Page 52 - Cultural Competence in Health Education

30 Cultural Competence in Health Education and Health Promotion

decisions, and overall access to primary care for themselves and their families. The
United States ranked twenty - seventh among industrialized nations in 2000, with an
IMR of 6.9 deaths per 1,000 live births (Child Health USA, 2004b). Another report by
Child Health USA also found higher death rates for U.S. infants among minorities and
disadvantaged groups. Only 17 percent of all U.S. births were to African American
families, but 33 percent of all low birth weight babies were African American (Child
Health USA, 2004a). Other data for African Americans refl ect this disparity in infant
mortality rates. What is interesting is that the African American infant mortality rate
has been consistently reported to be double the white rate since the United States
began to collect race - specific data. Some researchers have suggested that this disparity

is occurring because, over the years, African Americans have experienced consistent
deprivation as compared to whites (LaVeist, 2002). However, this apparently persis-
tent 2:1 ratio shows more variation when the relative rate is aggregated over the years
1981 to 1985 for all U.S. cities that are at least 10 percent African American. LaVeist
found that the degree of black to white relative disadvantage varied substantially
across cities, from .56 to 5.02, and in eight cities found a higher rate of infant mortality
for whites than for blacks. He suggests that these differences in disparity can be attrib-
uted to differences in racial residential segregation, poverty, and black political
empowerment (LaVeist, 2002).
One of the goals of Healthy People 2010 is to eliminate the disparities among
the racial and ethnic groups that have IMRs above the national average, including the
American Indian, Alaska Native, and Puerto Rican populations. The strategy will con-
sist of modifying the underlying determinants of birth outcomes including maternal
substance abuse, poor nutrition and lack of prenatal care, smoking, and chronic illness.
This plan to reduce infant mortality will require a partnership between health care pro-
fessionals and minority communities to encourage and support healthy behaviors.

HEALTH DISPARITIES BY ETHNIC GROUP
Asians and Pacifi c Islanders
Asian women have the highest life expectancy (85.8 years) of any ethnic group in the

United States (Office on Women ’ s Health, 2006). This life expectancy for women does
vary among Asian subgroups: Filipino women (81.5 years), Japanese women
(84.5 years), and Chinese women (86.1 years). However, Asians in the United States
also contend with numerous factors that threaten their health. Some negative factors are
infrequent medical visits due to the fear of deportation, language and cultural barriers,
and the lack of health insurance. Asians are most at risk for the following health condi-
tions: cancer, heart disease, stroke, unintentional injuries (accidents), and diabetes.
Asians also have a high prevalence of the following conditions and risk factors: chronic
obstructive pulmonary disease, hepatitis B, HIV/AIDS, smoking, tuberculosis, and liver

disease (Office of Minority Health and Health Disparities [OMHD], 2006). In 2004,
Asians were 5.6 times more likely than the total U.S. population to have tuberculosis.

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