There are cultural challenges that we must be aware of in treating minority populations and providing the best possible care.
By Margaret Lancefield, M.D. Princeton HealthCare System
The U.S. Census Bureau recently projected that by the year 2042, minorities will become the new majority in America.
According to the bureau, the Hispanic population is expected to nearly triple, the Asian population will more than double, and the African-American population also will increase.
This changing face of America requires our health care system to continue to adapt to the needs of our minority communities and provide opportunities to educate our various populations about common health issues that affect us all, from heart disease and diabetes to cancer and osteoporosis.
At Princeton HealthCare System, our Community & Education Outreach Program has long been committed to addressing the needs of our multicultural population. This month we are joining the Princeton Regional Health Department in sponsoring two events specifically tailored to our diverse communities.
The first is a lecture for Chinese-American women about osteoporosis that will be delivered in Mandarin. Osteoporosis is a major public health concern for all women and is characterized by low bone mass, which can lead to fractures and chronic pain. Twenty percent of Asian women age 50 and older are estimated to have osteoporosis and 52 percent has low bone mass.
The second is a discussion for the African-American community about managing blood pressure and blood sugar. While it is important for all individuals to reduce their risk for diabetes and high blood pressure, it is critical for members of the African-American community, who are at higher risk for these disorders. Uncontrolled blood pressure and blood sugar are the cause of many preventable disabilities, including stroke, kidney failure and blindness.
We must also recognize that, when determining risks for certain diseases, cultural differences are relatively insignificant when compared to socioeconomic differences.
Research shows that issues such as access to care, the availability of nutritious and affordable food, and opportunities for education are key factors in health outcomes. History indicates that as new immigrants move up the socioeconomic ladder those obstacles often diminish.
Nonetheless, there are cultural challenges that we must be aware of in treating minority populations and providing the best possible care.
Consider language. When English is spoken as a second language, visits with a health care professional may require extra time and other measures to break the language barrier and find out why a patient is not feeling well. Patients who do not speak English need an interpreter. Many physicians have access to skilled interpreters through their office staff or medical telephone lines.
Many families also bring a cultural belief about who tells a sick person they are sick. In a wide range of cultures, this is not the doctor, but a family member. This approach raises concerns among the medical community about the information being presented to the patient and the patient’s understanding of the illness and treatment. It is critical for families to realize that with the proper care many illnesses can be treated and prevented.
Additionally, different populations may hold different beliefs about health care and medicine. Immigrant patients may receive herbal products sent to them from their native country and neither the patient nor the doctor knows what they are. Herbal remedies can have serious conflicts with traditional medicine, so any treatments not prescribed by a physician need to be approached with extreme caution.
At the same time, physicians must be aware of certain conditions that are generally more specific to individual cultures. For instance, in much of Asia, hepatitis B is widespread throughout the population. Over time, the disease damages the liver, which is why liver cancer is the No. 1 cancer in Asia. In the United States, however, it is unusual for a patient to have primary liver cancer, but doctors must keep it in mind when treating patients of Asian descent.
Another example is a disease that is widespread in a certain segments of Mexico and Central and South America where people live in houses with thatched roofs. A beetle-like insect that inhabits the thatch carries a parasite that can inflict residents with Chagas’ disease. A silent infection, Chagas’ Disease damages the heart and often leads to heart failure in patients in their 30s and 40s.
As we become an increasingly global society, these cultural issues are becoming more and more common in the United States and requiring doctors and patients to become more aware.
Yet regardless of race or ethnicity, there are basic screenings and preventative steps we can all take to protect our health. Patients should consult with their doctors about when and how often the following screenings should be performed:
• Blood pressure screenings;
• Cholesterol tests;
• Mammograms and Pap tests for women;
• Prostate cancer screenings for men;
• Colon cancer screenings;
• Blood sugar testing, and
• Flu shots and other immunizations.
In addition, a healthy diet and regular exercise go a long way in keeping illness at bay.
Princeton HealthCare System — through its Community Education & Outreach Program and together with the Princeton Regional Health Department — will host a discussion in Mandarin on “Understanding Osteoporosis in the Chinese- American Community” on Wednesday, Sept. 17, and a discussion on “Managing Blood Pressure & Blood Sugar: An Imperative for the African-American Community” on Wednesday, Sept. 24. Both discussions will be held between 6 p.m. and 8 p.m. in the Princeton Township Municipal Complex Community Room, 253 Witherspoon St., Princeton. To register for the free sessions or for more information, visit www.princetonhcs.org/ calendar or call 888-897-8979.
To find a physician with Princeton HealthCare System, call 888-742-7496 or visit www.princetonhcs.org.
Dr. Margaret Lancefield is board- certified in internal medicine and is the medical director of the community clinic at University Medical Center at Princeton.

