Health Disparities
The “Middle East” is a non-specific identifier for the region of southwest Asia and Egypt. More than 20 countries and many more languages are included in this region. There is debate about the exact borders that define this region. Immigrants from the Middle East may identify with various religious and spiritual beliefs; the major religions of Judaism, Islam, and Christianity and other religious sects emerged and thrive in the region. The region includes a complex mix of cultures, health beliefs, social customs, and practices. In general, Middle Easterners may approach time, power distance, male/female roles, personal space, and privacy in ways that differ from many Westerners (Carteret, 2009). Health care providers working with clients from “the Middle East” will only be able to effectively use this general information when it is carefully combined with an assessment of client-specific information gained from observing, interacting with, and questioning each client.
The Office of Management and Budget (OMB) definition for the White race is “a person having origins in any of the original peoples of Europe, the Middle East, or North Africa” and the Census Bureau definition provides examples including “Irish, German, Italian, Lebanese, Near Easterner, Arab or Polish”. Therefore, while non-specific, “Middle Eastern” is a commonly used identifier for gathering information and determining trends about health at the population level. National, religious, and ethnic identifiers may be uncertain, incorrect, or non-specific due to lack of official identifiers for Middle East ethnicities in data generated from screening forms and public health databanks (Nasseri, Mills & Allan, 2007). In studies of health and disparities, length of U.S. residence has been used as a proxy for acculturation in ethnically diverse U.S. immigrants (Koya & Egede, 2007). Compared to length of U.S. residence, the more complex entities of language and health practices are more sensitive indicators of acculturation, but they are more difficult to obtain and measure.
Immigrants to the U.S. have been shown to be burdened by a range of health disparities, which may have little to do with their country of origin. Their employment and insurance status may be more important. Most immigrants are in the U.S. legally; undocumented immigrants account for only about 26% of immigrants. Even when working, immigrants are often low-income, and are less likely to have health insurance coverage. Immigrants often work in low-wage jobs, small firms, or occupations that are less likely to offer health benefits. The uninsured are more likely to report problems obtaining needed medical care and are less likely to get preventive care (Immigrants, 2004). Lack of health insurance coverage and access to a regular primary care doctor is a significant factor in determining health care status of immigrants (Siddiqi, Zuberi, & Nguyen, 2009).
Poverty drives health disparities more than any other factor (Freeman, 2004). There is a disproportionate representation of minorities in lower socioeconomic tiers. “Socioeconomic position in and of itself is correlated with health status, independent of individual risk factors, as people in each ascending step along the socioeconomic gradient tend to have better health, even when individual health factors are accounted for” (Unequal Treatment, 2003). However, cultural factors play a complex role in health disparities for immigrants. The health of many first generation immigrants has been shown to be better than those of their U.S. born peers (Unequal Treatment, 2003). Environmental living conditions, social, and behavioral risk factors contribute to health in general.
Exercise:
Purchase or borrow this short paperback book, A Framework for Understanding Poverty, by Ruby K. Payne, published by aha! Process, Inc, Highlands, TX (www.ahaprocess.com). It is commonly available in used bookstores for a nominal cost. Take the “Hidden Rules among Classes” quiz. This exercise assesses survival skills of individuals living in poverty, in middle class, and in wealth. Taking the quiz is an engaging way to point out how hidden rules are taken for granted by individuals in a particular class, which leads to assuming that these are the rules known by everyone.
Cancer health disparities have been shown to be driven by economic, social, economic, and health system factors (Freeman, 2004). “To understand the influence of culture on cancer, it is first necessary to untangle the confusion over definitions of race, biology, ethnicity, and culture and to carefully examine the assumption that socioeconomic factors trump race, culture, and ethnicity. Instead, it is the interaction of all these factors that determine health disparities and more clarity will increase the scientific basis for clinical practice and research among diverse populations” (Kagawa-Singer et al., 2010). Minorities are less likely to participate in cancer screening, genetic testing, and other prevention programs (Health Disparities in the United States, 2009). Poorer outcomes of cancer treatment due to delays from lack of access to care and lower quality medical services, result in minority populations as a whole having a higher total incidence of cancer and a higher total death rate (Health Disparities in the United States, 2009).
Exercise:
Take a minute to consider the personal actions you have undertaken in your lifetime to reduce health disparities. List 3 ways that you would like to become more involved at the community level in reducing health disparities due to poverty.
