Sociopolitical Histories

Many Asian and Pacific Islander populations have had stressful and painful experiences in their home countries and in the United States that affect their health and colors their interactions with the health care system. The effects of war, postwar experiences associated with migration, detention camps, or torture, and acculturation experiences associated with adjustment to US culture are major factors that might result in mistrust, fear, or helplessness, and may keep the patient from taking an active role in the clinical encounter.

Samuth Koam discusses the Cambodian experiences of being colonized and later the massacre by the Khmer Rouge known as the "killing fields." | 2.6 MB Flash File

Successive occupation by other cultures has resulted in repression of the unique Pacific Island cultures. Many Pacific Islanders have consequently experienced a loss of cultural identity and pride, leading to a sense of disconnectedness. Estrangement and the denigration of cultural strengths lay the foundation for what ails many Pacific Islanders and contribute to rising crime, substance abuse, and family violence. Providers should acknowledge this historical context and recognize its impact on current health and social conditions. Recent efforts to foster a Pacific Islander cultural renaissance have ignited hopes and should be encouraged.

Race, ethnicity, and socioeconomic status interact and influence the clinical encounter. Clients in poverty may lack the financial resources to follow physician recommendations. They may be uninsured and may refuse treatment that they consider unnecessary. Providers should try to understand the enormous stress associated with poverty—poor people often live in substandard housing, may be unable to buy essential items, and are often disrespected, scorned, and shunned by the larger society. Such experiences will certainly color the patient-provider relationship.

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