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INTRODUCTION

KEY POINTS

  • Physicians need to understand the traditional cultural attitudes, beliefs, and values of their African, Asian, and Hispanic patients, because these may affect healing practices.

  • Genetic, environmental, ethnic, and socioeconomic factors may play roles in the etiology and treatment of a disease.

  • Minority Americans typically receive poorer healthcare than Caucasian Americans.

  • The increased awareness of racial and cultural differences has encouraged more egalitarian healthcare delivery systems in America.

More than 5000 distinct ethnic groups exist in the world today. As people migrate to the United States and other developed countries in search of jobs, they bring along a broad collection of traditional customs and cultural beliefs. In its relatively short existence, the United States has become a melting pot of colors and cultures. In 1998, only 28% of the U.S. population was comprised of ethnic and racial minorities. By 2060, this figure is expected to reach 57%.1,2 In many metropolitan areas, cultural diversification has become the norm; Miami, for example, has the largest foreign-born population of any city in the world and is home to African Americans, Caucasian Americans, and Americans from Cuba, Central America, South America, and the Caribbean. New York and Los Angeles also have large foreign-born populations.3 Even historically homogeneous states—like Wisconsin or Iowa in the American Midwest, for example—are seeing a dramatic influx of immigrants, which is changing their demographic profiles.

Little has been published in the dermatologic literature on how cultural influences affect healthcare practices or physician–patient relationships. This chapter will attempt to shed light on this issue. It is clear that, as physicians, our cultural backgrounds influence how we communicate with patients and how patients respond to us. To deliver the best possible care, we must understand culturally driven, health-related behaviors and adapt our practices to accommodate them. Failure to do so may result in noncompliance or potentially harmful interactions between folk remedies and prescription medications, as well as missed opportunities for prevention or intervention.4,5

Attitudes toward illness have changed dramatically since the 1970s, to the benefit of physicians and patients alike, when the dominant model of illness was strictly biomedical. No room was left for the cultural, behavioral, psychological, or social dimensions that affect illness. Fortunately, it is generally accepted today that the social sciences can be used to bridge the gap between clinical medicine and specific cultural groups; biopsychosocial models are now being incorporated into medical school curricula, research, and teaching.

THE PROBLEM OF DEFINING RACIAL AND ETHNIC GROUPS

Defining the criteria for a specific ethnic group can be difficult. The term African American implies a family origin in Africa. The first Africans with skin of color were brought to the New World by Spanish conquistadors and slave traders in the sixteenth century. The first colonies were located in northern South American countries, such as Colombia and Venezuela, and in ...

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