Lisa Cacari Stone, PhD '04

Bridging the Health Care Gap for Latinos

Latinos are not only the largest and fastest-growing minority group in the United States. They also have the greatest health and health insurance challenges. It's a huge problem with roots in all the usual areas: low socioeconomic status, lack of education, employment with no insurance, social discrimination, and large populations in rural areas. The statistics are grim. Of the 45.8 million people in the United States without health insurance, 30 percent are Latinos.

A problem of this magnitude will not vanish any time soon. So it helps to be highly realistic, ambitious, and - perhaps most importantly - undaunted in trying to change this bleak picture. Enter Lisa Cacari Stone, PhD '04, a health disparities researcher, second-generation Mexican-American, Alonzo Yerby Public Health Fellow, and a W.K. Kellogg Foundation Scholar in Health Disparities at the Harvard School of Public Health.

With equal parts pragmatism and enthusiasm, she explains her strategy for brightening this reality.

"You've got to go for the low-hanging fruit," she says. "For example, many Latino children have benefited from the State Children's Health Insurance Program (SCHIP), which offers health insurance to working families who earn too much to qualify for Medicaid. But there are many more who could take advantage of it but have not enrolled."

Funding preventive measures is also key. "Less money goes to prevention and public intervention than goes to treatment," says Cacari Stone. "We need to keep health providers and public health professionals funded so we can prevent illness."

In the 2005 U.S. Census, 35 million people, or 14.5 percent of the U.S. population, identified themselves as Latino. By 2050, that number is expected to grow to 103 million, or 24 percent of the population. Though Latinos lead in numbers, they lag in all areas of health: they are less likely to have health insurance or a doctor whom they see regularly, and they are more likely to suffer from a variety of health problems, including cardiovascular disease, diabetes, and HIV/AIDS, than are non-Hispanic whites.

Changing these statistics will ultimately take nothing less than reducing poverty. "We lost the war on poverty and it's still the elephant in the room that no one talks about," says Cacari Stone, who previously worked on public health legislation and other health disparities elimination policies as a Congressional Health Policy Fellow for Senator Edward M. Kennedy (D-MA).

Cacari Stone offers a two-pronged approach to tackling the Latino health crisis. First, she says, "We have to work with mainstream health care policy venues as well as addressing the sociodeterminants of health, including income, work, education, and housing. Poverty is a strong determinant of health status and access. The cumulative disadvantages to Latinos of persistent inequalities in such areas as political participation and power, wealth and homeownership, racial discrimination, lower and poorer quality of education, and low wages without health benefits are all intersecting factors of health and well-being. The long-term solutions we must seek require consistent and dedicated resources at all levels of government as well as private contributions and partnerships."

Federal and state policymakers who want a quick-fix approach to addressing Latino health issues, she says, should focus instead on long-term improvements in health care insurance coverage; Medicaid and SCHIP eligibility, outreach, and enrollment; health literacy; language and culturally linguistic health care; and increasing the recruitment, retention, and training of more Latinos for the health care professional pipeline.

"Research demonstrates that Latinos are more likely to serve in areas where there is a shortage of health professionals and that cultural concordance between patients and providers increases quality and access and is more cost-efficient," she maintains.

Cacari Stone says she was drawn to the Heller School because of its mission of "knowledge advancing social justice." Despite the enormous obstacles separating Latinos from better health and health care, her work illustrates just how critical knowledge is in the pursuit of social justice.