Social Determinants of Health

A Mini-Ethnography: Social determinants of public health on the Texas-Mexico border

In early January, I traveled from the suburbs of Austin to the Rio Grande Valley (RGV) as a student researcher to test an app that would expand the outreach of healthcare. Despite being in the same state, the RGV’s distinctive culture seemed a world away. I journaled my observations and interactions in the town, and when I returned home, I learned more about trends I noticed through online research and interviews. In this mini-ethnography, I’ve published my recollections and findings on the social determinants of public health on the Texas–Mexico border region.

Cultural Disconnect from Healthcare

Unfortunately, the Texas-Mexico border is characterized by high rates of unemployment and poverty (i.e., 32% poverty rate vs. the national average of 23%). Due to America’s healthcare system that makes healthcare dependent on employment, many are left unable to afford hospital visits and treatment. In the border region, this phenomenon disproportionately affects Latinos.

Consequently, the lack of day-to-day interactions between patients and their providers drives a divide between Latino communities and the healthcare system, something that has gradually become a cultural trait of the region. Sam Pantusa, COO at the Lions Sight Research Foundation, describes how this leads to a mentality of extreme self-reliance: many of the patients he’s seen believe that they can be healthy without seeking treatment for their visual impairment. Indeed, in my time at the RGV, I observed that independence is often valued in Mexican-American culture, which may cause some to avoid seeking care unless absolutely necessary.

While its effects may be minor for acute health conditions, the avoidance of healthcare can pose deeper problems for chronic conditions. For example, diabetes—disproportionately prevalent in Latinos the border region—requires meticulous care; the risk of all-cause mortality is 50% higher for adults with due to the greater risk for “heart disease, nerve damage, [and] blindness,” thus requiring patients to closely work with their healthcare providers to manage their condition. Hence, having a strong connection one’s healthcare provider allows one to build a longitudinal relationship to provide more thorough care.

Photo credit Soham Govande

Language Barriers

In some cases, this distancing effect is exacerbated by linguistic barriers between healthcare providers and the largely Hispanic population. While approximately 90% of the RGV population is Spanish-speaking, Hispanic doctors are underrepresented, leaving some patients who only speak Spanish with an English-speaking doctor. Indeed, having a linguistic connection can foster more open communication, something necessary to accurately diagnose and treat patients. While an interpreter may bridge the language gap (if available), doctors’ diagnoses and treatments also need to be culturally competent. For example, one study found that having Spanish-speaking doctors improved diabetes outcomes for Latino patients who only speak Spanish.

To bridge this linguistic divide, some public health initiatives are trying to use targeted media campaigns to convey information in Spanish. For instance, the Centers for Medicare and Medicaid Services partnered with Univision, a leading Spanish cable network, to launch the Salud es Vida program (“Health is Life”): this partnership was greatly effective and has won awards for its success in bridging cultural and linguistic divides between healthcare systems and Spanish communities.

High Demand for Ophthalmic Care

At many of the clinics I worked at, I noticed that the waiting area was often filled with patients. Why was this the case? As the RGV is experiencing rapid population growth, there is a growing demand for affordable and low-cost healthcare services. Indeed, after speaking with some staff, I came to know that there was a high demand for ophthalmic care in the region, so patients were channeled to a small number of clinics. This led to the backlog of patients I could see through the office glass.

Community-Oriented Culture

The RGV’s communal atmosphere and rich Southern hospitality were a refreshing change from Austin: people were personally invested in the well-being of not just their immediate families, but also, their shopkeepers, teachers, and neighbors. Indeed, as I spoke with families at the clinic, many patients enjoyed laughs and spoke freely with me about their lives despite my being a stranger.

In terms of public health, the communal bond that unites many can be utilized to drive change. For example, I was asking patients for their help in developing a community vision screening app. I was amazed that all but two of the >40 families I spoke with were happy to spend their time and effort to help me validate this tool. This camaraderie can be channeled to other areas of community development, for instance, through mutual aid and nonprofit work.

Further Reading

de Heer, Hendrik Dirk et al. “Barriers to care and comorbidities along the U.S.-Mexico border.” Public health reports (Washington, D.C. : 1974) vol. 128,6 (2013): 480-8. doi:10.1177/003335491312800607

“Health Coverage of Immigrants.” Kaiser Family Foundation, 18 Mar. 2020, Accessed Feb. 18, 2020.

“United States-México Border Health Commission.” Rural Health Info, Nov. 2014, Accessed Feb. 18, 2020.

Featured image photo credit Soham Govande.

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3 thoughts on “A Mini-Ethnography: Social determinants of public health on the Texas-Mexico border

  1. Recently graduated with my BA in Anthropology and hoping to apply to an MPH program within the next year or so — thank you so much for this!

  2. Thanks! Sounds fascinating. I will read. And yeah, I would LOVE to get another degree, in anthropology.. agh.

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