Rising inequality, shifting demographics, and current immigration policies have intensified efforts to promote health equity and social justice for Latinos. The second-fastest growing racial group in the United States, Latinos now make up 18 percent of the population (Flores 2017). While California is home to the largest number of Latinos, growing numbers in states like Georgia and Illinois make Latino health equity an important issue for foundations across the country to address (Flores 2017).
Grantmakers In Health and Hispanics in Philanthropy (HIP) explored this issue at a meeting held in April 2018 in San Francisco. Supported by The California Endowment, the meeting convened national and regional funders to discuss how to build a movement for Latino health equity in California. Participants shared innovative funder strategies for improving health outcomes for Latinos and highlighted opportunities for collaboration with other communities of color. This article highlights key takeaways, ideas, and recommendations from the meeting.
Understanding Latino Health Disparities
Latinos face a range of disparities in health status and health outcomes. This is despite what is referred to as the “Latino paradox,” which describes how recent Latino immigrants often have better health outcomes compared to non-Hispanic white Americans (Ruiz et al. 2013). Research suggests this may be due to protective factors such as healthier diets and strong social ties (Ruiz et al. 2013).
The disparities become stark, however, for Latinos who were born in the United States or have lived here longer. Studies show Latinos report worse health status than white counterparts (Artiga et al. 2016). For example, Latinos are disproportionately affected by conditions such as asthma, diabetes, obesity, and liver and cervical cancer (Families USA 2014). Latinos are also more likely to confront language barriers, to be uninsured, and to delay medical care because of cost (Artiga et al. 2016).
Undocumented Latino immigrants face additional burdens that contribute to poor health outcomes. In California, for example, more than one million undocumented immigrants are uninsured (The California Endowment). These immigrants are more likely to experience high levels of toxic stress and less likely to participate in safety net programs because of uncertainty about immigration laws and fear of deportation (Artiga and Ubri 2017).
Latino health disparities are even more daunting when disaggregated by ethnicity and nationality. For instance, Mexicans and Puerto Ricans are about twice as likely to die from diabetes as whites (Centers for Disease Control 2015). Puerto Ricans also have higher rates of infant mortality and asthma compared to other Latinos (Office of Minority Health 2018). Afro-Latinos also experience unique health challenges, including higher rates of hypertension (Borrell and Crawford 2008).
Tackling the Root Causes of Latino Health Inequities
Past efforts to reduce racial and ethnic health disparities largely focused on expanding health coverage and improving medical care. Research has shown, however, that increased access to health care is not sufficient to eliminate systemic differences in health status and outcomes. Bringing a health equity lens is critical to efforts to eliminate health disparities for Latinos and other communities of color.
Ensuring that people have a fair and just opportunity to be as healthy as possible requires targeting the root causes of unequal health outcomes such as housing, education, and access to food. It also means removing barriers such as poverty, discrimination, and power imbalances that communities of color and other marginalized groups have historically faced (Tellez 2018).
Strategies for Building Healthy Latino Communities
A number of funders are engaged in partnerships to promote Latino health equity in California. The following examples were shared at the meeting:
Investing in Policy Change – The San Joaquin Valley Health Fund advances health equity by building the capacity of communities and organizations to pursue policy and systems change. Launched in 2014, the fund is a partnership of 89 organizations and 15 foundations including Sierra Health Foundation, The California Endowment, Rosenberg Foundation, The California Wellness Foundation, W.K. Kellogg Foundation, Blue Shield of California Foundation, Wallace H. Coulter Foundation, Dignity Health, Tides, Hellman Foundation, The James Irvine Foundation, Convergence Partnership, Health Net, The Grove Foundation, and WKF Fund.
The fund supports organizations in the San Joaquin Valley, a mostly rural region in California with a significant Latino population, high rates of poverty, and pervasive health inequities. The fund has invested in a range of strategies that leverage leadership development, data, communications, and grassroots organizing to improve health and promote racial equity. One of its most recent efforts was the Equity on the Mall day of action in 2018 that brought residents, community leaders, and local elected officials to Sacramento, California’s state capitol, to demand action on health, immigration, education, environmental, and land use policies.
Fostering Culturally Based Healing – The California Wellness Foundation, The California Endowment, Sierra Health Foundation, and Latino Community Foundation provide support for Fathers and Families of San Joaquin (FFSJ), a community-based organization that works to improve the health and well-being of the most vulnerable families in Stockton and the San Joaquin Valley. FFSJ uses a healing justice lens in its work, which is rooted in healing from historical and institutional trauma and maintains that healing is political, intersects with organizing, and can be found in culture and spirituality (Nunez 2018). FFSJ’s work is also grounded in La Cultura Cura, an indigenous health framework that links physical, emotional, mental, and spiritual well-being to cultural identity.
The organization’s commitment to “leading a healing movement” takes multiple forms and includes a health justice program that advocates for healthy eating and built environment change. FFSJ also offers culturally responsive community-based treatment services, family strengthening programs for formerly incarcerated individuals, youth leadership development programs, and racial justice initiatives. In addition, the organization serves as lead partner of the San Joaquin County Alliance for Boys and Men of Color.
Recommendations for Grantmakers
Meeting attendees shared insights that are applicable to funders across the country:
Support community engagement. Foundations can make a deeper impact by involving those directly affected by health inequities in their work. Bringing community members to the table to identify problems, guide funding priorities, and inform grantmaker strategies is essential to addressing Latino health equity.
Recognize the role of trauma. Growing research shows the effects of trauma on physical and mental health. Funders can play a valuable role in connecting communities of color to healing spaces that provide culturally relevant and responsive treatment and community-based care.
Target neighborhood conditions. Funders are encouraged to think more broadly about what it takes to build healthy communities. There is an urgent need to move upstream and invest in public safety, violence, affordable housing, and the living conditions that shape health.
Build new partnerships. Collaborating cross-culturally is vital to improving health for Latinos and other communities of color. Philanthropy is uniquely positioned to help communities convene, find common ground, and work in coalition to create stronger communities that center health and racial equity.
Invest in long-term change. Making meaningful progress requires taking action at the systems level. Funders can support long-term change by investing in advocacy and policy, providing flexible funding and multiyear grants, and exploring nontraditional funding techniques and innovative investment strategies that might enhance achievement of their missions.
HIP recently wrapped up the #Salud4All campaign to increase visibility and philanthropic support for Latino serving organizations advancing health equity across California. HIP has also partnered with the University of California, San Francisco to conduct a landscape assessment of California organizations addressing health equity, health access, and social justice. Results from the assessment will be released soon and more information can be found here.
Artiga, Samantha, Julia Foutz, Elizabeth Cornachione, and Rachel Garfield. Key Facts on Health and Health Care by Race and Ethnicity. June 7, 2016.
Artiga, Samantha and Petry Ubri. Living in an Immigrant Family in America: How Fear and Toxic Stress are Affecting Daily Life, Well-Being, & Health. December 13, 2017.
Borrell, Luisa N. and Natalie D. Crawford. “Disparities in Self-Reported Hypertension in Hispanic Subgroups, Non-Hispanic Black and Non-Hispanic White Adults: The National Health Interview Survey.” Annals of Epidemiology. 18, no. 10 (2008): 803-812. doi:10.1016/j.annepidem.2008.07.008
The California Endowment. #Health4All. Accessed August 14, 2018.
Centers for Disease Control. Hispanic Health. May 2015.
Families USA. Latino Health Disparities Compared to Non-Hispanic Whites. July 2014.
Flores, Antonio. How the U.S. Hispanic Population is Changing. September 18, 2017.
Nunez, Samuel. Fathers and Families of San Joaquin. “Strategies for Building Healthy Latino Communities.” Presentation at the Grantmakers In Health and Hispanics in “Philanthropy Investing in Latino Leadership for Health Equity and Justice” meeting, San Francisco, CA, April 5, 2018.
Office of Minority Health. Profile: Hispanic/Latino Americans. Last modified June 1, 2018.
Ruiz, John M., Patrick Steffen, and Timothy B. Smith. “Hispanic Mortality Paradox: A Systematic Review and Meta-Analysis of the Longitudinal Literature.” American Journal of Public Health. 103, no. 3 (2013): e52-e60.
Tellez, Ana. Human Impact Partners. “Tackling the Root Causes of Health Inequities.” Presentation at the Grantmakers In Health and Hispanics in “Philanthropy Investing in Latino Leadership for Health Equity and Justice” meeting, San Francisco, CA, April 5, 2018.