How Can Care Be Improved for Ethnic Minority and Underserved Groups?

The U.S. Preventive Services Task Force is an expert panel established by the federal government in 1984 to develop evidence-based practice guidelines on screening tests and other preventive services (Woolf et al., 1996). The second edition of the Guide to Clinical Preventive Services (U.S. Preventive Services Task Force, 1996) does not address multicultural or minority health issues. In the context of patient education, the physician is advised, "In considering a patient's belief system, the provider is challenged to facilitate the bridging of cross-culture gaps as well. Culturally sensitive education and counseling requires that clinicians assess their own cultural beliefs and be aware of local ethnic, regional, and religious beliefs and practices. Such knowledge aids the development of culturally specific health teaching" (U.S. Preventive Services Task Force, 1996, p. 77).

In one study, researchers examined 21 major health data systems of the U.S. Department of Health and Human Services and concluded that data on Hispanics are not included in several departmental national health data collection systems and that even when such data are collected, data on Hispanic subpopulations are found in few of the systems. When available, the databases often do not collect sample sizes adequate for analyzing any one of the four major Hispanic subpopulation. The researchers therefore support the call to collect data on Hispanics in all systems, to provide samples and subsamples large enough for statistical analysis, to support researchers and a research infrastructure for the Hispanic populations, and to support the broad dissemination of findings from the data that are presented in formats that are useful to Hispanic community-based organizations (Delgado and Estrada, 1993). Although the researchers do not address cancer per se, one researcher notes that hypertension is difficult to detect among groups such as Hispanics, for whom an array of impediments, including language and degree of acculturation, may retard the dissemination of information, making it difficult to detect and treat hypertension (Martinez-Maldonado, 1995).

In a survey of chronic disease directors in 50 states, only 16 states (32 percent) reported that they had sponsored or directly supported cancer prevention and cancer control services specifically targeted to American-Indian and Alaska-Native populations. Few state public health agencies had developed culturally relevant cancer education materials for American Indians and Alaska Natives. Although the respondents directed chronic disease or cancer prevention and control programs in their states, many were unfamiliar with the cancer patterns or general health problems among American Indians and Alaska Natives (Michalek and Mahoney, 1994).



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