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Nothing reflects the blend of cultures and ethnicities in America more thanwhat we like to eat—from flavorful soul foods to exotic Asian and MiddleEastern dishes.
Although the buffet table benefits from a diversity of ethnic foods, thenews is less favorable for the people who brought them to this country.Studies show that minorities suffer a disproportionate toll from diabetes,obesity, and cardiovascular disease.
Experts say that the health care system could do more to reach out toethnic groups and minorities.
"We need to think holistically about what we're asking people tochange, and what it means in different cultures," says Catherine A.Chesla, RN, of University of California, San Francisco, who recently completeda large study of personal, family, and provider factors in the health ofAfrican Americans with type 2diabetes.1
SHIFT FROM AUTHORITARIAN TO SELF-EMPOWERED APPROACH
Health care professionals have often expressed frustration that someminority patients are slow to develop the self-management skills educators tryto impart, even though language, finances, and cultural differences are commonbarriers to compliance.
For many years, Mexican Americans were perceived as "difficult todeal with," says Sharon Brown, RN, who coordinates a diabetes program inthe U.S.-Mexican border community of Starr County, Texas. "We had thisattitude towards them that they were just impossible because they would notfollow the guidelines or instructions they were given."
But the root of the difficulties was, and sometimes still is,recommendations that conflict with the culture.
Only in the last few decades have professionals tried to change theapproach to diabetes from being authoritarian to focusing on empowering peopleto deal with diabetes themselves, says Martha M. Funnell, RN, CDE, of theMichigan Diabetes Research and Training Center in Ann Arbor.
"The shift we have seen is the recognition that patients shouldn'thave to fit their lives to diabetes, but we should fit diabetes to theirlives," she says. "That's been critical to helping people achieveoutcomes."
This patient-centered approach involves taking the time to speak withpeople to learn their ethnic and cultural background, financial status, andtheir beliefs and values related to obesity and diabetes, Funnell says.
"It creates a different relationship with the patient," shesays. "It creates a partnership, rather than `I'll tell you what to do,and you better do it.'"
STEPPING UP TO THE PLATE WITH CULTURALLY SENSITIVE TOOLS
At its 2004 annual meeting, the American Medical Association (AMA) adopteda policy to address racial and ethnic disparities in the prevalence of obesityand related conditions (DOC News, July 2004). The policy recommendsthat providers use "culturally responsive care" to improvetreatment and that dietary guidelines include ethnic foods and multiculturalsymbols to depict serving sizes. The AMA also urges that nutritional anddietary research consider cultural and socio-economic factors.
Several organizations—including ADA and the American DieteticAssociation (ADietA)—have created materials specifically developed fordifferent cultures (see sidebar). But it wasn't always that way.
"In the early days, there was nothing for Spanish-speakingpatients," Brown says.
Dietary guidelines designed for a primarily white, middle-class audiencehave had limited meaning for people from other cultures. "We'd say thatif you want to save your life, you have to give up all the foods youlike," Brown says. "We'd recommend that they eat more like Anglosin order to be healthy. That's not only culturally insensitive, it's medicallyincorrect."
Today, a variety of health guides, cookbooks, and other resources areavailable for a range of cultural and ethnic groups.
"The positive point of the [new] foodpyramid* is that there's a lotmore of the grains and fruits and veggies, which give a lot of our ethnicpopulations more choices," says Karmeen D. Kulkarni, RD, coordinator ofthe diabetes center at St. Mark's Hospital in Salt Lake City, Utah.
While the situation has improved considerably for ethnic groups confrontingobesity and diabetes, more needs to be done to close the disparity gap,experts say.
"It seems as if people have begun to focus on foods that are morerelevant for different ethnic groups," Chesla says. "But itdoesn't go far enough."
The comprehensive self-management approach takes more time and effort,Funnell says, but the payoff is better compliance and healthier patients.
Footnotes
The American Diabetes Association (ADA) and the American DieteticAssociation (ADietA) have developed a series of patient education materialsand professional resources for a variety of regional and ethnic groups,including Filipino American, Alaska native, Hmong American, Chinese American,Jewish, Mexican American, Navajo, Northern Plains Indian, Cajun and Creole,Indian, and Pakistani, as well as groups that eat "soul" and"traditional Southern" cuisine.
The Ethnic and Regional Food Practices publications are available throughADietA atwww.eatright.org/catalog(search for "ethnic food") or by calling the organization'scustomer service at 1-800-877-1600, ext. 5000.
www.diabetes.org/shop-for-books-and-gifts.jsp
ADA's Web site offers several soul food cookbooks, including Month ofMeals: Soul Food Selections and New Soul Food Cookbook for People WithDiabetes.
ADA also has books in Spanish for patients and families, including Month ofMeals: Festive Latin Flavors (Mes de Comidas: Sabor Festivo Latino), Type 2:The Healthy Living Guide, Mr. Food's Quick & Easy Diabetic Cooking, andDiabetic Cooking for Latinos.
Materials created by ADA and written in Spanish for patients andprofessionals.
www.nhlbi.nih.gov/health/prof/heart/latino/latin_pg.htm
Latino resources for cardiovascular health from the National Heart, Lung,and Blood Institute.
* EDITOR'S NOTE: Watch for DOC News' coverage of the Departmentof Agriculture's new MyPyramid food guidance system in the August 2005issue. 
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