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.
Folk
Illnesses
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.
Increased Risks
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 Health
Copyright © 2007, Design by: Sunlight webdesign