Colorado has a reputation as a healthy place to live, but that doesn’t seem to benefit the state’s Hispanic residents, who are more likely to die of causes that could have been treated or prevented.
In all but six states, Hispanic Americans are less likely to die of potentially preventable causes than white Americans, according to a Denver Post analysis of data from the Commonwealth Fund’s state health system scorecard.
In Colorado, however, Hispanic residents are about 20% more likely than white residents to die of treatable conditions, such as asthma attacks, diabetes complications, appendicitis or certain cancers. Deaths of people older than 75 aren’t included in the data.
The information was collected before the pandemic, so it doesn’t reflect COVID-19’s disproportionate hit on communities of color.
Colorado’s Hispanic population is more likely to be uninsured and to go without health care, but that’s also true of the rest of the country, including states where they’re less likely to die prematurely.
There’s no one explanation for the disparity in deaths, experts say, with factors including a history of discrimination, Colorado’s high cost of living and unequal access to quality jobs, education and housing playing a role.
Colorado’s white population has one of the lowest rates of premature death in the country, but that doesn’t fully explain the gap. Some other states, like Minnesota and Massachusetts, have lower-than-average rates of preventable deaths for both their white and Hispanic populations. In Colorado, the Hispanic population actually has more preventable deaths than the national average.
The things that make Colorado a healthy place, like the abundant opportunities for outdoor exercise, aren’t equally available to people who work lower-paying jobs and don’t have the money or free time to enjoy them, said Patricia Valverde, a faculty member at the Colorado School of Public Health’s Latino Research and Policy Center. And who works in low-wage jobs, which also tend to be more dangerous and may not offer health insurance, isn’t random, she said.
Denver was a center of a civil rights movement in the 1960s and ’70s because of widespread discrimination against Latinos in education and other parts of public life, Valverde said. While much has improved since then, people who were discriminated against in school were less able to pursue higher education, which then reduced how much they earned later in life and what opportunities they could give their children — all of which contributes to worse health, she said.
“With each generation, their economic opportunities increase, but you’re already starting behind,” she said.
Some parts of the state, like many of the southern counties, have high rates of premature deaths for all ethnic groups, according to data from the Colorado Health Institute. Others, like Denver and Mesa counties, have relatively low rates for white residents, but high ones for Hispanics.
In Denver, predominantly Latino neighborhoods tend to have less access to healthy food and more pollution, said Emily Cervantes, program manager for public policy research and analysis at the Colorado Latino Leadership, Advocacy and Research Organization. A recent event in Globeville drove home how a neighborhood’s surroundings affect its residents’ health, she said.
“After being outside for only a few hours, our eyes were red and stinging and our throats were sore from breathing the emissions from I-70 nearby,” she said.
Bethany Pray, legal director of the Colorado Center on Law and Policy, said it’s difficult to point to one factor to explain the disparities in health outcomes, but state programs haven’t served parts of the Hispanic community well.
While most information about programs like Medicaid and food assistance is in both Spanish and English, a state audit found critical pieces were sometimes available only in English, making it difficult for people who prefer to communicate in Spanish to enroll and maintain access to services they need, she said.
In some counties, non-citizens who are eligible for Medicaid have been turned away, either because of training problems or bias among the workers handling the applications, Pray said.
“Although (the Department of Health Care Policy and Finance) has committed to improving training, that is difficult to do when budgets are limited and we have 64 counties involved in administering these complex programs,” she said.
Marc Williams, spokesman for the state Department of Health Care Policy and Finance, said all materials are available in English and Spanish, and the policy is to review all applications. Most legal permanent residents become eligible for Medicaid after five years, while children, pregnant women and refugees who are legal residents are eligible immediately, he said.
“We have provided counties guidance that they are to process applications for anyone who comes in their door, regardless of their citizenship status,” he said. “Even if they’re not an eligible non-citizen, we do provide services for those individuals if they have an emergency — through emergency Medicaid — that covers specific emergencies such as ‘life or limb’ emergencies for one month.”
People who don’t have health insurance can get primary care at community health centers, but not specialist care, Valverde said. Even though community health centers largely do a good job managing issues they’re equipped to handle, patients still face long waits for appointments with a specialist, if they can get one at all, and may have to wait until they’re sick enough to visit an emergency room before getting the next level of care, she said.
“People with chronic conditions that are (well) managed… those would not contribute to premature death,” she said.
It’s possible that Colorado’s expensive housing and health care are exacerbating the difficulties obtaining care, especially for those working in low-wage jobs, said Joe Hanel, director of communications at the Colorado Health Institute. In some ways, workers in agricultural and resort communities are “invisible” in the health system, he said.
“The system is geared to work for people who are wealthier,” he said. “When everything’s expensive, health care is often the expense that you don’t take care of.”