Cultural Diversity in Medicine and in Healthcare Delivery

  • Richard Allen Williams


The past century has borne witness to a most unique development in the annals of American medicine. The patients who 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.


Cultural Diversity Healthcare Delivery African American Isosorbide Dinitrate Jackson Heart Study 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Federal Register, October 30, 1997.Google Scholar
  2. 2.
    A provider’s handbook on culturally competent care (1996). Latino population. Kaiser Permanente National Diversity Council.Google Scholar
  3. 3.
    Flores, G., Abreu, M., Olivar, M. A., and Kastner, B. (1998) Access barriers to health care for Latino children. Arch. Pediatr. Adolesc. Med. 152, 1119–1125.PubMedGoogle Scholar
  4. 4.
    Hispanic health in the United States (1991). Council on Scientific Affairs. JAMA 265(2), 248–252.CrossRefGoogle Scholar
  5. 5.
    Pappas, G., Gergen, P. J., and Carroll, M. (1990) Hypertension prevalence and the status of awareness, treatment, and control in the Hispanic Health and Nutrition Examination Survey (HHANES), 1982–1984. Am. J. Public Health 80, 1431–1436.PubMedCrossRefGoogle Scholar
  6. 6.
    Fuentes, F. (1995) CV risk factors and mortality in the Hispanic population. J. Myocard. Ischemia 7, 128–131.Google Scholar
  7. 7.
    Rewers, M., Shetterly, S. M., Baxter, J., et al. (1992) Prevalence of coronary heart disease in subjects with normal and impaired glucose tolerance and noninsulin-dependent diabetes mellitus in a bi-ethnic Colorado population:The San Luis Valley Diabetes Study. Am. J. Epidemiol. 135, 1321–1330.PubMedGoogle Scholar
  8. 8.
    Haffner, S. M., Mitchell, B. D., Valdez, R. A., et al. (1992) Eight years of hypertension in Mexican-Americans and non-Hispanic whites: The San Antonio Heart Study. Am. J. Hypertens. 5, 147–153.PubMedGoogle Scholar
  9. 9.
    National Center for Health Statistics: Health, United States, 1992. Hyattsville, Maryland, Public Health Service, 1993. US DHHS Publication (PHS) 93-1232.Google Scholar
  10. 10.
    Winkleby, M. A., Fortmann, S. P., and Rockhill, B. (1993) Health related risk factors in a sample of Hispanics and whites matched on sociodemographic characteristics: The Stanford Five-City Project. Am. J. Epidemiol. 137, 1365–1375.PubMedGoogle Scholar
  11. 11.
    Mitchell, B. D., Stern, M. P., Haffner, S. M., et al. (1990) Risk factors for cardiovascular mortality in Mexican-Americans and non-Hispanic whites. Am. J. Epidemiol. 131, 423–433.PubMedGoogle Scholar
  12. 12.
    Marsh, W. W. and Hentges, K. (1998) Mexican folk remedies and conventional medical care. Am. Fam. Physician 37, 257–262.Google Scholar
  13. 13.
    Schur, C. L., Bernstein, A. B., and Berk, M. L. (1987) The importance of distinguishing Hispanic subpopulations in the use of medical care. Med. Care 25, 627–641.PubMedCrossRefGoogle Scholar
  14. 14.
    CDC (1994–1995). National Center for Health Statistics, National Health Interview Survey.Google Scholar
  15. 15.
    Sorlie, P. D., Backlund, E., Johnson, N. J., et al. (1993) Mortality by Hispanic status in the United States. JAMA. 270, 2464–2468.PubMedCrossRefGoogle Scholar
  16. 16.
    Healthy People 2000 Progress Report for Black Americans (1997). US Public Health Service.Google Scholar
  17. 17.
    Bennett, C. (1995) The black population in the United States. Department of Commerce, Bureau of the Census, Current Population Reports (US) 20-480. Washington: US Government Printing Office.Google Scholar
  18. 18.
    Kaiser Permanente National Diversity Council (1996). A provider’s handbook on culturally competent care. African American population.Google Scholar
  19. 19.
    Bachu, A. Fertility of American women: June 1995 (Update). Department of Commerce, Bureau of Census Current Population Reports (US) 1995, US Government Printing Office.Google Scholar
  20. 20.
    McCord and Freeman, H. (1996) N. Engl. J. Med. 335, 1552.CrossRefGoogle Scholar
  21. 21.
    Francis, C. K. (1999) Cardiovascular disease in Blacks. II. Cardiology Special Edition 5, 85–89.Google Scholar
  22. 22.
    Gillum, R. F., Mussolino, M. E., and Madans, J. H. (1997) Coronary heart disease incidence and survival in African-American women and men: The NHANES I epidemiologic follow-up study. Ann. Intern. Med. 127, 111–118.PubMedGoogle Scholar
  23. 23.
    Asher, C. R., Topol, E. J., and Moliterno, D. J. (1999) Insights into the pathophysiology of atherosclerosis and prognosis of Black Americans with acute coronary syndromes. Am. Heart J. 138, 1073–1081.PubMedCrossRefGoogle Scholar
  24. 24.
    Taylor, H. A., Jr., Burchfiel, C., Fletcher, B., Jones, D., Mehrotra, B., and Ruffin, J. (1999) The Jackson Heart Study. ABC Digest Urban Cardiol. 6, 27–33.Google Scholar
  25. 25.
    Gillum, R. F. (1993) Epidemiology of heart failure in the United States. Am. Heart J. 126, 1042–1047.PubMedCrossRefGoogle Scholar
  26. 26.
    Mortality from congestive heart failure: United States, 1980–1990. Morb. Mortal. Wkly. Rep. 1994 43, 77–81.Google Scholar
  27. 27.
    Gillum, R. F., loc cit..PubMedCrossRefGoogle Scholar
  28. 28.
    Bourassa, M. G., Gurne, O., Bangdiwala, S. I., Ghali, J. K., Young, J. B., and Rousseau, M. (1993) Natural history and patterns of current practice in heart failure. J. Am. Coll. Cardiol. 22(suppl A), 14A–19A.PubMedCrossRefGoogle Scholar
  29. 29.
    Mathew, J., Davidson, S., and Narra, L. (1996) Etiology and characteristics of congestive heart failure in blacks. Am. J. Cardiol. 78, 1447–1450.PubMedCrossRefGoogle Scholar
  30. 30.
    Liao, Y., Cooper, R. S., McGee, D. L., Mensah, G. A., and Ghali, J. K. (1995) The relative effects of left ventricular hypertrophy, coronary artery disease, and left ventricular dysfunction on survival among black adults. J. Am. Med. Assoc. 273, 1592–1597.CrossRefGoogle Scholar
  31. 31.
    American Diabetes Association (1997). Diabetes Info: Diabetes Facts and Figures.Google Scholar
  32. 32.
    Gaines, K. and Burke, G. (1995) Ethnic differences in stroke: Black-white differences in the United States population. SECORDS Investigators. Southeastern Consortium Racial Differences in Stroke. Neuroepidemiology 14, 209–239.PubMedCrossRefGoogle Scholar
  33. 33.
    Caplan, L. R. (1991) Cardiovascular disease and stroke in African Americans. Circulation 83, 1469–1471.PubMedGoogle Scholar
  34. 34.
    Dunbabin, D. W. and Sandercock, P. A. G. (1990) Preventing stroke by the modification of risk factors. Stroke 21(12 Suppl), IV36–IV39.PubMedGoogle Scholar
  35. 35.
    Collins, R., Peto, R., MacMahon, S., et al. (1990) Blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 335, 827–838.PubMedCrossRefGoogle Scholar
  36. 36.
    Taylor, A. T., Ziesche, S., Yancy, C., et al. (2004) Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N. Engl. J. Med. 351, 2049–2057.PubMedCrossRefGoogle Scholar
  37. 37.
    Bronner, L. L., Kanter, D. S., and Manson, J. E. (1995) Primary prevention of stroke. N. Engl. J. Med. 333, 1392–1400.PubMedCrossRefGoogle Scholar
  38. 38.
    Oddone, E. Z., Horner, R. D., Sloane, R., et al. (1999) Race, presenting signs and symptoms, use of carotid artery imaging, and appropriateness of carotid endarterectomy. Stroke 30, 1350–1356.PubMedGoogle Scholar
  39. 39.
    Hall, D., Ferrario, C. M., Moore, M. A., et al. (1997) Hypertension-related morbidity and mortality in the southeastern United States. Am. J. Med. Sci. 313, 195–209.PubMedCrossRefGoogle Scholar
  40. 40.
    Moore, M. A., Epstein, M., Agadoa, L., and Dworkin, L. D. (1999) Current strategies for management of hypertensive renal disease. Arch. Intern. Med. 159, 23–28.PubMedCrossRefGoogle Scholar
  41. 41.
    National High Blood Pressure Working Group (1996). 1995 update of the working group reports on chronic renal failure and renovascular hypertension. Arch. Intern. Med. 156, 1938–194.CrossRefGoogle Scholar
  42. 42.
    Hostetter, T. H. (2003) Prevention of the development and progression of renal disease. J. Am. Soc. Nephrol. 14, S144–S147.PubMedCrossRefGoogle Scholar
  43. 43.
    Kaiser Permanente National Diversity Council (1997). A provider’s handbook on culturally competent care. Asian and Pacific Island American populations.Google Scholar
  44. 44.
    Sawyers, J. and Eaton, L. (1992) Gastric cancer in the Korean American. Cultural implications. Oncol. Nurs. Forum. 19, 619–623.PubMedGoogle Scholar
  45. 45.
    Rosenblatt, K., Weiss, N., and Schwartz, S. (1996) Liver cancer in Asian migrants to the United States and their descendents. Cancer Causes and Control 7, 345–350.PubMedCrossRefGoogle Scholar
  46. 46.
    Marchand, L., Zhao, I., Quiaoit, F., Wilkens, I., and Kolonel, L. (1996) Family history and risk of colorectal cancer in the multiethnic population. Am. J. Epidemiol. 144, 1122–1128.PubMedGoogle Scholar
  47. 47.
    Armstrong, R., Imrey, P., Lye, M., Armstrong, M., Yu, M., and Sani, S. (1998) Nasopharyngeal carcinoma in Malaysian Chinese: Salted fish and other dietary exposures. Int. J. Cancer 77, 228–235.PubMedCrossRefGoogle Scholar
  48. 48.
    Yan, L., Xi, Z., and Drettner, B. (1989) Epidemiological studies of nasopharyngeal cancer in the Guangzhou area, China. Preliminary report. Acta Otolaryngol. 107, 424–427.PubMedGoogle Scholar
  49. 49.
    Bonacini, M. and Valenzuela, J. (1991) Changes in the relative frequency of gastric adenocarcinoma in Southern California. West J. Med. 154, 172–174.PubMedGoogle Scholar
  50. 50.
    McKenna, M., McCray, E., and Onorato, I. (1995) The epidemiology of tuberculosis among foreign-born persons in the United States, 1986 to 1993. N. Engl. J. Med. 332, 1071–1076.PubMedCrossRefGoogle Scholar
  51. 51.
    Tong, M. and Hwang, S. (1994) Hepatitis B virus infection in Asian Americans. Viral Hepatitis 23, 523–536.Google Scholar
  52. 52.
    Angel, A., Armstrong, M., and Klatsky, A. (1989) Blood pressure among Asian-Americans living in Northern California. Am. J. Cardiol. 64, 237–240.PubMedCrossRefGoogle Scholar
  53. 53.
    Imazu, M., Sumida, K., Yamabe, T., et al. (1996) A comparison of the prevalence and risk factors of high blood pressure among Japanese living in Japan, Hawaii, and Los Angeles. Public Health Rep. 111, 59–61.PubMedGoogle Scholar
  54. 54.
    Kagan, A., Harris, B. R., Winklestein, W., Jr., et al. (1974) Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: Demographic, physical, dietary and biochemical characteristics. J. Chronic Dis. 27, 345–364.PubMedCrossRefGoogle Scholar
  55. 55.
    Dumbauld, S., McCullough, J., Sutocky, J., Mitchell, T., and Abbott, G. (1994) Analysis of Health Indicators for California’s Minority Populations. Minority Health Information Improvement Project.Google Scholar
  56. 56.
    Fujimoto, W. (1995) Diabetes in Asian and Pacific Islander Americans. In: National Institutes of Health. Diabetes in America. USA: NIH Publication.Google Scholar
  57. 57.
    National Center for Health Statistics (1994). Public Use Data File Documentation. National Health Interview Survey Multiple Cause of Death, 1986–1994 Survey Years, 1–40.Google Scholar
  58. 58.
    Denny, C. H. and Taylor, T. L. (1999) American Indian and Alaska Native health behavior: Findings from the Behavioral Risk Factor Surveillance System, 1992–1995. Ethn. Dis. 9, 403–409.PubMedGoogle Scholar
  59. 59.
    Healthy People 2000 Midcourse Review and 1995 Revisions (1997). Department of Health and Human Services, Public Health Service, 1–20.Google Scholar
  60. 60.
    Broussard, B. A., Sugarman, J. R., Booth, K., et al. (1995) Toward comprehensive obesity programs in Native American communities. Obes. Res. 3(Suppl 2), 289s–297s.PubMedGoogle Scholar
  61. 61.
    Howard, B. V., Lee, E. T., Yeh, J. L., et al. (1996) Hypertension in adult American Indians. The Strong Heart Study. Hypertension 28, 256–264.PubMedGoogle Scholar
  62. 62.
    Yu, P. N. (1991) Heart disease in Asians and Pacific-Islanders, Hispanics, and Native Americans. In: Cardiovascular Diseases and Stroke in African Americans and Other Racial Minorities in the United States. AHA Medical/Scientific Statement, Special Report. Circulation 83, 1462–1480.Google Scholar
  63. 63.
    Healthy People 2000 (1997). Progress report for: American Indians and Alaska Natives. Department of Health and Human Services. Public Health Service Publication.Google Scholar
  64. 64.
    Orlandi, M. A. (1992) Cultural competence for evaluators office for substance abuse prevention. US Department of Health and Human Services.Google Scholar

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Richard Allen Williams
    • 1
    • 2
    • 3
  1. 1.The David Geffen School of Medicine at UCLAUSA
  2. 2.The Minority Health Institute, Inc.USA
  3. 3.Institute for the Advancement of Multicultural and Minority MedicineLos Angeles

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