IHP 501 Module 3 Milestone One Example

Milestone One: Type 2 Diabetes Among Latino Immigrant Adults at a Community Health Center

[Student Name]

Southern New Hampshire University

IHP 501: Global Health and Diversity

Module Three Milestone One

[Instructor Name]

[Date]

Milestone One: Type 2 Diabetes Among Latino Immigrant Adults at a Community Health Center

A disparity becomes workable when it is defined by population, outcome, comparison group and setting. This milestone defines the disparity the final project will address: poorer diabetes control among Latino immigrant adults at La Esperanza, a composite community health center with federal funding that anchors care in Riverside Heights. It describes the population, presents data, explains why the disparity matters, outlines likely causes and states the project's aim.

The Population

La Esperanza serves about 14,000 patients, 62% of whom identify as Latino. Among Latino adult patients, about 70% were born outside the United States, mostly in Mexico, Guatemala and El Salvador, and 58% prefer to receive care in Spanish. Many work in food processing, cleaning, landscaping and construction, often with irregular hours and without paid sick leave. The center's records do not collect immigration status, but staff estimate that a substantial share of immigrant patients lack permanent legal status, and most are uninsured and pay on a sliding fee scale.

The Disparity in Numbers

A review of the center's diabetes registry found 1,240 adults with type 2 diabetes, of whom 610 are Latino immigrants. Half of them have an HbA1c at or above 8.6%, a full point higher than the 7.6% median for everyone else in the registry. Forty-one percent of Latino immigrant patients have an HbA1c above 9%, the threshold for poor control used in national quality measures, compared with 24% of other patients. They are also less likely to have had an annual eye exam, 38% versus 52%, and more likely to have missed two or more visits in the past year. County data show that diabetes-related hospitalizations in Riverside Heights are about twice the county rate.

Table 1. Diabetes Indicators at La Esperanza

Note. Figures are illustrative for the composite center.

Why It Matters

Poorly controlled diabetes leads over years to heart attacks, strokes, kidney failure, blindness and amputations, and it reduces people's ability to work, which matters greatly for families living on hourly wages. The disparity also reflects a broader pattern. Marmot (2005) described how health follows a social gradient, with disadvantaged groups experiencing earlier and more frequent illness, and argued that such gradients stem largely from social conditions rather than biology. The gap at La Esperanza is one local expression of that gradient, and closing it is a question of equity as well as clinical quality.

Immigration as a Determinant

Immigration, a major review argues, should be treated as a social determinant of health in its own right (Castañeda et al., 2015). Immigration status shapes eligibility for insurance and public benefits, the kinds of jobs available, housing stability and exposure to exploitation. Policies and enforcement practices can create fear that discourages people from seeking care or giving personal information, even when services are available to them. These effects extend to family members, including citizen children. For La Esperanza's patients, missed visits and delayed care may reflect work that cannot be missed and fear of contact with institutions as much as individual choices.

Language as a Barrier

Most of the population prefers Spanish, and La Esperanza has bilingual staff in some roles but relies on family members or untrained staff to interpret in others. Flores (2005) systematically reviewed research on interpreter services and found that use of untrained or ad hoc interpreters, such as family members, was associated with more errors with potential clinical consequences, while professional interpreters were associated with better communication, comprehension and quality of care. Diabetes management depends on detailed explanations of medications, blood sugar monitoring and diet, making language access especially important.

Other Likely Causes

Beyond immigration and language, likely contributors include cost, since medications and test strips strain household budgets even on the sliding scale; work schedules that conflict with clinic hours; food environments with few affordable healthy options; and diabetes education materials that are translated but not adapted to the foods and cooking practices patients know. These causes will be examined further in the literature review and community input.

What the Data Cannot Show

The registry comparison has limits. It groups patients by the center's language and birthplace fields, which are sometimes incomplete, and it cannot capture immigration status, which is not recorded for good reason. HbA1c values come only from patients who had a test in the past year, so patients who stopped coming may be missing, and their control is likely worse. The comparison group includes a mix of U.S.-born Latino, Black and white patients, whose own disparities are hidden when combined. These limits mean the true gap may be larger than the numbers show, and they argue for combining records with interviews and community surveys before designing the intervention.

Project Aim

The final project will propose an intervention to reduce the gap in diabetes control between Latino immigrant adults and other patients at La Esperanza. The measurable aim is to reduce the share of Latino immigrant patients with HbA1c above 9% from 41% to 30% within eighteen months, while increasing annual eye exams to at least 50%. The intervention will be developed with community input and grounded in evidence on culturally and linguistically appropriate care.

Strengths to Build On

The population also brings strengths that the project should use. Many patients have close family networks and attend local churches, which can support behavior change. Traditional foods such as beans, corn tortillas and vegetables can fit a diabetes-friendly diet when portions and preparation are considered. La Esperanza already employs two promotoras for prenatal outreach, showing that the center can support community health workers. Starting from strengths rather than deficits keeps the project respectful and practical.

Conclusion

The disparity at La Esperanza is clear in the numbers and rooted in conditions beyond the clinic: immigration policy, language access, work and cost. Defining it precisely, with a population, comparison and aim, prepares the project to look for evidence-based solutions in the next milestone.

References

Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M.-E. D., Beyeler, N., & Quesada, J. (2015). Immigration as a social determinant of health. Annual Review of Public Health, 36, 375-392. https://doi.org/10.1146/annurev-publhealth-032013-182419

Flores, G. (2005). The impact of medical interpreter services on the quality of health care: A systematic review. Medical Care Research and Review, 62(3), 255-299. https://doi.org/10.1177/1077558705275416

Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099-1104. https://doi.org/10.1016/S0140-6736(05)71146-6