Walk into the kitchen of Eugenia Delgado's home in Faribault, and you'll see a dinnertime battle about to play out.
George, 5, and Gilbert, 9, bolt out of a room and take a seat at the kitchen table. Delgado serves each a plate of pan-fried tilapia, mashed potatoes, corn and steamed mixed vegetables. But there's some pushback on the vegetables.
"I only want fish and corn and mashed potatoes," George says.
When Delgado insists that her son also eat some of the vegetables, he tells her he doesn't want broccoli.
"Sometimes, I fight with them to eat," Delgado said. "It is hard. It is really, really hard. I am worried about them."
Delgado was diagnosed with gestational diabetes when she was pregnant with George. As a result, he is more likely to become obese during childhood and is at a higher risk for Type 2 diabetes later in life.
Although her sons are not overweight now, she worries about their health, and their eating habits, aware of how her own health has changed since she arrived in Minnesota in 1996. She had already lived in Oklahoma and California after leaving Mexico a decade earlier.
Like many people who immigrate to the United States Latino immigrants are often healthier when they first arrive than their U.S.-born counterparts.
But within a generation, they become almost twice as likely to develop diabetes and other chronic diseases, compared to non-Latino whites.
Delgado is among the thousands of Mexicans who have settled in Minnesota in the last two decades. She said adjusting to life in the rural Midwest was easy. But access to cheap, unhealthy food and a sedentary lifestyle took a toll on her health. She gained 70 pounds during her first two years in the United States — well before her two youngest sons were born.
"In Mexico, you walk," she said. "Now, I only walk only to the garage and then I get to the store and I'm looking for the closest parking and I don't want to walk no more. We got lazy here."
Since her diabetes diagnosis, Delgado has been more careful about what she cooks at home. That means fewer tacos and less fried food but more steamed vegetables and homemade burgers. She's also lost some weight.
But like many immigrants who now call southern Minnesota home, she works long shifts at a food processing plant and said convenience often trumps over cooking.
When Delgado works the 2 a.m. to 2 p.m. shift, she leaves work exhausted.
"I get home and I don't want to move," she said. "I stop and I buy a pizza."
Latinos are the fastest-growing minority group in Minnesota. From 2000 to 2010, the number of Latinos in the state jumped nearly 75 percent to 250,258 people. They now comprise about 4.7 percent of the state population.
Demographers estimate that by 2035 there will be more Latinos than blacks in Minnesota. Latinos also will make up more of the state's population than Asians or American Indians. Together, minorities will make up about a quarter of the state's population.
Much of that growth will happen outside of the Twin Cities in places like Rochester, Worthington and Faribault.
But as these communities grow, so do the disparities between the incidence of health problems among Latinos and that of non-Latino whites.
Latino adults are up to five times more likely to be uninsured, compared to whites, according to the Minnesota Department of Health's 2009 Populations of Color in Minnesota Health Status Report.
This rising prevalence of diabetes and other chronic diseases among a growing minority community poses a unique challenge for health care officials, said Jose Gonzalez, director of Minnesota's Office of Minority and Cultural Health.
Gonzalez and other state health officials say expanding health care coverage is a good first step toward narrowing the health gap between whites and racial and ethnic minorities.
"If our populations of color and American Indians are growing, and yet we have the largest health disparities, that's an awful big expense that we're not taking care of in the long run, especially when it comes to chronic disease," he said.
In 2009, the state launched a Statewide Health Improvement Program, which awarded grants to community health board and tribal governments to fund programs aimed at reducing obesity and tobacco use. In 2010, the grants totaled $20 million and in 2011, $27 million.
Another growing challenge for health officials is finding bilingual health care professionals who can ask nuanced questions to understand how their patients manage their health at home.
Gonzalez said it's important to have health care providers who can ask Spanish-speaking patients if they've tried any home remedies or brought medicines from home.
"If you're aware of these things, it saves a whole lot of trouble, a whole lot of unnecessary testing, other expenses," he said. "And it does contribute to managing our health care."
Managing the health of low-income minorities is the focus of a number of programs across Minnesota.
Twice a month, Eugenia Delgado visits HealthFinders, a community clinic that has operated since 2005 in the basement of a Methodist church near Dundas, Minn. Volunteer doctors and nurses treat about 750 low-income patients a year.
HealthFinders is the only place Delgado, who is uninsured, can obtain her diabetes testing supplies and other medications for free. She also attends a diabetes class.
Many of patients work in the poultry or food processing industry and live in the sparsely-populated region between Rochester and the Twin Cities.
HealthFinders Executive Director Charlie Mandile emphasizes that lifestyle changes, like eating habits and exercise, are just as important to treating chronic diseases as traditional medicine.
"You know, what happens outside of the doctors office, when you're at home," Mandile said. "What are you doing? What are you eating? What kinds of exercise are you doing? Are you even taking your pills?"
But even though immigrants suffer higher rates of chronic disease, Mandile said they often have a family history and way of life that kept them healthy their country of origin.
"Really, I think our job now becomes, adapting our instruction and lifestyles here in the U.S. to really pull out their inherent assets to enable them to really get them to take care of themselves in the best way that they know how to," he said.
For Eugenia Delgado, learning to take better care of her family's health is an evolving process, and with two young boys, she knows there's always room for negotiation.
"I'll peel and apple and I'll put caramel. Or I give [them] a banana, but they want something different," she said. "I understand it. Sometimes, I feel like I want cookies or I want a cracker or I want a brownie. I want it too. So I'm like 'poor kids. They want to eat it, too.' I think they need a little bit of everything."
Neither mom nor the boys won the kitchen table battle. George and Gilbert ate their vegetables, but only after she agreed to put Ranch dressing on them.
This story was the first of three reports produced in part as a project for the California Endowment Health Journalism Fellowships, a program of the University of Southern California's Annenberg School for Communications & Journalism.
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