Major Cultural Groups in the United States
Blacks/African Americans
The 2005 census estimated the number of African Americans in the United States to be approximately 39.7 million (13.4% of the population) (OMH, 2007a). Over 33% of this population was under the age of 18 years. This number is expected to increase to 61 million by 2050 (Dossey et al., 2000).
The term black lumps together a group of highly diverse people who arrived in the United States from all over the world, including the Caribbean, Haiti, the Dominican Republic, and Africa. The terms African American and black are often used interchangeably but this may be incorrect since many blacks/African Americans did not come from Africa (Dossey et al., 2000; Luckmann, 1999). In this course, the terms black and African American will be used interchangeably. However, the authors recognize that some readers may wish to differentiate between the two terms.
Cultural Issues
The black/African American culture is distinct and encompasses values that differ from mainstream white American values. Many black/African Americans experienced and struggled against racism and, because of a perceived need for solidarity, have sought strength in their family, church, and community (Dossey et al., 2000; Luckmann, 1999). Many have also experienced social injustice, societal inconsistency, and personal impotence, which have had a profound impact on character development.
The core elements of the black/African American character include the following (Dossey, 1997; Leininger & McFarland, 2002; Management Sciences for Health, n.d.):
- Self-identity is tied inseparably to that of the group. The self is considered an extension of the group. The extended kinship group is very important even though the individual is socialized to be in control and independent at an early age.
- Knowledge includes what is known through the senses and in an extrasensory manner. For example, rituals, symbols, and language are ways in which knowledge is transmitted from one generation to another.
- Emotions are expressed naturally and spontaneously in response to experiences. Blacks/African Americans are highly expressive people as a result of their sense of oneness with life and of harmony with nature. Their physical movements are also characterized by a rhythmic sense of balance.
- Behavior is expressed through subtle patterns of verbal and body language.
- Communication may be expressed in black English. When communicating, blacks/African Americans may maintain eye contact while speaking to someone but look away while listening to that same individual.
The strengths of the black/African American include (Management Sciences for Health, n.d.):
- a religious or spiritual orientation
- a sense of racial pride
- resourcefulness
- family unity and strong kinship bonds
- a strong desire for education
- community involvement
However, because of many cultural disruptions, the black/African American today experiences an increasing vulnerability as a result of the following (Management Sciences for Health, n.d.):
- weakening of cultural bonds, values, and sense of community
- growing class/status-based identity
- increasing sense of hopelessness and powerlessness
- pervasive sense of isolation from and abandonment by the larger community
Health Care Issues
Violence, alcohol and drug use, and weakened family structures have been the result of these cultural disruptions. Other health problems for this group include the following (Management Sciences for Health, n.d.; OMH, 2007a; U.S. Department of Health and Human Services [HHS], 2000):
- The infant mortality rate in the United States has declined, but the infant death rate among blacks/African Americans is still more than double that of white Americans.
- Heart disease death rates are more than 30% higher for blacks/African Americans than for whites.
- African American adults are over 30% more likely than their white adult counterparts to have a stroke.
- The death rate for all cancers is 30% higher for blacks/African Americans than for whites; for prostate cancer, it is more than double that for whites.
- Black/African American women have a higher death rate from breast cancer despite having a mammography screening rate that is nearly the same as the rate for white women.
- The death rate from HIV/AIDS for blacks/African Americans is more than nine times that for whites. About 64% of all women with new HIV infections in any given year are African American.
African Americans have a higher incidence of hypertension, diabetes, and sickle cell anemia than the majority population. - The rate of homicide for blacks/African Americans is six times that for whites.
Many of the folk remedies of African Americans come from the time they spent as slaves in the United States. Since physicians and nurses were often unavailable to the slaves, the slaves depended on remedies that they had brought with them from Africa. African Americans may seek assistance from folk practitioners and faith healers with a reliance on the professional health systems used only during extreme injury or illness (Leininger & McFarland, 2002). Some blacks/African Americans believe that "hexes," "sins" "disharmony," and the supernatural can impact their health. Individuals with curative power include the "old lady," "Granny," "voodoo priest," or "root doctor." Treatments include the following (Dossey, 1997):
- the use of teas and cod liver oils
- the effect of dietary choices
- the use of laxatives for purging
- the wearing of amulets, and copper or silver bracelets
Delivering culturally competent care to the black/African American means recognizing the following (Leininger & McFarland, 2002; Management Sciences for Health, n.d.):
Individual and community dysfunction results from the dislocation or disruption of core cultural systems.- The term healthy needs to be applied to the community as a whole, and not just to the individual.
- This culture believes in the connection between God, health, and illness. There is diversity in religious beliefs of African Americans as some are Christians, some are followers of Islam, some are Jewish, and others belong to various groups.
- Individuals and communities need to be empowered, instead of "fixed."
- Cultural heritages need to be celebrated and individuals must be assisted in reestablishing their "village."
- It is important to help blacks/African Americans expand their personal vision of possibilities for their future so they avoid destructive behavior.
- Points of intervention need to be appropriate and timely.
- Cultural arrogance on the part of the provider must be avoided.
