A significant proportion (30-41%) of older Americans has been found to use complementary and alternative medicine (CAM), including 38-50% of ethnic minority elders (Astin et al., 2000; Eisenberg et al., 1998). Although these data include more than culturally based practices, many elders who have immigrated from Asian and Latino countries use herbal or other culturally-based remedies, frequently without telling their American providers (Cohen, Ek, & Pan, 2002; Dole et al., 2000; Tanaka et al., 2008.)
All health belief systems are culturally based in that they are learned within the context of the culture’s values, knowledge system, and health care roles and organizations (e.g., the germ theory as a reflection of the value of science).
Major Systems of Culturally-Based Health Beliefs
BIOMEDICAL MODEL (WESTERN ALLOPATHIC)
Based on scientific reductionism, the biomedical model of medicine and nursing is the primary healing system of the dominant culture/group in the United States.
1. Mechanistic model of the human body
2. Separation of mind & body
3. Discounting of spirit or soul
TRADITIONS FROM AMERICAN INDIAN NATIONS
Health beliefs and views of death predate European immigration and vary by tribe.
CHARACTERISTICS OF MANY TRIBES
TRADITIONS FROM AFRICA AND EARLY AFRICAN AMERICAN HERITAGE
Various African traditions frequently integrated with American Indian, Christian, and other European traditions.
PREDOMINANT VIEW OF ILLNESS
In some Caribbean Islands, African traditions evolved into strong beliefs in power of spirits and use of healers to maintain health and treat illnesses. However, those beliefs probably have a weak influence on most urban African Americans today, except for more recent immigrants from Haiti.Many current African American elders, particularly those from the rural South, grew up using alternative practices of self-treatment, partly in response to lack of access to mainstream care during periods of segregation and discrimination.Experiences of segregation and memories of the Tuskegee Experiment (see below) may make the current cohort of older African Americans skeptical and distrustful of mainstream medicine, especially when making decisions about care at the end-of-life.
THE TUSKEGEE EXPERIMENT
In 1932, the U.S. Public Health Service began the Tuskegee Alabama Syphilis Experiment in which 599 black men with syphilis were studied. Although penicillin was discovered in the 1940s, the men were not treated until after the study ended in the 1970s.
TRADITIONS FROM LATIN AMERICA
Most Latino Americans practice the biomedical model, but among some elders there may be reminiscences of other beliefs. These beliefs are rooted in models developed from Native American, European, and African practices form an intricate cultural blend in which religion is an important component of the folk healing systems. For example:
- Santeria from Cuba
- Espiritismo from Puerto Rico
- Curanderismo from Mexico
USE OF HERBS
Use of herbs and other CAM practices are seen as in opposition to the biomedical model, although there is an integration of elements from both practices forming a complex cultural product.
OTHER EUROPEAN AMERICAN SYSTEMS
Folk healing systems from European countries predating biomedicine, many of which include religious healing and use of herbs, may still be practiced in some areas of the U.S. Variations on the belief systems of allopathic medicine, or competing health philosophies have emerged in the U.S. in the past century. Two of the major ones are:
MAJOR ALTERNATIVES TO ALLOPATHIC MEDICINE
Adler, et al., 2004; Boatman, 1992; Boatman, 1993; Eisenberg et al., 1998; Fabrega, 1993; Ma, 1999; MacLachlan, 1997; McBride et al., 1996; McCabe et al, 1994; McNeilly et al. 2000; Patcher, 1994; Purnell & Paulanka, 1998; Qureshi, 1994; Reynoso-Vallejo, 1999; Richardson, 1996; Semmes, 1990; Spector, 1996; Tinling, 1967; Villa, 1993; Watson, 1984; Zola, 1996.