Is Marketing Perpetuating Latino Health Care Disparities?

Michelle Markelz
Marketing Heath Services
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Key Takeaways

​What? Although race should have no bearing on a person's health care, Latinos in the U.S. continue to face disparities in care with their white and African American counterparts.

So what? Reports show that investment in Latino marketing in this industry is low. And those who have been recognized for their efforts are usually taking a total market approach.

Now what? Even a total market approach can be futile. The Latino population is so diverse in itself, some say total a total market approach may be efficient but ineffective.

​Race and health care practices should be mutually exclusive phenomena, yet in the United States, Latinos continue to be less likely than their non-Latino peers to have health insurance or a regular doctor. Are health care marketers allowing this demographic to slip through their fingers?

 

Visit uhclatino.com and you’ll find a landing page heavy on imagery and light on text. Click the photo of a salad above the Recetas Saludables (Healthy Recipes) title, and you’ll be directed to lists of entrees, appetizers, sides and soups made with frijoles (beans), arroz (rice), pollo (chicken) and jicama, among other ingredients that you might find in a typical Latino kitchen.

“They reflect real life,” says Beatriz Mallory senior vice president of SensisHealth, a cross-cultural health care marketing, advertising and branding agency. “You’re not going to see a recipe for maple glazed pork,” she says of uhclatino.com, a variation of myuhc.com, United Healthcare’s subscriber resource portal. Mallory believes United Healthcare is one insurance carrier demonstrating excellence in cultural competence when it comes to the Latino consumer: “[United Healthcare is] doing a good job because they can’t afford not to.”

The health care market potential for Latinos is large and growing. United Healthcare, like some other powerhouse insurers, stands to win or lose the Latino population, projected to reach 119 million (or nearly 29% of the U.S. population) by 2060. Already in California, Latinos outnumber non-Hispanic whites. 

In 2015, the Centers for Disease Control and Prevention (CDC) published a data brief that reported that more than 34% of Hispanics between the ages of 18 and 64 in the United States are uninsured. By comparison, only 11.5% of non-Hispanic white people, 17.6% of non-Hispanic black people, and 12.1% of non-Hispanic Asian people of the same age were without health insurance. The brief also reported that Hispanic adults were the racial demographic least likely to have a regular place to go for medical care.

Logic says that race should have no bearing on whether a person is insured or has a regular doctor, but there is no denying the health care disparity between Latinos and their non-Hispanic peers. So what’s the root of these trends? To be certain, there is a multitude of factors that contribute, but one of them, experts say, is marketing.

The Value of Latinos Isn’t Universally Recognized

“The health care industry, which includes pharma, is one of the last categories in this country to acknowledge the Hispanic market as viable,” says Jake Beniflah, executive director for the Center for Multicultural Science. Roy Kokoyachuk, co-founder of Hispanic market research firm ThinkNow, agrees. “Other types of insurance—auto, property/casualty, even financial planning type products—are marketed toward Hispanics. But health care insurance [companies] are interestingly less likely to call us to discuss the U.S. Hispanic consumer,” he says.

One reason, some have suggested, is that Latinos are more likely to use emergency room services. A survey by FAIR Health found that Latinos are two times more likely than the general population to go to the ER for non-emergency care. Because ER visits can cost more than 10 times that of an urgent care facility, Beniflah says some hospitals believe that Latinos drive down their margins.

In some instances, Mallory notes, ER use is a function of limited access to primary care. “If you’re in South [Los Angeles], there are no specialists within 10 miles,” she says. “You might have gone to the pediatrician or an urgent care facility, but there are none.” 



Despite these circumstances, Beniflah, who has been consulting marketing organizations for two decades, says that he sees a reluctance by hospitals to recognize Latinos as revenue opportunity, and this can negatively impact the investment on research and marketing targeted at Latinos. Last year AHAA: The Voice of Hispanic Marketing found that the average Hispanic ad spend of pharmaceutical companies decreased by 9% in 2014, and pharma companies as a category dedicates less than 4% of their marketing budgets to Hispanic-focused advertising. By comparison, leaders in Hispanic advertising dedicate at least 6.4% of their marketing dollars to Spanish/bilingual media.

The Whitewashing of Multicultural Marketing

Another perception Beniflah laments is the tendency of health care marketers to look at Latinos in aggregate. “There’s usually a big difference between the aggregated consumer and the target audience,” he notes. “Their general view of the Hispanic population may not line up with their [Hispanic] target audience.”

As of 2013, there were nearly 5,400,000 Hispanics living in the United States, about 34,500 of whom were of Mexican origin, reports Pew Research Center. That means more than 37% of the Hispanic population is not of Mexican descent. Pew reports 14 statistical profiles for Hispanics. Sixty-five percent of Hispanics in the United States are U.S.-born, and 44% of Hispanic Americans are millennials, a group whose familiarity, comfort and interactions with American health care differs from Hispanic Gen X’ers and boomers and whose language fluency and references are also distinct.

“The Hispanic market is very diverse and should be segmented,” says Robyn LaMont, director of client services for telehealth platform ConsejoSano. ConsejoSano partnered with HR consultancy Mercer to market its Hispanic-focused telehealth program, a subscription-based supplement to traditional health insurance that allows users to contact a medical professional 24/7 for medical advice. “Marketing channels and messaging would be very different for a 65-year-old female immigrant from Cuba versus a 20-something, U.S.-born male millennial of Mexican descent,” she says.

Immigrant Share Falls Among Largest Hispanic Origin Groups since 2000

Segmentation is increasingly becoming more defined by culture than solely by language. As Mallory notes, marketing to Latinos is effective when it’s culturally relevant, which comes through in everything from content to design to delivery. “Not only is content in Spanish on [United Healthcare’s] site, it’s also culturally relevant with things like fotonovelas, lots of video and bite-sized information,” she says. “Some companies, particularly big pharma, are not necessarily doing the best job in segmenting their marketing. They invest a lot of money on branding and then take the tactical end of it and just translate. They create a jump page on their site as opposed to a specific patient portal or site for Hispanics.”

A Consumer With Unique Preferences

It’s important to get health care marketing right in the digital space, especially for Latinos, who are adopting mobile phones faster than any other demographic, according to a Nielsen study, and who experts say are more likely to turn to the internet for health advice and information. “The internet has made a major advance as a trusted source of medical information for Hispanics,” Mallory says. “I saw the daughter of a Hispanic patient getting a second opinion on Google. The importance of the internet cannot be underestimated.”

ConsejoSano conducted focus groups prior to launching the telehealth service to understand both the holes in the market and how to market the service to their target audience.

“We learned we needed to use more images, videos and infographics in everything we do,” LaMont says. “We found a strong preference from Hispanics to watch videos and look at images versus reading blogs or articles. We needed to cell-phone optimize everything.” 

The focus groups also revealed that Latinos, especially those who are more comfortable speaking Spanish and familiar with Latin American medical systems, preferred to seek and get medical advice from a Spanish-speaking professional, particularly one based in a Latin American country. “Speaking with a doctor with shared cultural background was important [to focus group members] not only because of language but because they feel they are listened to better,” says Martha Ulberg, communications and customer service manager at ConsejoSano. “When they’re sick, it’s harder to think in English. They just want to say it fast and want a result right away.” For these reasons, says Ulberg, ConsejoSano consciously used words such as “easy,” “fast” and “convenient” when marketing the service.

In Latin America, a general practitioner may form a close relationship with a family, attending dinner at the home and developing a working knowledge of each member’s health. By contrast, doctor-patient relationships in the U.S. are often dictated by a schedule and can be undesirably brief and disconnected.

One reason for this perception among Latino patients is what Mallory refers to as a “lack of concordance.” Concordance refers to cooperative decision making between doctor and patient, which is difficult to achieve when patients don’t fully understand or trust their physician.

The language of health care is different culturally, Kokoyachuk says. “My mother always says she’s getting liver attacks and takes liver pills. Americans don’t acknowledge having a liver outside the context of alcohol. In Argentina, you have a liver attack; in the U.S., we’d call that indigestion. She goes to Argentina to visit her doctor because she feels he understands her and views her health care in the same context that she does.”

Who Will Seize the Latino Market?

When Mallory arrived in California last April after spending much of her life on the East Coast, she expected health care marketing in the predominantly Latino state to be ahead of the curve on cultural relevance. She was surprised to find that issues of cultural competence are nationwide, but she remains optimistic in the face of good work by United Healthcare and others.

Top 20 pharmaceutical company Boehringer Ingelheim partnered with Telemundo last year to produce a telenovela whose storyline raised awareness about type 2 diabetes, a disease that the CDC projects one in two Latinos will develop in their lifetime.

A popular strategy employed by organizations such as Kaiser Permanente, is the total market approach. Kaiser has been recognized for excellence in multicultural marketing using this model, but even this strategy has its limitations. “Right now the general market is taking control of cultural marketing and making vanilla out of everything,” Beniflah says. “‘A millennial is a millennial regardless of ethnicity.’ It’s very efficient, but the question becomes: Are you effective because it’s efficient? That’s the billion-dollar question.” 




 

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Author Bio:

 
Michelle Markelz
Michelle Markelz is managing editor for the AMA’s magazines and e-newsletters. She can be reached at mmarkelz@ama.org.
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