The Coming of Age of Multicultural Medicine

of 269,000 people nestled in California's largest agricultural valley, residents are reported to speak 100 different languages. Acculturation is diffi cult in the best of circumstances, but what happens when those people with limited or no profi ciency in English have a medical problem? Many United States hospitals are required to provide some manner of interpreter services for people with limited English profi ciency—but do those services also bridge the cultural divide? Meeting the challenge of providing health care for a multicultural population is now a major movement that is affecting health care in developed countries, principally the US but also in European countries and Australia. Although the bulk of studies and commentaries on the subject began to appear in the 1990s, the literature dates back much further, to articles written in the 1960s and 1970s by medical anthropologists, sociologists, nurses, mental health professionals, and others. In the US, the fi rst major alert on this problem came in 1985, when the Report of the Secretary's Task Force on Black and Minority Health was issued [1]. (The " Secretary " was the head of the Department of Health and Human Services (DHHS).) The report painted a bleak picture of the quality of health care afforded to African-Americans and other racial and ethnic minorities. A decade later, reports from the US Institute of Medicine began to appear. Three of the ten reports, which spanned a ten-year period, dealt with the need to greatly diversify the health professions work force—still a somewhat unachieved goal. The most recent, considered a new wake-up call, was the 2003 report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care [2]. It minced few words in describing the problems faced by racial and ethnic minorities who sought health care: " The conditions in which many clinical encounters take place—characterized by high time pressure, cognitive complexity, and pressures for cost-containment—may enhance the likelihood that these processes will result in care poorly matched to minority patients' needs. Minorities may experience a range of other barriers to accessing care, even when insured at the same level as whites, including barriers of language, geography and cultural familiarity " (Figure 1). Soon afterward, another US government arm, the Agency for Healthcare Research and Quality of the DHHS, issued two other reports: the National Healthcare Disparities Report [3] and the National Healthcare Quality Report [4], with annual updates promised. The reports focused …