Cultural Diversity in Medicine: Health Status of Racial and Ethnic Minorities

Abstract

The past century has borne witness to a most unique development in the annals of American medicine. The patients whom we treat have become more complex, not only in regards to the variety of illnesses that they present, but especially in regards to the increasing mixture of cultures, ethnic groups, and races. This steady progression of heterogeneity presents a challenge of major proportions to the practicing physician who must now acknowledge that the approach to patients cannot be monolithic, but instead should be tailored to fit their special needs. Interest in the public health aspect of healthcare delivery began in 1789 when the Reverend Edward Wigglesworth performed an assessment of American health and produced the first mortality tables in the United States. Since that time, the accumulation of data relating to the health of the country has been systematically compiled, and this vital statistics information has revealed changing patterns of illness and disease over the years. For instance, whereas the main causes of death in 1900 were influenza, pneumonia, tuberculosis, and gastrointestinal infections, and Americans could expect to live an average of 47 years, 100 years later it is found that the main causes of death are cardiovascular disease (CVD), cancer, stroke, and diabetes mellitus (DM), and the average life expectancy from birth is now more than 75 years. With the emergence of chronic diseases as the leading health problems in this country, the focus has shifted from acute intervention approaches to population-based preventive programs designed to identify and eliminate risk factors for these conditions. The federal government has taken the initiative in this regard through campaigns for improved health constructed by various agencies of the Department of Health and Human Services, such as the Centers for Disease Control and Prevention, and the Office of the Surgeon General. More recently, these governmental organizations have undertaken the monumental task of dramatically reducing and eradicating poor health through initiation of a program called Healthy People 2010. Among the objectives of these programs is the elimination of healthcare disparities, which exists between minorities and the major part of the population, an increase in longevity, an improvement in the quality of the healthcare delivered, an increase in access to care for minorities, and recognition of the importance of cultural diversity as we view the health status of the Americans. Beginning with the author’s medical education and continuing to the present time, he has been able to develop a perspective on the diverse nature of the patients who are treated, which spans a 40-year period. During this period, the author has looked critically at healthcare delivery dispensed to patients representing different cultures, and has found that the system of healthcare is sorely in need of change that would allow more considerate treatment of those with special needs. In this presentation, the author draws from personal experiences as a medical practitioner, educator, researcher, consultant to corporate organizations, and author of books and papers on the subject. A focus will be placed on experiences with various racial/ethnic groups, especially African Americans (AA). The purpose for providing this information is to attempt to influence medical providers to adopt more “patient-centered,” culturally sensitive approaches to treatment with the hope that there will be improved outcomes. In other words, the author’s main objective is to demonstrate why physicians should become culturally competent, and how this goal can be accomplished – at the level of the private practitioner, for the provider working in the managed care setting, and for the healthcare administrator within the governmental structure.

R.A. Williams

Clinical Professor of Medicine, UCLA School of Medicine, President/CEO, The Minority Health Institute, Inc., Founder, The Association of Black Cardiologists, Inc., Chairman of the Board, Emeritus Institute for the Advancement of Multicultural and Minority Medicine, Washington, DC, USA

Glossary

Culture

The shared values, norms, traditions, customs, arts, history, folklore, and institutions of a group of people.

Cultural competence

A set of academic and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups. This requires a willingness and ability to draw on community-based values, traditions, and customs and to work with knowledgeable persons of and from the community in developing focused interventions, communications, and other supports.

Cultural diversity

Differences in race, ethnicity, language, nationality, or religion among various groups within a community, organization, or nation. A city is said to be culturally diverse if its residents include members of different groups.

Cultural sensitivity

An awareness of the nuances of one’s own and other cultures.

Culturally appropriate

Demonstrating both sensitivity to cultural differences and similarities and effectiveness in using cultural symbols to communicate a message.

Ethnic

Belonging to a common group – often linked by race, nationality, and language – with a common cultural heritage and/or derivation.

Language

The form or pattern of speech – spoken or written – used by residents or descendents of a particular nation or geographic area or by any large body of people. Language can be formal or informal and includes dialect, idiomatic speech, and slang.

Mainstream

A term that is often used to describe the “general market,” usually refers to a broad population that is primarily white and middle class.

Multicultural

Designed for or pertaining to two or more distinctive cultures.

Nationality

The country where a person lives and/or one that he or she identifies as a homeland.

Race

A socially defined population that is derived from distinguishable physical characteristics that are genetically transmitted.

Religion

A system of worship, traditions, and belief in a higher power or powers – often called God – that has evolved over time, linking people together in a commonality of reverence and devotion [71].