Cultural Diversity in Health and Illness

Dr. Rachel E. Spector has been a student of culturally diverse health and illness beliefs and practices for over 40 years and has researched and taught courses on culture and healthcare for the same time span. Dr. Spector has had the opportunity to work in many different communities, including the American Indian and Hispanic communities in Boston, Massachusetts. Her studies have taken her to many places: most of the United States, Canada, and Mexico; several European countries, including Denmark, England, Greece, Finland, Iceland, Italy, France, Russia, Spain, and Switzerland; Cuba; Israel; Pakistan; and Australia and New Zealand. She was fortunate enough to collect traditional amulets and remedies from many of these diverse communities, visit shrines, and meet practitioners of traditional healthcare in several places. She was instrumental in the creation and presentation of the exhibit “Immigrant Health Traditions” at the Ellis Island Immigration Museum, May 1994 through January 1995. She has exhibited health-related objects in several other settings. Recently, she served as a Colaboradora Honorifica (Honorary Collaborator) in the University of Alicante in Alicante, Spain, and Tamaulipas, Mexico. In 2006, she was a Lady Davis Fellow in the Henrietta Zold-Hadassah Hebrew University School of Nursing in Jerusalem, Israel. This text was translated into Spanish by Maria Munoz and published in Madrid by Prentice Hall as Las Culturas de la SALUD in 2003 and into Chinese in 2010. There have been two International Editions of the book. She is a Fellow in the American Academy of Nursing and a Scholar in the Transcultural Nursing Society. The American Nurses’ Association—Massachusetts, the state organization of the American Nurses’ Association, honored her as a “Living Legend” in 2007. In 2008, she received the Honorary Human Rights Award from the American Nurses Association. This award recognized her contributions and accomplishments that have been of national significance to human rights and have influenced healthcare and nursing practice.

Brief Table of Contents

Unit I Cultural Foundations
Chapter 1 Building Cultural and Linguistic Competence
Chapter 2 Cultural Heritage and History
Chapter 3 Diversity
Chapter 4 Health and Illness

Unit II Health Domains
Chapter 5 Health Traditions
Chapter 6 Healing Traditions
Chapter 7 Familial Health Traditions
Chapter 8 Health and Illness in Modern Healthcare

Unit III Health and Illness Panoramas
Chapter 9 Health and Illness in the American Indian and Alaska Native Population

Chapter 10 Health and Illness in the Asian Population
Chapter 11 Health and Illness in the Black Population
Chapter 12 Health and Illness in the Hispanic Populations
Chapter 13 Health and Illness in the White Populations

Chapter 14 Cultural Competency

Detailed Table of Contents

Unit I Cultural Foundations 1
Chapter 1 Building Cultural and Linguistic Competence 3
National Standards for Culturally and Linguistically Appropriate Services in Health Care 8
Cultural Competence 8
Linguistic Competence 10
Institutional Mandates 11
Cultural Care 12

Chapter 2 Cultural Heritage and History 17
Heritage Consistency 18
Acculturation Themes 25
Cultural Conflicts 26
Cultural Phenomena Affecting Health 29


Chapter 3 Diversity 34
Census 2010 and 2014 Estimates 36
Immigration 38 Poverty 43

Chapter 4 Health and Illness 48
Health 49
Illness 57

Unit II Health Domains 67
Health 68
Chapter 5 Health Traditions 72
Health and Illness 74
Health Traditions Model 75
Health Protection 78
Healthcare Choices 86
Folk Medicine 87
Healthcare Philosophies 88

Chapter 6 Healing Traditions 97
Healing 98
Ancient Forms of Healing 100
Religion and Healing 101
Healing and Today’s Beliefs 105
Ancient Rituals Related to the Lifecycle 108

Chapter 7 Familial Health Traditions 117
Familial Health Traditions 119
Consciousness Raising 123

Chapter 8 Health and Illness in Modern Healthcare 129
The Healthcare Provider’s Culture 130
Healthcare Costs 132
Trends in Development of the Healthcare System 136
Common Problems in Healthcare Delivery 138
Pathways to Health Services 140
Barriers to Healthcare 141
Medicine as an Institution of Social Control 142

Unit III Health and Illness Panoramas 147
Chapter 9 Health and Illness in the American Indian and Alaska Native Population 150
Background 151
Traditional Definitions of Health and Illness 153
Traditional Methods of Healing 155
Current Healthcare Problems 160
The Indian Health Service (IHS) 165
Cultural and Communication Problems 166

Chapter 10 Health and Illness in the Asian Population 171
Background 172
Traditional Definitions of Health and Illness 173
Traditional Methods of Health Maintenance and Protection 177
Traditional Methods of Health Restoration 178
Current Health Problems 184

Chapter 11 Health and Illness in the Black Population 190
Background 191
Traditional Definitions of Health and Illness 195
Traditional Methods of Health Maintenance and Protection 196
Traditional Methods of Health Restoration 196
Current Health Problems 202

Chapter 12 Health and Illness in the Hispanic Populations 213
Background 213
Mexicans 214
Current Health Problems in the Hispanic Population 232
Chapter 13 Health and Illness in the White Populations 237
Background 238
German Americans 239
Polish Americans 242
Italian Americans 245
Health Status of the White (Non-Hispanic) Population 249

Chapter 14 Cultural Competency 254
Cultural Competency 262

Appendix A Selected Key Terms Related to Cultural Diversity in Health and Illness 265
Appendix B Cultural Care Assessments 275
Appendix C Calendar: Cultural and Religious Holidays That Change Dates 281
Appendix D Selected Data Resources 284
Credits 286
Index 290