Latinas and their families face many challenges to staying healthy. About half of all Latino children are likely to be obese and at an increased risk for childhood diabetes, according to the Centers for Disease Control and Prevention. Two million Hispanic adults, or about 8.2 percent of the population, had diabetes in 2002, reported the U.S. Department of Health and Human Services, including 25 to 30 percent of those age 50 and over. Invasive cervical cancer is about twice as prevalent in Latinas as in non-Hispanic white women, according to the National Cancer Institute. Latina teens are more likely to give birth than other teens. Depression and arthritis also affect many Latinas.

Access to information and treatment is crucial. Yet poverty, lack of insurance and education, and negative attitudes from providers often stand in the way. In 2001, over one-third of U.S. Latinas did not have health insurance, and in the uninsured, problems often go untreated until a crisis occurs. A recent study showed that Latinos are less likely to get medication for asthma, heart disease, HIV/AIDS, mental illness, and pain. "Hispanics are always the last to get medical care" says Dr. Elena Rios, president of the National Hispanic Medical Association. Language and cultural differences also keep many Latinas, especially new immigrants, from getting quality care. Those who don't speak English can't communicate with their providers, while cultural attitudes make it hard for patients to trust their doctors. Also, Latinas are often raised to think first about their families, not themselves. If money is short, a mother may skip her own prescription and buy medicine for her child instead. "Often Latinas don't look at their own welfare. If they call, they call about their husband or children, not about themselves," says Elena M. Alvarado, president and CEO of the National Latina Health Network. "Putting Latinas first goes against the grain of thought in the community."

Elena Rios National Hispanic Medical Associatio

National Latina Health Network
"Putting Latinas first" was on the agenda back in 1989, when Alvarado joined about 30 Latina leaders from many fields to discuss the health problems facing their communities. With the HIV/AIDS epidemic taking many lives, they were alarmed that not enough had been done to stop the spread of the virus among Latinos. In fact, in many areas of Latina health, people were not paying attention. "At that time, there was no health-care agenda for Latinas and their families," says Alvarado, a public-health educator. The women decided to pull together to tackle these serious problems.

The group, now the National Latina Health Network (NLHN), began to receive federal funds for health projects in 1997. Today, based in Washington, D.C., with 1,500 dues-paying members, the NLHN works on a wide range of issues, including diabetes, hypertension, cardiovascular health, substance abuse, and issues relating to reproductive health. In six regions across the country, the NLHN's AHORA! Project works with community groups to train young people as peer educators and advocates to help reduce homophobia and stigma and to talk frankly about issues of sexuality in the battle against HIV/AIDS.

"We find that many Latinas are not on track with their health," says Alvarado. Many women don't get regular screenings for bone density, cholesterol, breast cancer, and other health problems. Latinas are less likely to get regular mammograms than women in other ethnic groups, making it difficult for early detection of breast cancer. As a result, says Alvarado, "Many Latinas are dying from diseases that could be prevented."

To educate consumers and improve access to health care, the group partners with the government, public and private groups, and health-care providers. Regional conferences bring experts together to discuss Latina health issues. Alvarado reaches out to local Latina leaders to "empower them with tools and knowledge to make changes at the local level," she says. For instance, the Teatro AIDS Prevention Project combines traditional Latino teatro with peer education to teach HIV/AIDS prevention to Latino teens and young adults. The NLHN’s National Latino Tobacco Control Partnership works to combat statistics showing that almost one-third of Latino teens smoke. The NLHN also pushes for more federal focus on Latina health and recently honored Congresswoman Hilda Solis (D-CA) for her work as chair of the Congressional Hispanic Caucus Health Task Force. "We want Latinas to have a voice in Washington," Alvarado says.

National Alliance for Hispanic Health
Health information for Latinas is just a phone call away, thanks to the National Alliance for Hispanic Health. Callers to Su Familia: The National Hispanic Family Health Helpline (1-866-Su-Familia, or 1-866-783-2645) get confidential bilingual information on topics ranging from diets to mammograms. The hotline is one of many programs at the Alliance, founded in 1973 by a group of Spanish-speaking mental-health organizations. The Alliance, headquartered in Washington, D.C., now has a staff of 25. Members include some 800 organizations, from the Eofula Spanish Senior Center in Washington D.C., to the American Medical Association. Along with health facts and project updates, its website tracks the status of legislation affecting Latinos, such as the Legal Immigrant Children's Health Improvement Act. The website also posts a report by the Alliance and the National Pharmaceutical Council showing sharp disparities between Hispanics and other groups in getting medication for chronic diseases.

Jane Delgado, president and CEO of the Alliance, is the daughter of a factory worker. Growing up, she rarely saw a doctor. Now a clinical psychologist, Delgado joined the Alliance two decades ago to bring better health care to people like herself.

To improve health care for the elderly, the Alliance is funding 25 local agencies to distribute information on the new prescription-drug benefit for low-income seniors offered by Medicare in 2006. Many people don't know how to sign up, says Delgado. "Last year, we reached about six million Hispanics. It's not just seniors but baby boomers who take care of them," she says. "We need to get low-income seniors enrolled."

The Alliance has joined a national initiative to help medical staff access patient information. The Patient Safety Institute, a nonprofit organization led by consumer, doctor, and hospital advocates, is developing a communications network to give hospitals quick access to a patient's medical history. This information is important for Latinos in emergency rooms, says Delgado. "We often have very fragmented medical records," she says. The Spanish-speaking patient in crisis may have trouble listing her medications or her allergies, for example.

To tackle the obesity crisis, the Alliance recently started "Get Up! Get Moving!" The project will encourage family exercise with annual events across the country. Delgado points out that exercise programs have to be sensitive to the community. Many low-income neighborhoods have poor air quality, so walking outside might not be recommended. One group expressed interest in tai chi, the Chinese exercise and meditation discipline. Any activity that gets people exercising is fine with Delgado.

National Association of Hispanic Nurses
Maria "Terry" Villot knows only too well the challenges faced by Latino patients. After her family moved to the United States from Puerto Rico when Villot was a teenager, her mother, who did not speak English, periodically had to go to the hospital for diabetes treatment. During hospital stays, she did not want to eat the American food, nor did she understand the doctors. The language and cultural differences were too much. The hospital staff labeled her "noncompliant," and she didn't get the care she needed, recalls Villot.

Villot became a nurse to help patients like her mother. She now works as the Women Veterans Program Manager at the Philadelphia VA Medical Center. About eight years ago, she helped start the Philadelphia chapter of the National Association of Hispanic Nurses (NAHN) with the goal of breaking through the barriers preventing Latinos from getting adequate health care. "We bring our cultural competence. We can speak the language. We can identify with them," says Villot. Today, there is a nurse from NAHN in almost every Philadelphia hospital, easing the way for Latino patients.

Since it was founded in 1975 by a pioneering nurse, Ildaura Murillo-Rohde, the NAHN has grown to 37 chapters with over 2,000 members. Murillo-Rohde saw the desperate need for Latino nurses in Spanish-speaking communities—and for an organization to represent them. "We are the voice of Hispanic nurses," says Villot, president-elect of the NAHN. (Rudy Valenzuela of the Regional Center for Border Health in Arizona is the current president.) The group strives to improve the nursing and health-care delivery system in the Hispanic community, as well as to provide equal access to opportunities for Hispanic nurses. Its bilingual journal, Hispanic Health Care International, is published three times a year.

Jane Delgado National Alliance for Hispanic Health Maria Villot National Association of Hispanic Nurses Luz Alvarez Martinez National Latina Health Organization

Helping immigrant nurses get licensed to work in the United States is a special focus. Nurses from other countries often take low-paying non-nursing jobs because they lack the English to pass state nursing exams. Despite nursing shortages, most states have done little to help them. NAHN member Jacqueline Perry formed "Nurses Helping Nurses" in Houston, a project to help new arrivals from Latin America study for the exams and get licensed. Villot started a similar program in Philadelphia for Puerto Rican nurses. The nurses are also working to change state laws to allow more foreign-born nurses to work immediately.

The NAHN also encourages more young Latinas to enter the nursing field. In Philadelphia, the NAHN offers a mentoring program through United Way. Experienced nurses serve as mentors to young teens interested in nursing, keeping in close touch with the students and their families. The chapter recently held their third annual scholarship banquet, handing out three $1,000 scholarships to students entering nursing school.

National Latina Health Organization
Even while working at IBM and raising four sons in the 1980s, Luz Alvarez Martinez’s real passion was advocating for women's health services. She got involved in her community, joining the board of the Berkeley Women's Health Collective. A first-generation Chicana, Martinez also attended meetings of the National Black Women's Health Project. In 1985, she joined the group on a trip to the United Nation's World Conference on Women in Nairobi, Africa. Martinez and three other Latinas—Paulita Ortiz, Alicia Bejarano, and Elisabeth Gastelumendi—decided to start a similar group for Latinas. The National Latina Health Organization (NLHO) was established on International Women's Day in 1986.

Based in Oakland, Calif., the NLHO works to improve Latinas' access to women's reproductive health services. Reproductive health includes family planning, fertility treatment, birth control, prenatal care, prevention and treatment of sexually-transmitted diseases, and access to safe and legal abortions. "Reproductive health means access to services and resources. We need to make decisions ourselves within our language and culture," says Martinez, the NLHO’s executive director.

The statistics show that more needs to be done to reach young Latinas, who have a 24 percent likelihood of giving birth before age 20, according to the Centers on Disease Control. "Latinas of all ages are not getting the information they need about reproductive health, about how their bodies work, about birth control and sexually-transmitted diseases, especially not in Spanish," Martinez explains. Also, she says, many Latinas do not have choices in reproductive health due to "economic status, racism, lack of clinics in their communities, and language differences.”

The NLHO's philosophy is to help women take control of their own lives. Martinez calls this the "self-help" model. One of their first programs was a women's health class at a local community college. Topics included HIV/AIDS prevention, diabetes, mental health, and family violence. Students learned to take more responsibility for their health. For seven years, the group ran a class called "Redefining Latina Health: Body, Mind, and Spirit," at the University of California at Berkeley and Hunter College in New York City. In 2004, the NLHO held a class for a group of Oakland parents, some of whom did not speak much English. "Finally, they have the information. They need to know how to talk with their kids,” says Martinez.

These days, the phone is always ringing in the NLHO's office. Funding is a constant challenge for minority women's groups, says Martinez; she has a shoestring but dedicated staff of three, as well as outside consultants. Martinez urges women to take care of themselves. "If we are working to make our communities healthy, we have to be healthy ourselves. We have to be present, centered, and balanced," she says. "It's taking care of yourself first, or you can't do anyone any good."

National Hispanic Medical Association
Often, barriers between patient and doctor inhibit health care. Physicians might have preconceptions about a patient and not explain things well, while patients might be reluctant to be honest and open. "It's really about trust and having patients feel comfortable with the hospital or clinic. Patients need someone who can talk their language, understand their culture, and communicate," says National Hispanic Medical Association (NHMA) President Elena Rios.

Helping physicians provide better care for Hispanic patients is a goal of the nonprofit association, which represents 36,000 licensed Hispanic physicians in the United States. Founded in 1994, the NHMA has grown, not only in size but in influence. Today, its agenda includes expanding access to health care, encouraging more young Hispanics to study medicine, helping physicians and nurses care for Hispanic patients, and advocating for health research on Latinos. In 2004, the group launched a journal, Caring for the Hispanic Patient, with the American Academy of Family Physicians. The publication offers strategies on "how to provide quality care to Hispanic patients," says Rios.

To help tackle the obesity problem, the group is working on an Obesity Abatement project with the U.S. Office of Minority Health. The group also has a grant for congressional briefings on Hispanic health issues. "We bring doctors in to testify," she says. It has formed partnerships with many medical associations, such as the American Medical Association, and regional Hispanic doctors' groups, to strengthen its base.

Increasing the number of Latino health professionals is vitally important, says Rios. The NHMA supports the Minority Health Professions Bill, which would recruit and train ethnic-minority students, as well as provide funding for scholarships and recruitment programs. Rios also wants to get more Latinos into federal government to create and influence health policies, and the NHMA sponsors a Leadership Fellowship with the Robert F. Wagner School of Public Service at New York University. Says Rios, "We are building leaders for the next generation.”

These health organizations and their Latina leaders have made great progress toward a healthier future for Latinas and their families. Today, more scientific research is being done on Latino health. The federal government is working on several new fronts to close the health gap between minorities and whites. But a long road still lies ahead. As Dr. Jane Delgado points out, Latinos tend to have longer life spans than other ethnic groups; the challenge is to make those years healthy ones. "Hispanics are a pretty healthy group, if we take care of ourselves," says Delgado. "The message of prevention has to get out to our community."