NUTRITION EDUCATION AND HEALTH AWARENESS TO HISPANIC POPULATIONS
By Carlos E. Montano
The demographic patterns of the United States are changing. Minority groups (African Americans, Hispanics, Asians, Native Americans, and Pacific Islanders) now make up more than one-fourth of the US population1. This means that strategies to improving the health of all Americans must consider ethnic differences in disease prevalence, as well as culturally specific issues related to the development and implementation of health promotion and disease prevention programs.
Hispanic Americans are the second largest minority group in the United States and currently represent one of the most rapidly growing segments of the US population1. Hispanic Americans present a complex mixture of cultures, races, and religions. Therefore, strategies for addressing health issues of Hispanics must consider the particular health needs and differences among Mexicans, Puerto Ricans, Cubans, and other populations from Central and South America living in the United States. For example, obesity and diabetes mellitus are major health problems in Mexican-Americans. Up to 40% of adults in this population are obese, and in individuals over the age of 45, one in four has diabetes2. Unfortunately, only about half of those who have diabetes know that they have the disease. Moreover, many of those that are aware of their condition may delay seeking treatment until the disease has advanced and complications have developed.
Mexican Americans, like other Hispanics, face cultural, language, and economic barriers to accessing needed health care2. To effectively address the specific health needs and obstacles to care amongst Mexican Americans, culturally appropriate interventions are required. Health information that is compatible with the Mexican culture is key. For example, nutrition educators working to reduce prevalence of obesity and diabetes among this population need to support the preservation of healthy aspects of the traditional Mexican diet (which is rich in fiber and vegetable sources of protein), while simultaneously reducing the excessive use of animal sources of protein and fat (that has resulted from acculturation to the larger Anglo culture). This approach is practiced by Esbeltez, a chain of weight-reduction centers in San Diego, California geared specifically to the Hispanic population. The aim of Esbeltez is to improve the eating habits of its participants without attempting to alter the consumption of traditional Mexican foods (such as rice, beans, tortillas, and tamale). Through attending weekly Esbeltez meetings, participants learn achievable forms of behavior modification, receive support and motivation, and are educated about proper nutrition and better methods for cooking traditional fruits, vegetables, and beans. Members receive guidelines to develop food habits based on traditional Mexican foods, with recipes they are comfortable with and those which are pleasing to the Mexican palate.
To design effective interventions to reduce disease risk among Hispanics, emphasis should be placed on prevalent cultural values of that population. In general, Hispanics have great respect and deference for elders, and the extended family remains an important facet of the culture. Therefore, programs that use peer educators having a shared cultural background with the target audience are more successful than those that use educators with a different heritage. For example, the use of "promotoras," or health promoters, chosen within the target community is an effective way to deliver health information to those populations isolated from the health care system. The "Mensajeras de Salud" Chronic Disease Prevention Program of the University of Arizona in Tucson utilizes the "promotora" model for outreach to lower income Spanish speaking women. Through training and support of older recognized women leaders in predominantly Hispanic neighborhoods, the program includes culturally appropriate strategies to address cardiovascular disease, cancer, and diabetes. In community churches and households "promotoras" combine teaching healthier lifestyle with advocacy for accessing available health services. In addition, promotoras include family members in decision making, since health decisions among Hispanics is often a family process.
The risk of chronic diseases related to food consumption patterns of Hispanics and other minority populations is great. The methods of health education presented in this article are examples of effective strategies that program planners can incorporate in health programs directed to those populations.
1 Us Bureau of the Census (1990): The Hispanic population in the United States. Current Population Reports. Washington DC, Government Printing Office, Ser. P-20. No. 444.
2 Bassford, T.L. (1995) Health status of Hispanic elders. Clin. Ger. Med. 11:25-38
