Book Review

Multicultural Clients: A professional handbook for health care providers and social workers

N Engl J Med 1995; 332:1797-1798June 29, 1995

Article

Multicultural Clients: A professional handbook for health care providers and social workers
By Sybil M. Lassiter. 197 pp. Westport, Conn., Greenwood Press, 1995. $65. ISBN: 0-313-29140-3

Lassiter has attempted, somewhat naively and with an overall result that seems unacceptable, to foster increased awareness of cultural differences among white, middle-class health care professionals by summarizing key information about various cultural groups in American society. After an introduction that explains the rationale for the book, there are 15 chapters, each devoted to a particular cultural group selected because it accounts for a large minority of the U.S. population or large numbers of recent immigrants.

Some chapters describe cultural groups designated by the Census Bureau as racial or ethnic minority populations: African, Haitian, Chinese, East Indian, Filipino, Japanese, Korean, Vietnamese, Cuban, and Mexican Americans. Other chapters describe ethnic groups within the majority white population: Arab, German, Irish, Italian, and Jewish Americans. Ordered alphabetically, these chapters have standardized subheadings, such as “Population Characteristics,” “Communication,” “Chief Complaint,” “Beliefs about Death and Dying,” and “Physical Assessment.”

The book has several serious flaws. Most noteworthy are some erroneous statements that detract from the credibility of the overall book (e.g., “Generally, black people are of African origin, many of them ancestors [italics added] of the slaves” or “Muslims who believe that Allah was the true descendant of the prophet Muhammad are called the Shia”). There is also a blending of historical perspectives and sociological analysis (usually out of context) with current information, which could be misleading to the unsuspecting reader who has no independent knowledge of the subject (e.g., “A popular image of the African-American woman is that of Mammy, the affectionate nursemaid of both white and black children”). The only clues to the vintage and appropriate context of some of the perspectives in this book are the dates and sources in the citations. Also, the absence of any discussion of American Indians or Puerto Rican Americans, for example, seems inappropriate, given the prominence of these cultural groups in the population of people who may be least well served by the health care system. The strict format of the chapters seems self-defeating at best, since it results in the very stereotyping that the author cautions against in the introduction.

The positive message is the importance of what the author intended to do. We desperately need a good discussion of aspects of professional interaction in multicultural settings, and books of this type are relatively scarce. General textbooks and handbooks for health care providers often do not specifically discuss cultural issues. The failure to address such issues openly suggests the attitude that cultural factors are not meaningful in the delivery of health care, because they are homogeneous within the mainstream culture, are not relevant (i.e., not legitimate considerations in treatment or service delivery), or — worst of all — are to be suppressed in favor of the provider's views and customary practice.

The task of addressing cultural issues in health care may seem deceptively simple. In fact, these issues are very complex, and they must be addressed carefully in concert with scholars in the social sciences who are constructing paradigms that can provide a much more comprehensive understanding.

Shiriki Kumanyika, Ph.D., M.P.H.
Pennsylvania State University, Hershey, PA 17033