Cultural context of medical practice.

Abstract

ne of the most striking characteristics of the con- temporary American West is the number and variety of ethnic minority group members who make it their home.There has been a steady growth of migrant and immigrant populations in the western states for more than a century.While the overall US population is rapidly expanding, growing by 6% between 1970 and 1980, the West has increased at an even more rapid rate.Rates of growth for individual states range from a low of 13.3% in Montana to a high of 63.5% in Nevada.'During the 1970s, furthermore, the num- ber of minority group members increased at a much more rapid rate than did the US population generally.Blacks grew by 17.3%, Native Americans and Hispan- ics* by even more, and the number of Asian and Pacific Island peoples more than doubled in the ten- year period.2With the exception of blacks, all major ethnic groups are heavily overrepresented in the West (See Table 1).For example, in 1980 42.8% of all Hispanics, 50.7% of Native Americans, 52.7% of Chinese-Americans, 69.3% of Pilipino-Americanst and 80.6% of Japanese-Americans lived in the western states.Many western US cities contain many tens of thou- sands of immigrants from every major part of the world.For example, it is estimated that since 1970, 2 million foreign immigrants have settled in the Los Angeles area alone, more than 90,000 of them during the single year of 1982.According to one report, "of L.A.'s 550,000 schoolchildren, 117,000 speak one of 104 languages better than they do English" (Time, June 13, 1983, p 20).With such numbers and such proportions, it is im- possible for physicians and other health professionals to ignore the special problems and needs of patients from these communities.These problems are of several kinds: First, many immigrant and refugee populations have higher rates of infectious disease and parasitic *Census data indicate that the population of Spanish-speaking origin increased by 61.0% and Native Americans by 71.4% between 1970 and 1980; however, these figtires are likely inflated becatise of changes in censuis procedures.