemic, but infectious diseases providers have long been familiar with health disparities because many infections ranging from tuberculosis to HIV have disproportionately affected certain populations for years. Reporting demographic information helps public health officials identify and track trends in infectious diseases among different populations and allows us to develop targeted prevention and intervention strategies to reduce health disparities.”
Juan Santamaría, MD, assistant professor of surgical oncology, said:
“Recently a study on cancer survivors from a rich and cultural diverse cohort demonstrated disproportionate rate of forgone care due to patient-clinician identity discordance. Evidence like this begs the question about the diversity of our healthcare workforce; while this is a problem with not a simple and immediate solution, becoming culturally adept and sensitive to others, as for example, to Latin/Hispanic, and recognizing that even among them there is a rainbow of identities, will improve the experience and adherence to care for our patients.”
Failure to acknowledge diversity has implications for the health of our populations. We must not rely on assumptions and remain open to ask and listen how each person self-identifies and wants to be addressed. Ultimately, our commitment to providing quality service must remain a priority regardless of background.