Tackling health equity and Latinx representation in medicine as U.S. Hispanic population grows
10/15/2021, Cancer Letter
Happy Hispanic Heritage Month!
Spanning part of September and October, it is a time to celebrate and recognize Hispanics or Latinos or Latinx persons* for their contributions. This nationwide observation begins on Sept. 15 when several countries in Latin America celebrate independence—Costa Rica, El Salvador, Guatemala, Honduras, and Nicaragua. Mexico celebrates independence on Sept. 16 and Chile on Sept. 18. Towards the end of Hispanic Heritage Month, Oct. 12 is also recognized as Día de la Raza. Persons of Hispanic ancestry have walked the Americas since 1492.
What does Hispanic Heritage Month mean for us, who are focused on the care of patients facing a cancer diagnosis? And as we grapple with equity in all sectors, let’s also reflect on cancer health equity with a focus on Hispanics.
First, as outlined above, persons with Hispanic heritage cover a large part of the planet and represent an ethnically diverse population that may also share some common cultural elements. As a Latina, born in Bolivia, I felt special kinship when I met others who spoke Spanish regardless of their country of ancestry. And, although there were differences, there were many similarities as we shared stories of growing up that reflected our culture, our values, our commitment to family, to community, and to caring and supporting each other.
In medicine, about 5-6% of physicians identify as Hispanic. This number has been relatively stable over time. Approximating this same time-period, from 2010 to 2019, the U.S. population grew by 18.9 million, and Hispanics made up half of that growth. Among practicing oncologists, the American Society of Clinical Oncology reported 6% of oncologists identified as Hispanics. (References included in original article.)
With the growth of the Hispanic population, we must wonder why this growth is not reflected in the physician population. This is especially important since we know from the literature that equity may be impacted favorably by receiving care from a clinician who is culturally similar, who is culturally fluent.
Let’s turn to our patients, the reason that we exist. Hispanics in the U.S. tend to be a younger population. The risk for cancer tends to be higher for liver, stomach, and cervical cancer. Cultural factors such as lack of tobacco use in women may be responsible for a lower risk of lung cancer in Hispanic women. With the heterogeneity of the population, cancer burden is somewhat difficult to ascertain.
Recognizing that there is a lot to be learned to meet the cancer health care needs of the growing Hispanic population in the United States, the National Cancer Institute recently convened a virtual workshop, Cancer Epidemiology in Hispanic Populations.7 Recordings of the virtual presentations will be available in November 2021. In addition, the National Hispanic Medical Association, established in 1994, serves as the leading professional organization to support Hispanic physicians and to advocate for equity in the care of the Hispanic population.
With the growth of the Hispanic population, we must wonder why this growth is not reflected in the physician population.
As we consider facilitators and barriers to improve representation in the oncology workforce and to achieve clinical cancer care equity, we, like others in our profession, face structural barriers that must be confronted, addressed, and dismantled to reach our goals. Ours is neither an easy nor an overnight task.
Equity is not the responsibility of a few but of all. Guided by our ethic of compassion, by our focus on the patient, and by our commitment to science and collaboration, we will gain best practices and move the needle forward, together.
And, since it’s Hispanic Heritage Month, let’s season our work with alegria y cariño and remember, sí, se puede!
*The terms Hispanic, Latinos, Latinx may be used to refer to persons whose heritage stems from Spain, Mexico, Central America, South America, and/or the Caribbean. The term Hispanic is generally used in this essay for consistency with the theme of Hispanic Heritage Month.