The Influence of Culture and Genetics on Health
Case Study: A Native American family of four lives in a trailer park outside of Tallahassee, Florida. The father is a construction worker and works 12-hour shifts, relaxing at the end of the day with a few cold beers. The mother works part-time at a gas station until late afternoon. The two children, ages 9 and 12, eat breakfast and lunch through the free meal program at their school, and attend a free community outreach-tutoring program during the week. They stay with their maternal grandmother on weekends while the parents work. The grandmother suffers from diabetes. Their paternal grandfather passed away 6 years ago from pancreatic cancer. Both parents smoke. How might the family’s culture and genetic history influence your communication and approach in addressing their health risk?
In 2010, there were roughly 5.2 million American Indians and Alaska Natives living in the U.S., representing approximately 1.7% of the U.S. total population, (CDC, 2010). There are many tribes within the Native American culture and family structures vary from tribe to tribe; from the matriarchal structure (ruled or controlled by women), to the patriarchal structure (ruled or controlled by men). Elders in both matriarchal and patriarchal structured tribes are highly regarded. An example of the matriarchal structured tribe is the Cherokee Indians, in which the women owned the homes and garden plots, which were passed from mother to daughter.
It was also the Cherokee Women’s Council who determined which men were worthy of performing sacred duties or holding public office (PBS, 2006). Regardless of the diversity, Native American families value traditional beliefs such as relation, harmony, balance, spirituality, and wellness. It is a tradition in the culture to live in extended families, living in the home or very near the homes of one another in order to provide support in child rearing and family/cultural values. When nurses address Native American families, they must be observant and recognize who is the matriarch or patriarch of the family and include and respect them when communicating, providing services and educating anyone in the family.
When caring for the family in the case study, there are several health issues that would need to be addressed. The father drinking alcohol after work to relax needs to know that, Native Americans have alcohol dependency rates that are three times higher than the national average. Almost 20 percent of all Indian deaths are alcohol-related, compared with less than 5 percent for the general population. In 2009, Native American Indian youth aged 12-17 years and adults aged 18 years or older had the highest prevalence of smoking compared with other racial/ethnic populations (CDC, 2010). Both parents smoking can have an abundant influence on the children smoking. The grandmother’s battle with diabetes is not an uncommon one among Native Americans.
Diabetes has reached epidemic proportions amid this population; Native Americans are 2 times more likely to die from diabetes than other races; and more likely to be stricken with diabetes than Whites. Pima Indians (A tribe located in Arizona), has a 50% diabetes rate. Studies have shown that Native Americans are 43% more likely to be at risk when 3 or more alcoholic beverages are consumed each day (Office of minority health, 2010). Cancer among Native Americans is the third leading cause of death in people 45years and older. Pancreatic cancer in Native American men and women occur at an increased rate (natamcancer.org, 2010). Risk factors relating to the elevated rate of occurrence such as obesity, alcohol and tobacco use are modifiable and can be subjects the nurse can teach the family about. How would you build trust with the family before and during the visit?
The first step in building trust in a culture other than your own would be to learn what that culture values and considers as disrespect/respect before you visit. During the visit those cultural values must be respected even if you have to teach about subject that are differ from the cultural norms, the teaching must be done in a respectful manner. References
Stanhope, M., ; Lancaster, J. (2012). Public Health Nursing: Population centered healthcare in the community. Philadelphia, PA.: Mosby Elsevier Center for Disease Control
http://www.cdc.gov/cancer/healthdisparities. Retrieved 11/12/13 Native American Cancer Research Corporation
http://www.natamcancer.org/products.html. Retrieved 11/12/13 The Office of Minority Health. (2010). Diabetes and American Indian
http://minorityhealth.hhs.gov/templates/content Retrieved 11/12/13 Public Broadcasting Service. Indian Country Diaries
http://www.pbs.org/indiancountry/challenges/health.html. Retrieved 11/12/13