Italian-Americans The standard history of the Italian-American experience, La Storia by Jerre Mangione and Ben Morreale, speaks of the "five hundred year" span of that experience.

This is a somewhat whimsical reference to the Italian (specifically Genoese) explorer Christopher Columbus: although Columbus' 1492 voyage of discovery did indeed bring an Italian into North American waters, one can hardly call Columbus an "Italian-American." However the annual federal holiday of Columbus Day was initially proposed by a first-generation Italian immigrant, Angelo Noce, and promoted by Italian-American fraternal groups (including the Roman Catholic fraternity, headquartered in New Haven, Connecticut, whose predominantly Italian-American members are called "Knights of Columbus"); the holiday stands as an annual reminder of the size and vitality of the community of Americans who claim descent from Italian immigrants (primarily during the great wave of Italian immigration in the later nineteenth and early twentieth centuries. It was recognized in the period immediately following World War Two that familiarity with the constitutive details of various American ethnic groups was valuable from a nursing and from an overall medical perspective. Dougherty and Tripp-Reimer (1985) sketch out a history in which the large Italian presence, less assimilated than at present, would be surveyed from the standpoint of medical anthropology. They write of the "history of the interface of nursing and anthropology":

Focus on the client's culture has a long history in nursing, particularly in public health nursing. Early in the century, public health nurses worked with immigrant groups, and a series of articles in the Public Health Nursing Quarterly gave cultural overviews of groups such as Italians, Russians, and Portuguese. While an intent of this literature was to promote assimilation of immigrant groups, other authors sought to improve understanding of their cultures. Yet, other than in public health nursing, inclusion of the cultural dimension was generally lacking until around the 1940s. Cultural content was introduced by nurses who had served with the military during World War II, and had learned the necessity of understanding cultural differences. After World War II, experienced public health nurses were added to nursing faculties and were able to teach from their experience with different ethnic groups (Dougherty and Tripp-Reimer, 219).

Yet the remarkable accelerated assimilation of the Italian-American community into the Italian mainstream in the six decades or so which have ensued since these initial anthropological studies of Italian-Americans necessitates a new look at this remarkable and high-profile American ethnic group, to assess its particularities for use by health-care professionals.

The health of Italian-Americans is addressed by Mangione and Morreale in La Storia, largely because it is an important part overall of the immigrant experience (regardless of country of origin). Mangione and Morreale write about the Italian-Americans:

Because of increased stress, the incidence of mental disorders was significantly higher among immigrants. Although the Italians were the most mentally stable of the immigrant groups in America, their suicide rate (as we have seen) almost tripled. The Italian immigrants were less prone than Americans to schizophrenia; alcoholism and drug addiction were virtually unknown among them. American statistics indicated that Italians rated among the lowest in admissions to both general and mental hospitals; but those particular statistics can be attributed to the great distrust that Italians (both in Italy and the United States) had for hospitals, which were seen as institutions of authority where bodies, especially of the poor, were used for experimental purposes. Hospitals and death were closely associated in the Italian mind, and many preferred to die at home. In Italy it was common for the family to care for the mentally ill at home, except in truly violent cases....Recent studies of the first and second generations show that those who fell ill had a "higher level of affective disorder -- "a rejection attitude towards authority, fixity in delusions systems and hypochondriacal complaints....and generally higher levels of depression and anxiety." The disorders differed by generation. The first generation suffered from somatic complains, physical ailment which the immigrants sometimes attributed to malocchio - the evil eye. Their offspring tended to develop "typical neurotic or psychotic symptoms" - guilt toward the parents whose culture they had broken with. The third generation's mental disorders were often of a "psychopathic type." Assimilation, however limited, had other negative effects. Poor living conditions made the immigrants susceptible to anemia, catarrh, poor appetite, bad teeth, curved spines, pneumonia, meningitis, diphtheria, and tuberculosis. And they died quickly. Industrial accidents...

Some of the men were literally buried in cement; the tunnels around New York and the coal mines of Pennsylvania became the graveyards of others. Even more disturbing to the immigrant than the hostility of the Americans was the emergence of health problems they had seldom encountered in Italy. (Mangione and Morreale, 229-231).
This is a good basic summary of the health-related issues with Italian-Americans, and I shall have occasion to refer to it in the analysis that follows. For now, I would like to note that Mangione and Morreale assume a certain level of rude health on the part of Italian-Americans, which to some degree has been followed up by empirical research as well. No less a connoisseur of statistical anomalies than Malcolm Gladwell, in his book Outliers, has a reason to consider one particular Italian-American immigrant community in Roseto, Pennsylvania (located in the eastern central part of that state, not far from Scranton). Gladwell writes:

In Roseto, virtually no one under fifty-five had died of a heart attack or showed any signs of heart disease. For men over sixty-five, the death rate from heart disease in Roseto was roughly half that of the United States as a whole. The death rate from all causes in Roseto, in fact, was 30 to 35% lower than expected….[Bruhn said:] "There was no suicide, no alcoholism, no drug addiction, and very little crime. They didn't even have anyone on welfare. Then we looked at peptic ulcers. They didn't have any of those either. These people were dying of old age. That's it."

After the medical researchers systematically studied -- and then eliminated -- diet, exercise, genetics, and environmental conditions, the reason they wound up citing for Roseto's "outlier" status was the town itself…As Bruhn and Wolf walked around the town, they figured out why. They looked at how the Rosetans visited one another, stopping to chat in Italian on the street, say, or cooking for one another in their backyards. They learned about the extended family clans that underlay the town's social structure. They saw how many homes had three generations living under one roof, and how much respect grandparents commanded. They went to mass at Our Lady of Mount Carmel and saw the unifying and calming effect of the church. They counted twenty-two separate civic organizations in a town of just under two thousand people. They picked up on the particular egalitarian ethos of the community, which discouraged the wealthy from flaunting their success and helped the unsuccessful obscure their failures. (Gladwell 7-9)

The lack of heart disease among the Italian-Americans of Roseto has been ascribed to the traditional Italian-American diet, which substitutes the use of olive oil for the use of butter and animal fats in cooking. But as Gladwell notes, the deeply conservative and family-based social life of the Italian-American community probably also plays a considerable role.

The heritage of Italian-Americans is slightly complicated: the largest subgroups are those who come from the Mediterranean island of Sicily (which has a somewhat different culture and dialect from mainland Italy) and those who come from the southern part of the Italian peninsula -- largely Neapolitan, Abruzzese, Calabrian or Campanian -- and then the northern Italians (which, for the purposes of American immigration, counts as anything from Rome upwards). Within Italy itself even to the present day, the northern part of the country is considered to be economically better off, and more "civilized" than Naples or Sicily: in any case, the regional differences mean that the great majority of Italian-Americans come from southern Italy or Sicily. To a large degree, the American conception of "Italian food" -- pastas and pizzas with tomato-based marinara sauce -- reflects southern Italian cuisine. Italian-Americans came, in other words, originally from the poorer and less industrialized regions of Italy, where many were not much different from peasants: certainly the monarchy and old aristocracy of Italy lingered on well into the twentieth century, and in portions of Sicily and Calabria almost feudal conditions persisted alongside the antiquated social order. The historic affiliation of Italian-Americans with the Democratic Party (which has altered somewhat in more recent decades) may be attributable to the existing political attitudes of those who emigrated, which were motivated largely by social justice. The famous case of Sacco and Vanzetti -- Italian immigrants executed in 1920s Massachusetts for a crime that they did not commit-hinged largely on their leftist ("anarchist") political convictions, combined with their status as Italians (Tropp 2005).

Gender roles in Italian-American culture are highly traditional, with a particular emphasis on masculine control. Marianna De Marco-Torgovnick refers in Crossing Ocean Parkway to "the way Italian-Americans are trained to think about…