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Increasing the cultural competence of health care providers serving Minnesota's diverse populations
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Common medical issues and cultural concerns of Europian patients
Cultural competence is the ability to recognize and understand the role culture plays in health care and to adapt care strategies to meet patient needs.
Get to know patients on an individual level. Each person’s preferences, practices, and health outcomes are shaped by many factors. Generalizations in this material may not apply to your patients.
European Americans in Minnesota
More than 4.4 million Minnesotans identify as white, non-Hispanic. According to the 2010 U.S. Census, white Americans descended from European ancestors accounted for 85.3 percent of Minnesota’s population, compared with 72.4 percent of the nation’s population. That figure is projected to fall to 75 percent by 2035. Although Minnesota is considerably less diverse than some states, populations of color are growing at a significantly faster rate in Minnesota than the white population. In Minnesota, the white population grew at a rate of only 2.8 percent in the last 10 years.
About 2 percent of whites in Minnesota are foreign born and 71 percent have been here for more than 11 years. The largest reported ancestries of European-Americans in Minnesota are German (38%), Norwegian (17%), Irish (12%), and Swedish (10%)—groups that settled in Minnesota during the mid-1800s.
Nearly all European Americans in Minnesota speak English. Whites were among the four cultures which indicate 0 percent do not speak English well.
Data on whites or non-Hispanic whites generally applies to European-Americans. Because of the large percentage of white Minnesotans, their health outcomes are generally the same as the overall population. Some health issues could be biologically tied to race; many are tied to social inequities, including poverty.
Social determinant disparities
Social determinants of health are economic and social conditions that influence the health of people and communities.
Many aspects of European-American culture in Minnesota reflects the culture of the general U.S. population, althoughgenerational differences impact social practices. The white population is a loosely associated series of subcultures and non-cultures. More than many other cultures, European-Americans tend to value individualism and independence. They believe in responsibility for self—that individuals, not fate, control their destinies. European-Americans in general have a logical, problem-solving learning style.
European-Americans are described as being future-oriented—believing the future will bring happiness. European-Americans tend to value practicality and efficiency. They often attach significance to taking initiative and place importance on promptness. Many Minnesotans of European descent have a no-nonsense attitude toward work and tend to respect the dignity and intrinsic value of work. Many are identified by their professions and believe they will be rewarded based on individual achievement. They believe in competition and in the idea that free enterprise brings out the best in the individual.
In this population, the nuclear family is respected even though family members may be separated by distance. In 2015, about half all Minnesotans were married, although that percentage is shrinking. The majority of mothers work outside the home; children are often cared for in homes or schools that provide day care.
Many European-Americans follow the Standard American Diet, characterized by high consumption of red meat, high-fat salty foods, processed foods, sugary desserts, and often alcohol, contributing to an increase in obesity, diabetes, and hypertension. For non-Hispanic whites, 37.6 percent ate fast food on a given day, the second highest after African Americans. The percentage of adults who consumed fast food increased with increasing family income level. This diet is low in the fiber, complex carbohydrates, plant-based foods, vitamins, and minerals provided by fresh fruits, vegetables, whole-grain foods, and fish.
European-Americans often celebrate their heritage by preparing traditional ancestral dishes on holidays and special occasions, such as stollen and schnitzel (German), lutefisk and lefse (Scandinavian), and corned beef and cabbage or soda bread (Irish).
Traditional Western medicine, favored by most European Americans in Minnesota, is characterized by methods developed according to medical and scientific traditions and rigorous safety protocols with treatments and medications that must pass a strict review before they can be used for patient care. Western medicine’s greatest strength is in trauma care and therapies for acute problems, such as surgery, medications, chemotherapy, radiation, and physical therapy.
European American Minnesotans, in general, practice preventive medicine, such as getting immunizations regularly and testing for high blood pressure, high cholesterol, diabetes, and cancer. Prevention addresses the growing rates of chronic diseases and preventable cancers, and the epidemic increase in obesity and diseases related to obesity, such as heart disease, high blood pressure, stroke, and type 2 diabetes.
The Western diet is associated with epidemic obesity and chronic disease, resulting in illness and death from diabetes, heart disease, stroke, and cancer. In the 1800s and early 1900s when Minnesotans lived a primarily agricultural life, heart attacks were rare. By 1960, heart disease accounted for more than 500,000 deaths per year nationally. By 2006, heart disease accounted for more than 631,636 deaths per year.
Approximately one in five of all adults in the U.S. experiences mental illness in a given year. Rates of depression are higher in whites (34.7%), than blacks (24.6%) and Hispanics (19.6%). White Americans are more likely to die by suicide than people of other ethnic/racial groups.
End of life
As part of the Western model of health care, families often use palliative and hospice care services to manage advanced illness at end of life. In 2016, a substantial majority (86.5%) of Medicare hospice patients were white.
When discussing end of life issues with any patient, health care providers need to understand preferences based on personal and family views. At end of life, patients may be visited by family, friends, and clergy, and be prayed for by members of a religious congregation. Family, friends, and community members support the bereaved. Funerals and memorial services may be religious or non-religious. Traditional cemetery burial and cremation are practiced equally by this population.
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