HEALTH: SALUD! Body, Mind, Spirit; User-Friendly Health Book By and For Women
Latinas have higher rates of infertility, abortion, suicide, depression, cervical cancer, and diabetes and lower rates of breast cancer, hypertension, and blood cholesterol than other women have, according to the first comprehensive health guide specifically designed by Hispanic women for Hispanic women.
'The reasons for these differences are unclear because only now are health researchers beginning to explore who Latinas are and the reasons our health differs from that of other women,' said Dr. Jane Delgado, a clinical psychologist who co-wrote SALUD! A Latina's Guide to Total Health-Body, Mind and Spirit with the National Hispanic Women's Health Initiative, a network of Hispanic community-based organizations. 'This book celebrates who we are. It was fun to write. It has been a wonderful experience.'
The book, published by HarperCollins in New York in both Spanish and English, explores health problems from the Latina's perspective, using true-life stories of women throughout the nation. Delgado builds on these often poignant stories to offer common sense approaches to total health that integrate the body, mind, and spirit as well as expert advice and the most recent medical findings.
Latina Leaders Comment
Many Latino leaders have praised the book. Dolores Huerta, co-founder of the United Farm Workers, wrote that the book provided a 'clear understanding that for Latinas, our health is more than just our bodies. Latina health means we have to also care for our mind, our spirit, our families, and even our environment.'
'Known for placing family needs above their own all their lives, Hispanic women need to become more aware that caring for themselves is as important as caring for others,' wrote Antonia Coello Novello, a visiting professor at Johns Hopkins University School of Hygiene and Public Health, and former Surgeon General of the United States, in the forward of the book. 'Since it is well known that when the health of a woman collapses, the health of the family of which she is the center collapses as well, Hispanic women -- through this book -- should feel more inclined to care for themselves.'
Other Latino leaders have said that the book doesn't go far enough.
Araceli Panameno, executive director of the Washington-based National Latina Institute for Reproductive Health, said that while she felt the book 'can only help as another resource,' SALUD! did not go into the depth she had hoped on issues of reproduction, sexual orientation, contraception, and sexuality.
'It's very basic,' Panameno said. 'There's still a lot of room for more discussion. Some of us are beyond [the issues raised in the book] and would like our communities to discuss reproductive health more in depth. Nevertheless, I think it is a positive contribution.'
Antonia Villaruel, an assistant professor at the University of Pennsylvania School of Nursing and president of the National Association of Hispanic Nurses, argued, however, that the book cannot be definitive 'because women are always changing' and that SALUD! 'is a good foundation on which to build.'
'I'm sure as people read it, they will say, `What about this and what about that?'' she said. 'People just have to remember that it's a first time effort. I think it's a wonderful book. She does a good job of incorporating the women's perspective from a broad spectrum of Latinas of all ages.'
Delgado, who since 1985 has been president of the Washington-based National Coalition of Hispanic Health and Human Services Organization (COSSMHO), a network of health, mental health, and human service providers, said that despite all of the praise for her book from leaders in the Latino community, one of the biggest challenges in writing and publishing it has been simply to get more Latinas to buy the book.
'One of the challenges is getting our community into bookstores to buy books in general, not just my book,' said Delgado.
The idea for the book came from her work at COSSMHO and from her experience of working in 1983 for then-Secretary Margaret Heckler of the U.S. Department of Health and Human Services. Delgado was a key force in the development of the landmark Report of the Secretary's Task Force on Black and Minority Health.
Sins of Omission
Delgado said that the experience showed her the lack of information available on the health of Latinos in general. When the report was published in 1985, for example, the U.S. government still did not include in its vital statistics information on the number of Hispanics who died in a given year. The federal government began collecting this data in 1989.
'Since mortality data for Hispanics were not available, no one could say how many Hispanics died of heart disease, cancer, or any other disease,' Delgado wrote in the book. 'The assumption was that all minorities were the same, and what was true for the Black community would be true for Hispanics.'
According to Delgado, current research reflects many differences between Latinas and other U.S. women. Recent studies, for example, have found that Latinas metabolize drugs differently than do other women and tend to live longer than do other women. The only way to find out more about how Latinas react to different pharmaceutical drugs is for them to participate in clinical trials, which Delgado argues the Latino community has historically not participated in either out of reluctance or simply not knowing that these trials exist.
'Studies have shown that Hispanics tend to need lower doses of anti-depressants and tend to experience more side effects from them,' Delgado said.
But the issues of depression and suicide are striking in the Latino community, she said. The book notes that in 1995, 21 percent of Latina teenagers reported they had made at least one suicide attempt. [The source of this statistic is not cited, but each chapter includes a useful list of relevant resource organizations, hotlines, pamphlets, and other publications.] Delgado partially attributes the high rate of attempted suicide to the anti-immigrant mood plaguing this country.
Reproductive Health
It's important, Delgado said, for Latino couples to discuss their infertility openly with healthcare providers to determine the cause and that women should not feel inadequate if they have not been able to conceive because in about 40 percent of infertility cases, the male is the significant factor.
On abortion, Delgado said that most of the Latinas who have an abortion are married and have children and that abortion is a difficult topic for them.
'Most Latinas who have had an abortion still refer to their experience in terms of the baby they did not have,' wrote Delgado in the book. 'For Latinas, it seems that once they know they are pregnant, they do not use the words embryo or fetus -- it is their baby.'
Rx: Self-empowerment
'We live in a society that doesn't value us and ignores our presence,' Delgado said. 'This doesn't affect just the undocumented. It affects all Hispanics. How people see us contributes to our self-esteem.'
A lack of self-esteem is very common among Latinas, and Delgado urges Latinas to learn to develop a better sense of self-esteem and to listen to their bodies. This means that along with regular check-ups with a doctor, Latinas need to focus on keeping their mind and spirit robust by learning to set limits with their family life and practicing whatever type of ritual -- religious or otherwise -- to keep feeling healthy. She stresses the importance of working with and learning from a health-care provider, and keeping that provider informed as to what ethnic remedies one is using, such as teas or herbs.
'How we Latinas care for ourselves begins with the mind-set of where we place our individual needs within the priorities created by our relationships with our families,' said Delgado.
Her own research for the book found that Latinas need more information about health care, that Latinas must take more control over their health and their health care, and that healthcare providers need to be more culturally competent. Delgado argues that it is not enough to teach healthcare providers basic Spanish.
'Why teach people key phrases when they don't understand the responses,' said Delgado, adding that COSSMHO has written a book on cultural competence and provides cultural competence courses to healthcare providers nationwide.
Photo (Dr. Jane L. Delgado)
