Questions one through four deal with patients’ perceptions of their illnesses. Latino/a populations in the United States are very diverse with many different backgrounds and countries of origin. Although each patient has his or her own unique view, a practitioner should be aware of the following ideas in order to recognize them should they be presented.
Disease vs. Illness
The first important concept is the difference between disease and illness. Disease is a term given to a health condition by biomedicine (scientific medicine). It must be testable, observable, and measureable. It generally has a known cause. This view emphasizes biological factors over the sociocultural and psychological.11 In contrast, illness is the subjective response of the individual and those around him or her to the change in health.11 Meaning, origin, and significance are more important than measurable quantities. Views of illness are unique to each situation and individual, yet it is vital for practitioners to realize that many of their patients’ perceptions, including those of Latinos/as, will fall nearer to the definition of illness.
Balance Creates Health
Beyond that basic definition, a practitioner may encounter more specific differences. An example is the idea of “bienestar” or well-being.5 In this view of health, a balance between emotional, physical, and social contexts must be achieved. A lack of balance results in disease. One possible method of prevention under this model would be avoiding strong emotions. The idea of balance and health extends further into the hot and cold or humoral model of health.5 Hippocrates originally theorized that the body was composed of four fluids: blood (hot and wet), phlegm (cold and wet), yellow bile (hot and dry), and black bile (cold and dry).16 To maintain health, the amount of hot, cold, dry, and wet must be equal; any shift in one direction results in illness. Eventually the dry and wet faded, but the hot and cold part of the theory remained. Some Latino/a cultures ascribe to this explanation of illness.
Other explanations deal with specific conditions. Arthur Rubel defines folk illnesses as “syndromes from which members of a particular group claim to suffer and for which their culture provides an etiology, diagnosis, preventative measures, and regimens of healing”.22 Examples include mal de ojo (evil eye), empacho, ataque de nervios, susto, pasmo, and caida de mollera (sunken fontanel). Each has its own set of symptoms and causes. For instance, susto is caused by a loss of the soul. It is characterized by restless sleep, lethargy while awake, and loss of interest in life.22 Empacho is caused by eating too quickly or consuming the wrong foods. It results in nausea, a bloated stomach, and cramps.20 While these illnesses do not necessarily fit into the biomedical definition of disease, they still need to be addressed. For the patients, they are very real concerns. In addition, although a person may have a different name and explanation, a serious health condition may be present. A mother brought her child to a clinic and said that the baby had caida de mollera. The characteristic sunken fontanel was due to severe dehydration.20 Awareness prevents poor reactions or surprise when a patient presents with a folk illness.
Although health risks do not deal with a patient’s perceptions of illness, practitioner’s need to know the conditions that are more prevalent for a population. Patients can be screened for these, and preventative plans can be made in collaboration with the patient. The Centers for Disease Control lists the top ten causes of death among Latino/a populations as heart disease, cancer, unintentional injuries, stroke, diabetes, chronic liver disease/cirrhosis, homicide, chronic lower respiratory disease, influenza/ pneumonia, and certain conditions in the prenatal period.13 Of these, unintentional injuries and diabetes are a greater causes of death with Latinos/as than with general population. Chronic liver disease/ cirrhosis, homicide, and certain conditions in the prenatal period do not fall under the top ten causes of death for the general population.13 In addition to these conditions, the American Cancer Society states that Latino/a populations have higher rates of stomach, uterine/cervix, and liver/bile duct cancers.4 Other health issues should also be noted. Latino/a populations have the second highest rate of HIV/AIDS. Because some of the population may live in poor housing and in close proximity, there is an increased risk of infectious disease such as tuberculosis.13 Immigrants may also bring diseases from the countries they left. Along with these, rates of immunization are decreased which increases risk. According the Centers for Disease Control, while 70.2% of the Caucasians over 65 years of age received the flu vaccination in 2002, only 46.7% of Hispanics or Latinos/as did. With the pneumococcal vaccine, 60.6% of Caucasians were vaccinated as opposed to the 23.8% of Hispanics or Latinos/as.13 These specific health risks need to be addressed to provide the best possible care.
Acculturation and Health
A number of studies have been performed to determine the effect of acculturation on health. Ayala et al. and Arcia et al. found that more acculturation was associated with less healthy eating habits. This could be due to decreased access to healthy food and lower socioeconomic status in the United States (nutritious food is generally more expensive).1,2 The change in food consumption due to acculturation could increase a patients risk for diabetes and obesity. Although this would be difficult to remedy due to economic factors, practitioners could work with their patients to determine healthier but not more expensive foods.
Political Violence and HealthA final issue to be addressed in this guide is exposure to political violence in the native countries of immigrant Latinos and Latinas. An article by Fortuna, Porche, and Alegria argued that such experiences could increase the risk for mental illnesses such as depression and post traumatic stress disorder. Increased substance abuse is another result.10 In addition, immigrants may experience additional violence and discrimination in the
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