Mexican Americans in Minnesota

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Increasing the cultural competence of health care providers serving diverse populations

In order to provide equitable and effective health care, clinicians need to be able to function effectively within the context of the cultural beliefs, behaviors, and needs of consumers and their communities. According to the 2002 Institute of Medicine report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, racial and ethnic minorities tend to receive lower quality health care than nonminorities even when access to insurance and income is accounted for. Failing to support and foster culturally competent health care for racial and ethnic minorities can increase costs for individuals and society through increased hospitalizations and complications.

In 2009, the U.S. Census Bureau American Community Survey reported 30,746,000 Mexicans in the U.S., compared with 46,822,000 Hispanics/ Latinos overall. Mexicans comprised 30 percent of foreign-born residents in the U.S. According to the Mexican Ministry of Foreign Affairs, 10 percent of Mexico's population lives in the U.S. The Pew Hispanic Center reported that 11.2 million unauthorized immigrants lived in the U.S. in 2010, with Mexicans comprising the largest group.

In Minnesota, the Hispanic/Latino population overall increased dramatically from 54,000 in 1990 to 144,000 in 2000, to 250,260 in 2010. Mexican Americans have lived in Minnesota since the early 1900s. Migration to Minnesota occurred as a result of Mexico's 1907 economic depression, the Mexican Revolution, and discrimination against Mexicans in the southwestern U.S. Demand for low-wage labor following World Wars I and II, and the Immigration Acts of 1917 and 1921, which limited immigration from southeastern Europe, also contributed to the influx of Mexicans to Minnesota. Mexicans were recruited as low-wage laborers for the railroad and for the food processing, sugar beet, and meat packing industries.

Mexican communities developed in rural and urban areas across the state, including Chaska, Faribault, Glencoe, Minneapolis, Northfield, Owatonna, St. Paul, Willmar, Worthington, and the Red River Valley. The metropolitan area has the highest populations of Mexicans in Minnesota, with established communities on St. Paul's west side and in north and south Minneapolis. These communities have hundreds of Mexican businesses, more than 25 churches offering services in Spanish, 10 Spanish-language newspapers, and 10 Mexican soccer leagues.

For years, St. Paul was home to the largest Mexican population in Minnesota; however, in 2000, the population in south Minneapolis, centered along Lake Street and Nicollet Avenue, surpassed St. Paul's population.

The Mexican Consulate in St. Paul provides services related to obtaining identification papers, repatriation, and visas for Mexicans with dual nationalities, as well as providing a variety of services related to labor concerns, prison issues, and domestic violence. The office also promotes Mexican culture, understanding of Mexicans beyond stereotypes, as well as the economy of Mexico. In addition to serving the Mexican community, the consulate provides referrals to all Spanish-speaking residents for medical needs, preventive screenings, and low-cost health insurance.

In the metro area, Centro de Salud in south Minneapolis and East Side Community Health Services (La Clinica) in St. Paul provide health services to Spanish-speaking clients.

Social structure

Most recent arrivals to Minnesota come from central and southern Mexico. Mexico has more than 100 languages. Although many Mexicans in Minnesota speak Spanish and English, they may not be able to read or write either language. Nearly half of Mexican-born residents in the U.S. are employed, primarily in construction and service industries. Traditional Mexican families are intergenerational and include grandparents, aunts, uncles, cousins, godmothers, and godfathers. Children are highly valued and elders are respected and cared for. In a traditional home, the man is the head of the household. However, acculturation, assimilation, and separation of family members have changed family roles.

Religion

Many Mexicans are Roman Catholic Christians, who attend church regularly, pray to God, Jesus, the Virgin Mary, saints, and the Virgin of Guadalupe. They may light candles, maintain home shrines, and visit shrines throughout Mexico. Some Mexicans in Minnesota have converted to protestant religions.

Diet

Until the 1960s, many ingredients for traditional Mexican meals, such as chiles, tomatillos, cumin, and cilantro were not available in Minnesota. A traditional meal may include soup or a meat and vegetable stew served with corn tortillas, rice, and pinto beans. Tamales, which often take an entire day to make, are made with seasoned chopped meat and crushed peppers, are wrapped in corn husks spread with masa (a corn dough), and steamed. Mexican chocolate is used to make a mole sauce that is often served over meat. Traditional Mexicans may believe in balancing hot and cold foods for good health. Hot foods may include chocolate, eggs, oil, red meat, chilies, and onions. Cold foods include fresh vegetables, fruits, dairy, fish, and chicken.

Many assimilated Mexicans have replaced traditional meals with fast food, contributing to increased obesity, diabetes, and hypertension in this population. Their diet tends to be low in fruits and vegetables and high in flour tortillas, white rice, and processed foods. High consumption of alcohol is also a health consideration, and Mexicans do not tend to get as much exercise in the U.S. as they did in Mexico.

Medical care

Common health problems for this population are obesity, diabetes, hypertension, HIV/AIDS, preventable cancers, and trauma from domestic abuse and gun violence. Diabetes is twice as prevalent in the Mexican population as in the white population. According to the Centers for Disease Control and Prevention, more than 66 percent of Mexican-American women and 64 percent of Mexican-American men are overweight or obese, compared with 49 percent of white women and 61 percent of white men. Childhood obesity is of particular concern in this population.

Studies show that half as many Hispanics as whites are likely to be immunized for influenza and pneumonia, and the incidence of cervical cancer in Hispanic women is double that of white women.

Health care providers are encouraged to establish a relationship with Mexican families and be receptive to family suggestions before care begins. When possible, interpreters should understand regional differences in language and be the same gender and approximate age of the patient. Provide written educational materials with pictures or a video in Spanish. Explain how to navigate your health facility and assist in scheduling appointments and arranging for transportation. Tactfully explain how being on time for visits is important and affects other patients.

Mexican patients may prefer the family to be involved in serious discussions about disease or terminal illness. Males are typically the head of the household in the older generation, and often answer questions and sign papers. When treating a female patient, providers should listen to male family members, but direct questions to the female patient. Explain the importance of hearing from the patient about her illness. Providers are encouraged to ask patients what they believe caused their illness, and to explain its medical cause. Patients may not agree with the cause of illness. Also inquire about patients' use of home remedies and assess the safety of the remedies they use. Women who do not have access to health care or insurance may seek childbirth care from doulas and midwives.

Some Mexicans may not believe in the value of preventive care, believing that life is in God's hands. However, educating patients about the importance of diet, exercise, not smoking, and preventive tests may influence changes in their eating, exercise, and smoking habits.

Asking patients to repeat the health information they've been given helps ensure their understanding. Frequently repeat information and offer reassurance during long procedures. Consent forms should be written in Spanish at a fifth-grade reading level. Undocumented immigrants may be suspicious of any written consent, fearing that they may be signing away their rights and may be deported.

End of life

Some Mexicans believe that death is at God's will. They may see death as a release from the troubles of life and passage to a better life. Some patients, especially the elderly, wish to die at home, believing that the spirit may be lost at the hospital. At end of life, Roman Catholics may request a visit by a priest to anoint the patient. Rosary beads and religious medallions are often kept near the patient. Families may consult an elder or an educated or influential person in the community when deciding treatment and making end-of-life decisions. If a patient dies before the priest arrives, a sacrament still takes place before the body is removed. The family may request to see the body and help prepare it for burial. Traditional persons may observe nine days of prayer following death.

Culture in context

Culture is essential in assessing a person’s health and well-being. Understanding a patient’s practice of cultural norms can allow providers to quickly build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Also important is making connections with community members and recognizing conditions in the community.

Get to know your patients on an individual level. Not all patients from diverse populations conform to commonly known culture-specific behaviors, beliefs, and actions. Generalizations in this material may not apply to your patients.

Culture Matters DVD Training - Hispanic/Latino. Stratis Health's DVD series offers insights into the beliefs and norms of three of Minnesota’s prevalent cultures: Hispanic/Latino, Hmong, and Somali. DVDs available for purchase; facilitator discussion guides available at no cost. CEU credit available.

Additional Resources

Additional reading specific to caring for diverse populations.

Video Clips on Faith, Culture & Identity Perspectives in Latino Communities. Sometimes communities have their own way of thinking and talking about end of life issues. Use thse videos to support community-based conversations regarding end-of-life care planning. Produced by Honoring Choices Minnesota.