Multicultural Health

Journal of Rehabilitation, Oct-Dec, 2010 by John L. Garland L. A. Ritter & N. A. Hoffman Jones & Bartlett Publishers As the United States moves toward a majority of its citizens belonging to one or more minority groups, cultural competence among helping and healthcare professionals has become a necessary and ethical component of our training and practice. Today's diverse culture requires that helping and healthcare professionals are knowledgeable of others beyond their own community and cultural group. Multicultural Health provides a well-organized compendium of concepts and theories grounded by case studies that highlight ethnic and cultural group health issues and practices. Regardless of one's healthcare or helping profession focus, Multicultural Health is, as the authors explain, not intended to be a panacea but rather a beginning point for helping readers along their journey toward increased cultural competence. Both authors are faculty in the Nursing and Health Sciences department at California State University, East Bay.

The text is divided into three units for organizing the authors' broad topic. The first unit includes a well-written foundation for informing the reader about important components of health care considerations across the United States' diverse cultural groups. These components include basic information on terms and concepts related to culture and race. This introductory unit also includes topics related to health care access, outcomes, and disparities that are often connected to a disability. The authors do a nice job of integrating broad ethnic belief systems and practices in the context of contemporary health care. They present evidence-based material in a non-paternalistic fashion that should appeal to students, faculty, and practitioners alike. This is especially evident in their chapter on legal and ethical issues where the chapter is presented as a tool chest of resources rather than a simple reporting of laws and ethical standards often found in similar texts. U.S. history is often told from a Euro-American perspective in textbooks and over time many textbooks have simply tacked-on chapters related to civil rights movements and struggles rather than integrating their content throughout the texts. Thus, we frequently find the histories of non-White, non-heterosexual, and noncitizen experiences presented as add-on chapters. This approach to informing our multicultural understanding seems to compartmentalize, rather than integrate, our multicultural history and understanding of others. When it comes to understanding specific health care needs of certain racial, cultural, regional, sexual, gender, and ethnic populations within a diverse society, however, separate chapters are often helpful with initial learning. The second unit of the text tends to walk in both of these worlds. Unit Two's chapters are presented across the primary racial and ethnic groups found in the United States today with a culminating catch-all chapter titled "No ethnic Populations: Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals; Migrant Farm workers." Certainly these last groups are also represented among all the racial/ethnic populations discussed in the preceding chapters, which

could imply the prior chapters are presented from a heterosexual, non-migrant perspective. The authors seem to be careful to not reinforce racial and ethnic stereotypes or generalizations through their ethnic chapters as so often happens in similar texts, but fall short in their case studies. Specifically, the authors' case study in the well-written chapter on American Indian and Alaska Native populations uses a narrative that may reinforce the notion that most American Indians live on reservations when, in fact, less than one-third reside on land reserves. This case study also uses an outdated proxy for American Indian racial identity known as blood quantum. The case study presents a client to the reader as a "full-blood" without challenging the reader to focus on the client's self-stated tribal/racial/ethnic affiliation. The inclusion of an antiquated blood quantum proxy for American Indian identity may reinforce stereotypic beliefs that blood quantum, or the idea that percentage of "Indian blood" determines identity over how one may identify culturally. It is important to note the use of blood quantum with American Indians was a Colonial assimilation tool imposed on American Indian communities for eliminating their cultural connections (Takaki, 1993). This critique notwithstanding, the text comes across as an outstanding primer on much of the foundational knowledge necessary for cultural competence. Aptly named "Looking Ahead," the third unit presents evidence-based solutions and resources for healthcare practice within a diverse and multicultural society. Unit Three's sparseness is an indication of the dearth of healthcare research available regarding many cultural and ethnic populations for addressing disparities in disease, disability, and mortality. This presents many opportunities for students, faculty, and practitioners to build on the text by considering new research, best practices, and cultural competency additions specific to their particular field.