European Patients in Urban and Rural Areas

1. European Patients in Urban and Rural Areas Essentials of Cultural Competence in Pharmacy Practice: Chapter 16 Notes Chapter Author: Dr. David M. Scott

2. Learning Objectives • Understand differences between early immigrants of the Midwest. • Articulate how the etiology of some European migration affects the health of Midwestern Americans. • Understand how cultural eating habits contribute to health risks.

3. Health Care in Rural Areas • All states in the U.S. have underserved rural and urban areas. • Rural areas often have shortages of health professionals as well as other difficulties accessing health care. • Growing immigrant populations that may work in rural areas. • One solution to expand health care access: • ND telepharmacy project

4. Immigrants to the Midwest • Irish • Swedish • Norwegian • German

5. Irish • Communication: jokes, limericks, and storytelling; direct eye contact and space. • Family: traditional nuclear families, with traditional lifestyles and belief in the Roman Catholic Church. • Workforce: Many 1st generation Irish Americans were sources of willing and cheap labor and worked as fishermen, construction workers, and industrial workers. Valuing education, 2nd and 3rd generation Irish Americans are well represented in all occupations. • Nutrition: Food is an important part of celebrations for Irish Americans. Meat, potatoes, and vegetables are staples, with lamb, port and poultry being common. Traditional dishes include Irish stew, oatmeal, soda bread, broths, and pudding. • High-risk health behaviors: Given the fair skin, they are at risk for skin cancer. Alcohol and tobacco use are major problems among Irish Americans as are heart disease and lung cancers. • Health care practices: many ignore symptoms and delay seeking medical treatment until they interfere with carrying out activities of daily living.

6. Swedish • Workforce: Like many immigrants, the 1st generation was primarily employed in sawmills and flour mills and/or became domestic servants or worked in textile plants. The 2nd and 3rd generations recognized the value of education and became professionals in their communities. • Spirituality: Most immigrants belonged to the Lutheran church, though others have joined many other denominations. • Nutrition: Traditional cuisine includes Swedish meatballs, rice pudding, cardamom bread and Swedish rye bread. During the Christmas season, lutefish, a dried cod fish, may be enjoyed

7. Norwegian • Workforce: Immigrants initially worked as farmers, iron miners, lumberjacks and commercial fishermen. • Spirituality: Lutheran Church was the primary affiliation of Norwegian immigrants. • Nutrition: Lutefish and lefse (a potato pastry) are included in holiday celebrations.

8. German • Workforce: Traditionally Germans valued education and employment. Many immigrants were farmers, millers, construction workers, shopkeepers, and brewers. • Family: Traditionally, a nuclear family with the father as the head of the household. Family reputation is very important. • Nutrition: Cuisine is high fat and can lead to overeating and obesity. • Spirituality: About 90% of the population has some religious affiliation including Roman Catholic, Methodist, and Lutheran. • Health care practices: Health care providers are awarded a high status.

9. Reflection Questions • How does having a historical understanding of the Midwest help you understand contemporary American culture? • What is your heritage? How does it impact your health behaviors? • How is diversity found in places where people look very similar? • What can your pharmacy practice do to be culturally sensitive even when cultural practices encourage unhealthy behaviors?