Administering quality health care is not just about treating ailments or preventing sickness - it’s about community and culture, too, according to Jose Cucalon Calderon, M.D., division chief of advocacy and outreach for and associate professor of pediatrics at the .
Jose Cucalon Calderon, M.D.Language and literacy are also crucial components of quality health care, said Dr. Cucalon, who is a native Spanish speaker born in Ecuador, which is why he worked with others to create a partnership between Renown Children’s Hospital and Washoe County Library System. The partnership helps provide library cards for families when their new babies are born in Renown.
The program, which launched last year, is called “” Upon a baby’s discharge from Renown Nursery, families are given a resource to apply for a library card, giving them free instant access to countless books and learning resources once activated.
Although a library card might not be parents’ first priority for their newborn while in the hospital, exposure to books starting at birth is associated with higher literacy rates later in life. Plus, many of the library’s services and resources are available in Spanish, which Dr. Cucalon says makes it more accessible and inclusive for Northern Nevada’s Latino population, a community that comprises 25% of the region’s demographic.
Dr. Cucalon is a passionate advocate for improving care, accessibility and representation for the Latino population as the chair of the chapter. This is one of the many reasons he was recently selected to be a spokesperson for the American Academy of Pediatrics.
“My work and background and even my upbringing as a native Spanish speaker offered a lot of value in being able to serve the community here in Reno,” he said.
Language barriers adversely affect the way Latinos access and receive health care. It’s not just Spanish that is underrepresented in medical care, but the many other languages and dialects spoken throughout Latin and South America. For example, more than 200 dialects are spoken in Mexico, most from indigenous communities.
“We work with many Latino families whose main language is not Spanish,” said Dr. Cucalon. “We have families from different countries, different communities, families from Peru or Bolivia or Argentina.”
While having more Spanish-speaking medical professionals is valuable, language alone doesn't necessarily capture the cultural backgrounds, norms, or traditions that may play a role in how a doctor builds rapport with patients and advises treatment.
“There are specific problems that the Latino community faces,” he said. “The number one is that the Latino community is highly heterogeneous. We have a lot of people coming from different parts of Latin America, and there is absolutely no way to make a one-size-fits-all decision. There is a lot of multiculturality within the Latino community here.”
Dr. Cucalon said he has seen improvements in meeting multilingual needs as the medical community has grown and other initiatives have been put in place, including cultural humility training, but there is still a long way to go.
Only 5-6% of Nevada’s medical professionals are Latino, which is on par with the national average. The disparities in language and cultural representation have a tangible effect on the health of local Latino communities, and the state has a large gap to fill, he said.
‘Where there is a health impact, there is an economic impact’
One of the health challenges unique to the region’s Latino population is higher rates of exposure to secondhand smoke and thirdhand smoke, which refers to the smoke inhaled from somebody’s lit cigarette and the residual nicotine and tobacco left behind from extinguished cigarettes. This is because the hospitality and gaming industries are the largest employers in the state, and many casinos and bars still permit smoking and tobacco use inside since Nevada clean air laws exclude them.
“Hospitality businesses don't have clean air indoors, and people who work there are getting exposed to second and thirdhand smoke and e-cigarette aerosol,” said Dr. Cucalon. “And then they bring this home to their families. And when there is a health impact, there is an economic impact on them as well.”
Addressing this requires a multipronged approach. The first is awareness, which includes outreach efforts directed toward the affected population. Then, education - the more people know about the dangers of secondhand smoke, the more they can take action to prevent or mitigate it, even if they work in environments where smoke is unavoidable. It’s important to note that the best way to prevent the health effects of secondhand smoke is to expand clean indoor air laws to include gaming areas and bars, Dr. Cucalon suggested. Education can help families recognize the risks and advocate for their own health. And lastly, those whose health has already been affected by exposure should seek proper treatment and care from doctors who follow evidence-based practices.
Additionally, tobacco companies have intentionally marketed menthol cigarettes to Latino communities, and as a result, Latinos smoke menthol cigarettes at a higher rate than other demographics. Dr. Cucalon has seen firsthand the effect of smoking, in its many forms, on families, such as an increase in children with asthma.
All these factors mean that outreach must be direct, specific, multilingual and presented from trusted sources, such as doctors who understand how and why the Latino community faces these issues at higher rates.
Because tobacco use or exposure can be so ingrained in daily culture for some communities, education must be authentic to be effective. Dr. Cucalon works tirelessly to spread awareness and combat misinformation surrounding first and secondhand smoke. His other topic of advocacy is the importance of vaccines. He said that it’s common for Latino families to share misinformation through private text chats and glean disinformation from social media, so word-of-mouth and community-based recommendations tend to hold more weight.
A changing tide
Like health care itself, efforts to diversify the medical field also require a multi-faceted approach. And like literacy, this starts at birth. The earlier children encounter medical professionals with whom they share common ground, the more likely they will see that option as a possible career path.
Dr. Cucalon said the tide is changing, both organically and through concerted efforts to make medicine a desirable career choice for students who identify with underrepresented groups in medicine. Diversity, Equity and Inclusion and nationwide seek to elevate historically underrepresented communities resulting in increased enrollment from those communities, too.
Locally, the Latino Research Center at the University highlights the “cultural capital” of the region’s Latino population. Aspiring medical students from Latino families can join the at UNR Med, and the provides support, including scholarships and networking opportunities, to those at all stages of their careers.
As with everything, a combination of tactics to improve representation in health care is the best approach. Dr. Cucalon said clinical research focusing on health disparities in the Latino community is vital, but so is empowering people to re-invest their time and knowledge into their communities.
More inclusive, effective health care comes down to “more time and resources allocated, finding more people who want to do research,” Dr. Cucalon said. “And yes, more faculty with different backgrounds: people who have that lived experience.”
