Manhattan Cross Cultural Group
The Quality Interactions® E-Newsletter
An Update on Issues in Cross-Cultural Healthcare

Introduction to the Quality Interactions® Newsletter

Welcome to the 14th issue of the Quality Interactions e-newsletter. This is a quarterly supplement to the Quality Interactions e-learning program that aims to provide updates on the field of cultural competence. Each issue includes a feature article, a literature update, and policy briefs on topics related to cultural competence and health disparities, including practical tips, case vignettes, and new research findings.

Feature Article

Complementary and alternative health practices across cultures

A 58 year-old woman from Mexico living in the US for 3 years presents to the emergency room with right upper abdominal pain and nausea for several days. The doctor in the emergency room asks her many questions and she responds. Initially, she is reluctant to tell the doctor about the fact that she sees a curandero (a traditional healer) for symptoms of fatigue that she has had for months. But the physician seems very open about this and non-judgmental, so eventually she mentions it. The curandero has been giving her herbal teas that have helped her somewhat. She has been reluctant to seek help from a physician as she views doctors and medicine as a last resort to be used only for very serious illness. Her feeling is that "Doctors are very costly and I don't like to take strong pills." She has only seen a physician once before for an appendectomy when she was twenty. She is very respectful of physicians however and believes that they can work miracles when a person is very sick. In the ER she is found to have serious inflammation of the liver (hepatitis). When the doctor looks into the specific herb that she has been using, she finds out that it has the potential to cause injury to the liver.

Understanding patients' perspectives and being open to them will help you to adapt your medical approach to one that can bridge the differences and lead to better outcomes. Here is a set of guidelines on how to approach patients about their complementary or alternative medical practices.

Literature Update

Socioeconomic Status, Not Race/Ethnicity, Predictive of ED Use for Routine Health Care

Researchers in New Jersey conducted a study on the role of race/ethnicity and socioeconomic status (SES) in the use of the emergency department (ED) as a source of routine healthcare. A total of 936 adult patients presenting to an urban ED completed the survey. After controlling for insurance status, income, employment status, and education, neither race nor ethnicity remained a strong predictor of routine ED use. Race/ethnicity-based disparities in routine ED use were due to the confounding effects of SES. The authors conclude that programs to reduce inappropriate ED use must be sensitive to an array of complex socioeconomic issues and may necessitate a substantial shift in how acute care is provided in low SES communities.

Racial/Ethnic Differences in Use of Complementary/Alternative Medicine for Arthritis

Data were obtained from individuals from 4 ethnic groups (African, Asian, and Hispanic Americans, and Caucasians) with osteoarthritis in a recent study focusing on complementary and alternative medicine (CAM) use. Use of 42 specific therapies within 7 categories-alternative medical systems, mind-body interventions, manipulation and body-based methods, energy therapies, and 3 types of biologically based therapies were explored. More than 80% of subjects reported that they used some CAM for arthritis in the past month. In contrast, 50% reported the use of prescription medicines, and 52% reported the use of over-the-counter medicines. Dietary practices were the most common type of CAM (71.5%), followed by mind-body interventions (42.4%), topical agents (38.1%), use of supplements or herbs (32.9%), and manipulation and body-based methods (21.4%). African Americans were more likely to report any CAM use than other groups (89.1% versus 83.1% [Asian], 81.1% [Hispanic], 77.7% [Caucasian]). African and Asian Americans more commonly reported the use of mind-body interventions in general, and prayer in particular. African Americans were also most likely to report the use of topical agents. Asian Americans were most likely to report use of alternative medical systems, manipulation methods, and supplements. Caucasians were least likely to report use of dietary practices. This research suggests that routine queries by physicians concerning CAM use would be beneficial.

Policy Update

Colorado Governor Signs Bill That Seeks To Eliminate Health Disparities

Colorado Gov. Bill Ritter (D) on Tuesday signed a package of health care bills, including one (SB 242) that seeks to eliminate health disparities. The bill calls for creating an Office of Health Disparities and two advisory councils to address racial, ethnic and rural health disparities. According to bill sponsor state Sen. Peter Groff (D), blacks, Hispanics and rural residents in the state have higher rates of diseases and are dying at faster rates than whites and urban residents. The new office will assess the disparities and develop solutions. Ritter said that eliminating racial and rural disparities in diabetes alone could save the state $80 million annually. "These new laws make good health care sense and good fiscal sense," he added.


  1. Keith VM, Kronenfeld JJ, Rivers PA, Liang SY. Assessing the effects of race and ethnicity on use of complementary and alternative therapies in the USA. Ethn Health 2005; 10(1): 19-32.
  2. Graham RE, Ahn AC, Davis RB, O'Connor BB, Eisenberg DM, Phillips RS.
  3. Use of complementary and alternative medical therapies among racial and ethnic minority adults: results from the 2002 National Health Interview Survey. J Natl Med Assoc. 2005; 97(4): 535-45.
  4. Hong R, Baumann BM, Boudreaux ED. The emergency department for routine healthcare: race/ethnicity, socioeconomic status, and perceptual factors. J Emerg Med 2007; 32:149-58.
  5. Katz P, Lee F. Racial/ethnic differences in the use of complementary and alternative medicine in patients with arthritis. J Clin Rheumatol 2007; 13:3-11.
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