Culture and Health Disparities - Filipinos PERSONAL SOCIAL STATUS: In researching this project, I found a study prepared by the Canadian Nurses Association (2005). It reviewed the social determinants of health and how one's social status impacts their or their family health outcomes. The focus of this piece was on issues such as poverty, economic inequality, social isolation and social support systems and their impact on the health of minorities, many of the same categories and characteristics mentioned in the Journal of Transcultural Nursing (Andrews et al., 2010). While their study was more on a broad base of Canadian conditions, their findings seem to reflect the circumstances of many first and second generation Filipinos. First and later generations of Filipinos who move to new cultures do act differently, but for the most part there remain many family connections and networks that cannot be overlooked.

My social status is mostly a reflection of the fact that I come from a low to moderate income culture of people who respect work, opportunities, and the ties we have to our families (McBride, nd). The Filipino culture is strongly linked to English and Western practices and really emphasizes our commitment to hard work, accomplishment and the desire to ground my work in activities that help others (something which also leads them to nursing and other healthcare professions) (Castillo, nd). Many Filipinos move out of the islands to other nations, often to the U.S. Moving to a new culture allows Filipinos to adjust their cultural attitudes and expectations of success and pride in our families toward career opportunities that reflect well on us and our families as we become minorities who are able to make a comfortable living. It has been noted that Filipinos have for the most part been the "least poor" of the Asian people, even though there is plenty of evidence that many of our families still live in poverty; and there is other evidence that suggests that because of our strong cultural and family commitments, we remain anchored to a variety of cultural actions that directly impact the determinate factors of our own health.

CULTURAL HEALTH FACTORS: For the most part the Philippines are like many other island countries -- characterized by challenging poverty and a lack of advancing economic opportunities. These facts and the pride they often take in the Filipino tradition of wanting to help their families financially has been tied to their tendency to move to other countries. This dispersion of the Filipino people has emphasized some of the strengths and weaknesses of their culture when it comes to health and wellness issues (McBride, nd).

Filipinos can be extremely strongly tied to their families or to closely associated "fictive" networks of intimate others who may not be blood relatives but who are often accepted as part of their natural or extended family (Semics, 2007). While this may not always be a bad thing, it can have a number of implications for poor or nontraditional health considerations if what is expected is carried over to their new national experience. While having strong senses of family may be good for support, the same inclination can result in poor eating, exercise and even health care patterns when commitments to cultural and family patterns carry over poor habits. For example, it is well accepted that Filipinos are fond of eating (Sulit, 2010). They often welcome people with food or inquiries about whether someone has eaten yet. A food nutrition writer on this issue put it this way about the island culture even today,

Feast days and other celebrations and gatherings are incomplete without festive food on the table. They show their hospitality to visitors by serving them food. They invent new dishes and improve the old ones, mixing up whatever ingredients could tickle one's tongue. Try to walk on the streets in the Philippines and count how many carinderias (food houses) you pass by (Sulit,...

In a study of the health issues of Filipinos in Los Angeles, it was noted that while many respondents to a survey talked positively about their doing some levels of exercise regularly, they often turned to fast food just as often on a weekly basis (Semics, 2007). Their eating habits were reflective of the income levels in that poorer transplant families probably rely more on fast food outlets for family connections, but it is clear that eating publicly is an important element of Filipino dietary patterns. Holidays are significant periods across the year when Filipinos affirm their family allegiance by opting to get together and affirm their culture's eating patterns, much of which is centered on fatty and poor nutritional foods (Sulit, 2010).
A related issue of concern that is linked to Filipinos -- and that has direct implications for healthcare -- is the fact that their ties to their families (and their strong history of alternative medicines) means that they may well opt not to spend their resources on their personal health care, if someone in their direct or extended family network is more in need of care. In some ways this can be good. If a family has a member in a healthcare profession, for example, they may be pressured or feel pressured to care for family members. But it can also mean that some of these caregivers do not receive the care they need -- and the most likely family members to be in this position are older immigrants who come to the new culture later or who retain strong ties to their past beliefs (McBride, nd).

TRADITIONAL BELIEFS: Religion and traditional natural balancing practices still seem to have important implications for Filipinos of various socio-economic levels, even if they say that they do not consider these issues too much in their daily or professional lives. In a study of Filipino nurses in Boston, for example, where the researchers were studying why so many Filipinos went into healthcare professions, it was noted that it is still common for religious-based "healing masses" to play an important role in the lives of many Catholic Filipinos (Castillo, nd). Such spiritual togetherness was seen as a way of affirming the strength of the family and also making sure that a higher power could help with everything from drug or alcohol problems to gambling.

There is also still an acceptance that even though, for the most part, Western medicine is best, Filipinos still believe that there are important positive health benefits to the idea that a healthy body balances its own forces, a whole-body, holistic perspective. Filipino health understandings that are tied to older beliefs often assume that balancing hot and cold influences in one's body is good, and that when imbalances occur, the bad elements can be flushed out (either literally or figuratively). Past research on older Filipino health issues has affirmed the these attitudes have been associated with the importance of people keeping a healthy layer of fat on their bodies to product them from the cold (or heat) that might otherwise cause them ailments (McBride, nd).

EMPATHETIC DISABILIITES: In the Stanford study on older Filipinos, they review many of the traditional belief and the links between these factors and over health considerations in elder Filipinos. That work identified what is called kapwa, or the phenomena of "shared identity, interacting on an equal basis with a fellow human being." This viewpoint is directly related to the extension of family connections to the "fictive" networks where Filipinos can be very welcoming to others even at the expense of their own interests. When children or even elders are stricken with or born with a disability, for example, it is this sense of loyalty and equality that relates to how Filipinos address long-term…