IV. Culture and Race In the Epidemiology of Disease

Both culture and race can affect the health and mental health of individuals but in quite different ways that are critical for health care policy makers, planners, and providers of services to discern. To illustrate: Most Japanese men and women, like many Asians, metabolize alcohol differently from Whites or Blacks, a circumstance that is genetically based.

Among many Japanese, consumption of even a very small amount of alcohol causes a visible phenomenon called facial flushing, a pronounced redness or blush. This is a biological effect linked to race. However, strong cultural norms encourage Japanese men to socialize together, drinking heavily while ignoring the flushing effect. On the other hand, Japanese cultural norms which proscribe heavy drinking among women cause them to report being embarrassed if flushing occurs and to refrain from drinking heavily. In working with Japanese alcoholics or abusers, culturally aware treatment providers will be cognizant of the interaction between culture and inherited traits.

Similarly, members of the Papago cultural group within the American Indian racial group have an inherited propensity to Type 2 diabetes. This propensity is exacerbated and expressed if a Papago’s diet is high in saturated fats and she/he has a sedentary life style. Diet and life style are culturally shaped; the inherited susceptibility to diabetes is not. In planning health care for members of this cultural group, culturally informed policy makers and treatment providers would take into consideration the complex etiology of the disease within this population.

In response to the finding that many black people metabolize medications differently from white people, a medication, BiDil, has been formulated for black people with heart failure. Culturally aware health care providers including pharmacists will understand that a black patient’s need for this specific medication is based on biology. The development and marketing of a drug for a specific racial group has not been without controversy.

Please refer to the following for more information about BiDil: June 23, 2005 news release from the Food and Drug Administration at http://www.fda.gov/bbs/topics/NEWS/2005/NEW01190.html; articles by Carmody & Anderson, 2007; and Temple & Stockbridge, 2007.