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Permission is granted to copy and distribute this Web page (excerpted from the National Center for Cultural Competence Policy Brief "Rationale for Cultural Competence in Primary Care") or reproduce excerpts as long as credit is given to the National Center for Cultural Competence.

Nowhere are the divisions of race, ethnicity and culture more sharply drawn that in the health of the people in the United States. Despite recent progress in overall national health, there are continuing disparities in the incidence of illness and death among African Americans, Latino/Hispanic Americans, Native Americans, Asian Americans, Alaskan Natives and Pacific Islanders as compared with the US population as a whole.

In recognition of these continuing disparities, the President of the United States has targeted six areas of health status and committed resources to address:

  1. cancer,
  2. cardiovascular disease,
  3. infant mortality,
  4. diabetes,
  6. and child and adult immunizations aggressively.


Research shows, in general, that people of diverse racial, ethnic and cultural heritage are less likely to get regular medical checkups, receive immunizations, and be routinely tested for cancer, when compared with the majority U.S. population.

  • Cancer deaths are disproportionately high among Latino/Hispanic Americans and African Americans.
  • Vietnamese women are five times more likely to have cervical cancer and Chinese Americans five times more likely to have liver cancer.

Cardiovascular disease

Disparities exist in the prevalence of risk factors for cardiovascular disease (coronary heart disease and stroke). Racial and ethnic groups have higher rates of hypertension, tend to develop hypertension at an earlier age and are less likely to undergo treatment to control their high blood pressure.

  • Mexican-American men and women have elevated blood pressure rates.
  • Obesity continues to be higher for African American and Mexican-American women.
  • Only 50 percent of Native Americans, 44 percent of Asian Americans and 38 percent of Mexican Americans have had their cholesterol checked within the past two years.
  • Coronary heart disease mortality is higher for African Americans
  • Stroke is the only leading cause of death for which mortality is higher for Asian-American males.

Infant mortality

Current studies document that despite recent advances, African American and Native American babies still die at a rate that is two to three times higher than the rate for white American babies.

  • Statistics reveal that among Native Americans and Alaskan Natives, the incidence of Sudden Infant Death Syndrome and Other Infant Death (SUID) is more than three to four times the rate for white American babies.
  • While the overall infant mortality rate has declined, the gap between black and white infant mortality rates has widened.


Studies indicate that diabetes is the seventh leading cause of death in the United States. Approximately 16 million people in the US have diabetes.

  • African Americans are 1.7 times more likely, Latino/Hispanic Americans are 2.0 times more likely, and Alaskan Natives and Native Americans are 2.8 times more likely to have diabetes than whites.
  • The Pima Tribe of Arizona has the highest known prevalence of diabetes of any population in the world.
  • Native Americans and African Americans have higher rates of diabetes related complications such as kidney disease and amputation as compared to the total population.


Recent data from prevalence surveys and from HIV/AIDS case surveillance continue to reflect the disproportionate impact of the epidemic on racially, ethnically and linguistically diverse groups, especially, women, youth and children.

  • African Americans and Hispanic/ Latino groups accounted for 47 and 20 percent, respectively, of persons diagnosed with AIDS in 1997.
  • Among African Americans, 56 percent of new HIV infections and AIDS cases are a result of intravenous drug usage; for Hispanic/Latino groups, 20 percent of new HIV infections and AIDS cases result from intravenous drug use.
  • Seventy-five percent of HIV/AIDS cases reported among women and children occur among diverse racial and ethnic groups.

Child and Adult Immunizations

Statistics from the President's Initiative on Race reveal that for the most critical childhood vaccines, vaccination levels for preschool children of all racial and ethnic groups are about the same. However, immunization levels for school age children and elder adults of diverse racial and ethnic backgrounds continue to lag when compared to the overall vaccination rates of the general U.S. population.

  • While 79 percent of white preschoolers are fully immunized by two years of age, only 74 percent of African American and 71 percent of Hispanic/Latino children, including preschoolers and school-aged children, are fully vaccinated against childhood diseases.
  • Annually approximately 45,000 adults die of infections related to influenza, pneumococcal infections and hepatitis B despite the availability of preventive vaccines.
  • Among the elderly, there is a disproportionate amount of vaccine preventable diseases in racial, ethnic and underserved populations.

Although the reasons for these disturbing gaps are not well understood, it appears that disproportionate poverty, discrimination in the delivery of health services and the failure of health care organizations and programs to provide culturally competent health care to diverse racial, ethnic and cultural populations are all contributing factors.

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