Essentials of Cultural Competence in Pharmacy Practice: Chapter 6 Notes

Chapter Author: Dr. Wendy Brown

Caucasian Patients

Learning Objectives1. Understand Caucasian culture as the

majority culture in the United States.2. Articulate key health concerns affecting

Caucasian individuals.3. Recognize the high-risk behaviors present

in Caucasian culture.

Caucasian RaceDefined by the Oxford English Dictionary as “a

broad division of humankind covering peoples form Europe, the Middle East, South Asia and North Africa” and as “white-skinned; of European origin.”

White and Caucasian are used interchangeably.In the United States, Caucasians comprise the

majority of the population and have historically been bestowed privileges because of this fact.

Caucasian, as a race, is filled with great diversity impacted by many religions, ethnicities, and sexual orientations.

Communication StylesThe primary language used by this majority

culture is American English.There are within-group differences in non-

verbal communication, though some commonalities among Caucasians exist (smiling, direct eye contact)

Family RolesThe make-up of contemporary Caucasian

families is varied.Earlier decades presented the ideal of the

nuclear family, though it is no longer the norm.Cohabitation, marriage, divorce, and

remarriage have shaped family roles.Most Caucasians marry. However, over half of

all US marriages end in divorce. The greatest risk factors for separation or divorce include living in neighborhoods with high levels of poverty, receiving welfare and/or unemployment, and having a low level of income and/or education.

Biocultural Ecology and Relevant Disease StatesCystic Fibrosis is the most significant

genetically linked disease embedded in the Caucasian culture.Currently 1 in 3300 Caucasians has cystic

fibrosis1 in 29 Caucasians is a carrier

Drug metabolismCaucasians are also known to have great

variability in drug metabolism (i.e. NAT gene and CYP 450)

High-Risk BehaviorsNotably high incidence of alcohol, illicit drug

use, and sexual assault.Alcohol:

13.4% lifetime abstainers17.09% former drinkers42.34% light drinkers15.18% moderate drinkers11.29% heavier drinkers

Illicit Drugs4% of pregnant women reported using illicit substance

within 1 month of being surveyed7.2% reported currently using illicit drugs

Sexual Assault17.9% of Caucasian women reported being raped at

some time in their lifetime.

Nutritional TrendsThere has been a historical shift from

nutrient deficiencies to overconsumption, decreased diet quality and poor food choices for the majority of the Caucasian population.

In 2004, a survey by the National Immunization Survey showed that 71.5% of Caucasian children were ever breastfed.

Further, 53.9% of those ever breastfed continued breastfeeding until at least 6 months.

Pregnancy/Childrearing PracticesCaucasian women have a higher rate of

multivitamin use before becoming pregnant, typically have lower rate of pregnancy-related complications, and are equal to other races in prevalence of infant checkups and postpartum contraceptive use.

According to abortion surveillance data reported by the Centers for Disease Control and Prevention, approximately 53% of women who obtained legal, induced abortions were Caucasian compared with 36% black and 8% other.

Death RitualsThe underlying theme of death practices

and beliefs is resolving loss.Most deceased bodies are embalmed,

displayed in a chapel or funeral home for a few days, and then buried or cremated.

Funerals are held to honor the deceased and the death is typically followed by a time of deep mourning and expression of pain and sadness by loved ones or survivors.

SpiritualityThe general population of Caucasians believes

in one God and life after death. Many individuals have a religious affiliation

and 77% think of spirituality in a “personal and individual sense” rather than in terms of “organized religion.”

People with higher level of spirituality have a lower incidence of mortality from cardiac-related illness, lower blood pressure, less substance abuse, recover quicker from depression, and are better able to cope with serious illness.

Health Care PracticeIn a 2000 census, 89.3% of Caucasians had

some form of health insurance.Among all adults, the likelihood of having

health care coverage correlated primarily with education level and income.

Caucasians report more pain than people of other races.

The health care workforce, in general, lacks diversity. Thus, Caucasians continue to be the dominant group of both practitioners and patients.

Reflection Questions1. How would you address the high incidence

of alcohol, illicit drug use, and sexual assault in treating Caucasian patients?

2. As a pharmacist, how will you work with Caucasian patients to treat diseases more prevalent in Caucasians, such as cystic fibrosis and poor drug metabolism?

3. How will you use the information contained in this chapter to inform your practice?