Puerto Rican culture and effects on health and illness

Puerto Ricans - Culture and Effects on Health and Illness

Anthropologists, sociologists, health care providers as well as other scientific researchers agree that while Puerto Ricans share some of their cultural traits with the larger Hispano-Caribbean population, they also present a specific cultural identity. Regardless of the political status of the islands that form the Commonwealth, Puerto Ricans are an ethnically distinct group (Wagenheim, 1973, 91). From the original inhabitants of the islands, the native population known as the Tainos, few survived the diseases the Spaniard explorers and settlers brought form Europe. Colonialism, slavery, migration and the fact that in the early twentieth century the islands became part of the United States with a special political status, all these contributed to the development of an extremely diverse population with sharing the genetic heritage from numerous populations that happened to come here from all over the world.

According to one of the United States Department of Health and Human Services 2000 reports, comparing the health risks of Hispanics / Latinos to those of the non- Hispanic white population, the former group is "twice as likely to die form diabetes…account for a disproportionate percentage of new cases of tuberculosis… have higher rates of high blood pressure and obesity…"(Hispanics/Latinos: Health Disparities Overview, p.1). On the other hand, according to the same material, while "the rate of low-birth-weight infants is lower for the total Hispanic / Latino population than for whites, the rate for Puerto Ricans is 50% higher than the rate for whites" (idem).

The special status of the Puerto Ricans in the context of their relationship with the United States and the fact that over the past decades they became U.S. citizens, created a round trip effect in the patterns of migration to the U.S. mainland and back to their native islands. Puerto Ricans brought thus with them their cultural beliefs, customs, traditions and other social factors that heavily influenced their health care seeking patterns. On the other hand, the new culture they encountered on the mainland also influenced their behavior, changing to some degree their attitude towards health care (Zayas, Palleja, 1988, 260).

According to the literature Zayas and Palleja reaserched for their article, Puerto Rican Familism: Considerations for Family Therapy, the first generation of Puerto Ricans born on the U.S. mainland tend to lean towards a sort of biculturalism instead of aspiring to being assimilated. Generally, Puerto Ricans, like other Hispanics / Latinos, place a great deal of importance on the value of family. The individual Puerto Rican on the islands grows up being taught that his or her family ties are sacred. This Puerto Rican places the integrity and well being of the family above anything else and acts in society accordingly. This attitude towards family and the resulting behavior in society tends to remain the same even after one's arrival on the mainland. The general health status of the family is among the factors of concern for all those involved in the family or relating to the members of the family thorough other ties the children who are brought up here, on the other hand, will naturally tend to develop a higher degree of independence, encouraged by the new culture they found here and influenced by their peers.

Traditional gender roles are challenged through the economic situation a respective Puerto Rican family will encounter upon having migrated to the mainland. Even if the traditional role of the head of the household, which is the father, is challenged through the economic conditions that may offer the wife better opportunities of employment, the fact that the larger family, friends, and even members of the same religious congregation can participate in the decision making in the nuclear Puerto Rican family remains mostly the same on the islands as well as in mainland. This includes the decision making in choosing the adequate health care provider and sticking to a health care plan prescribed by medical professionals ((Zayas, Palleja, 1988, 262).

Taking the case of infant mortality rates into consideration, Nancy S. Landale et al. start their study of the causality between the migration of the Puerto Ricans to the mainland and the rates of infant mortality with research results that show that Puerto Rican children born after their families have migrated here are at lower risks when it comes to infant mortality than their ethnic counterparts born by Puerto Rican women born here. This raises up the question of assimilation vs. rejection of the new host culture. On the other hand, "infant mortality is substantially lower among recent migrants to the mainland than it is among nonmigrant women in Puerto Rico" (Landale et al., 2000, 888).

The traditional attitude towards family among Puerto Ricans, be it nuclear or extended, was also heavily influenced by the migration patterns from the countryside to the urbanized areas, both within the island and from the islands to the mainland. Such changes occur naturally and the Puerto Ricans were affected by such effects like any other ethnic group sharing similar traditional views. In terms of the general health situation of this particular ethnic group, compared with the rest of the population on the U.S. mainland, the Puerto Ricans share the same fate with other ethnic groups that are generally affected by lower incomes. The socio-economic status of this group is directly negatively influencing its deteriorating health and death rates, compared to the rest of the non-Hispanic / Latino white population (Cordasco, Bucchioni, 1773, 152).

Pete Hamell is more drastic when it comes to asses the situation of physical and mental illness of the migrant Puerto Rican families on the mainland. He uses examples of Puerto Rican men, heads of the household, who could not bear the idea that their wives or daughters could earn more and thus contribute more to the total income of the family and committed suicide or even went to the extreme and killed their whole families before taking their own lives.

The younger generation, who have been brought up and lived most of or their whole lives on the mainland, are more inclined towards assimilation, even if at home they are educated in the same traditional Puerto Rican spirit. Therefore, the gap between the younger and the older generation is naturally widening, not necessarily because there is something specific about Puerto Ricans in this respect, but purely because it is a natural evolution that makes the young more open to change and the adoption of new revoluti9onary ways, while their parents and grandparent are struggling to fight preconceptions and prejudice both from the inside and from the outside (Hamell, 1973, 209).

When it comes to religious considerations, one must take into account that even if the majority of the Puerto Rican islanders are Catholic, religion is not bearing an essential influence on their health status just as it does not significantly influence the health situation of the Puerto Rican migrants to the mainland. Pete Hamell concludes that "religion itself doesn't seem very strong anymore. Some 85 per cent of the Puerto Ricans in Puerto Rico are Catholics, but until very recently the church there was run by outsiders….In New York this meant that not many Puerto Ricans ever went to church" (Hamell, 1973, 209). Focusing on the causes that lead to the increased risks of getting ill of diabetes miellitus the Puerto Rican migrants from South Florida face compared to the rest of the non-Hispanic / Latino white population from this region, Laura Gonzales considered factors such as cultural beliefs, religion and the perception of their health care providers. Like Hamell, the researcher reached the conclusion that although both "religiosity and spirituality did not influence decision-making" (Gonzales, 2008, iv ) when it came to getting health care assistance, they "did have a role in coping with the chronic disease" (idem). Based on her researches, in the case of diabetes among cases incidence among Puerto Ricans, Gonzales concluded that her aim group ended to favor the treatment offered by the American health care system over the traditional treatments they knew from their ancestors (idem).

Among other health risk factors that the Puerto Ricans are subject to, there is the Asthma syndrome that Peter Guranaccia had taken into consideration for his study of the relationship between this particular ethnic group, the illness and the care providers. The anthropologist studied a significant number of Puerto Ricans residing in two neighborhoods in Hartford, Connecticut. The author of the study starts from the premise that social and cultural factors play a certain role in the degree a group of people is affected by a particular disease. According to a National Heath Survey from 1970, the percentage of the patients reported to suffer from asthma in the U.S. was between 2 and 5% from the total population (Guaranaccia, 1981, 11).

Environmental factors appear to contribute to an overwhelming degree to the number of people affected by this illness. In the particular case of the Puerto Ricans, in the context of studies on this group among other tropical peoples, it was found that "allergens and climactic conditions" may contribute to triggering the disease. The genetic factors were also excluded as having a major influence in the medical condition according to studies that showed that genetic factors that may influence the illness are overcome in proportion of 3:1 by environmental factors (Guaranaccia, 1981, 11).

In her study, Laura Gonzales points out that Puerto Rican migrants are keeping in close contact with their relatives, friends and acquaintances from the islands, traveling back and forth, being engaged in what Christenson had defined as a "circulatory migration"(Gonzales, 2008, 2). The fact that the first language on the Puerto Rican Island is Spanish, English being widely taught in schools, but as a second language, made things harder for the older generations who migrated to the mainland. On the other hand, in a city like New York, one of the most targeted cities for the Puerto Rican migrators, Spanish is one of the languages "most commonly heard" after English, of course (Hernan LaFontaine, 1973, 326). They will thus naturally tend to associate with other Spanish speaking groups residing here.

After the end of WWII, Puerto Ricans came to New York in large numbers and kept on coming during the next decades. LaFontaine found out that at some point during this massive migration to New York, the Puerto Rican students accounted for a quarter of the total number of students in this city (idem). Based on his findings, the author tends to conclude that in spite of the high number of students with Puerto Rican origins in New York, in the 1960s, the efforts to encourage them to pursue a higher degree education that the authorities made were kept to a minimum. Consequently, the number of dropouts within this ethnic group was very high compared to the rest of the population (idem).

As mentioned before, studies show that the native Puerto Rican women on the island have lower rates of infant mortality. One possible explanation is that the survival of these infants is guaranteed, like in the case of other Hispanic / Latino groups, by the overwhelming role family protection plays in the care giving for these children (Landale et al., 2000, 890). The cultural and behavioral transformations Puerto Ricans are undergoing consequently to their migration to the mainland as well as the added stress that naturally occurs following a relocation of such proportions may have a general negative contribution to the rate of infant mortality within this ethnic group. On one hand, family traditions are subjected to changes due to the new cultural influences, while on the other, shifts in gender roles mainly due to socio-economic conditions, encourage the women to assume more active roles as financial providers for the family. The mother's time and ability to care for her young will be consequently reduced, although she will still receive the help of those around her.

A higher level of poverty spread among the Puerto Ricans residing in the two Hartford neighborhoods Peter Guarnaccia used for his study of cases of asthma suffering patients is also adding to the general level of poor health conditions. Guarnaccia takes into account environmental factors and the poor housing conditions that lead to the spread of parasites that cause infections such as Ascaris Lumbricoides or cockroaches and rats that contribute to the spread other infectious diseases. Deteriorating housing conditions, air pollution in the urban areas, along with the stress of family problems and the scarcity of programs to support families in need are all contributing to a deteriorating state of the health conditions of the Puerto Rican families that came under the attention of the scientists (idem). They are, of course, particular cases, but they are relevant in terms of the general population originating from the island or with Puerto Rican ancestry in so far similar socio-economic conditions are to be found prevailing elsewhere on the mainland for this ethnic group or on the island.