Introduction
Hypertension is a heart disorder that causes increased diastolic and systolic blood pressure. Normal diastolic blood pressure in arteries ranges between 60 and 80 mmHg while systolic pressure ranges between 90 and 120 mmHg. During hypertension, the diastolic blood pressure in arteries increases and ranges from 80 to 100 mmHg while systolic blood pressure increases to ranges from 120 to 160 mmHg. Hypertension is a fatal heart disorder that does not only affect the heart and circulatory system, but also the functions of other organs like liver, kidney, and the brain, thus affecting general health condition of a patient. Epidemiological studies in the United States of America show that there is a significant racial and ethnical difference in the prevalence of hypertension among Americans. The studies show that Mexican-Americans are the second largest ethnical minority in the United States with high prevalence of hypertension as compared to other racial or ethnic groups. Salcido argues that, “two decisive factors make Mexican- Americans high-risk candidates for hypertension; their low socioeconomic status and the barriers erected against them by the health care system” (1979, p.373). Hence, their social and economic lifestyles together with inaccessible health care services predispose Mexican-Americans to hypertension. In order to understand the extent of prevalence of hypertension among Mexican-Americans, this essay explores the causes, treatment, cultural beliefs, health care barriers, cultural pattern of communication, and design culturally sensitive treatment plan.
Causes
Current studies indicate that the leading cause of hypertension is lifestyles such as poor diet and lack of physical exercise. Poor diet among Mexican-Americans due to social and economic factors has predisposed them to hypertension because “the researchers concluded that they had demonstrated a difference between Mexican-Americans and whites in occupational level, education, and family income” (Salcido, 1979, p.375). Therefore, Mexican Americans are prone to hypertension for they cannot afford healthy diets because of their low economic status as ethnical minority in the United States. Moreover, low educational level coupled with cultural beliefs make Mexican Americans to live lifestyles that predispose them to hypertension such as smoking, lack of exercise, alcoholism, and unhealthy diet. Unhealthy diet results into lack of important vitamins and minerals that are essential in regulating the homeostasis mechanism of the body resulting into hypertension. Studies have established that deficiency in potassium and vitamin D will result in hypertension particularly in an individual with poor health lifestyle.
Obesity and diabetes are also responsible for the development of hypertension. Obesity increases cholesterol levels in blood and constricts blood vessels and thus resisting smooth circulation of blood in the body. Research studies conducted on Mexican-Americans relative to other racial groups show that Mexican-Americans are more obese due to their unique lifestyles. Salcido reports that although cardiovascular conditions among Mexican Americans are comparatively similar to those of the whites, “like other low socioeconomic groups, they had a higher prevalence of obesity than persons of higher socioeconomic status, which may constitute a predisposing condition for hypertension” (1979, p.375). Hence, the prevalence of obesity among Mexican-Americans reflects the prevalence of hypertension in the community. Insulin deficiency results into poor regulation of sugar level in blood and subsequent osmotic potential of the body, which contributes to the occurrence of hypertension in the body. Hence, hypertension can arise due to complication of obesity and diabetes.
Hormonal imbalances in the endocrine system can cause hypertension. Adrenal hormones such as cortisol are responsible for regulating osmotic potential of blood and the functioning of the heart. Thus, diseases such as Cushing’s syndrome that causes overproduction of cortisol hormone increases osmotic potential of the blood vessels and increases pumping stress of the heart and eventually leads to hypertension. Eamranond and Patel argue that, “hormonal disorders such as hypothyroidism and Cushing’s syndrome significantly contribute to the hypertension among the elderly” (2007, p.671). Prevalence of hypertension in the older Mexican-Americans can be due to weak hormonal balance by their endocrine system. Endocrine system plays a significant role in homeostasis mechanism, which is very important in regulation of osmotic and ionic content of blood. Therefore, hormonal imbalance affects osmotic and ionic regulation of blood and predisposes one to hypertension.
Genetic factors also predispose one to hypertension and that explains existence of racial and ethnical disparities of the disorder. Pickering argues that epidemiological studies regarding hypertension show that, “there are huge differences in its prevalence among ethnic or cultural groups, as hypertension was more than 50% more common in many West European countries than in the United States or Canada, despite a presumably common gene pool” (2004, p.281). Therefore, prevalence of hypertension among Mexican-Americans can be due to genetic factors that dominate the gene pool of the ethnical minority relative to other racial and ethnical groups in the United States.
Treatment
Since hypertension is a heart disorder that results from changing lifestyles such as unhealthy diet and lack of exercise, it follows that proper nutrition and exercise will help in preventing the disorder. Medical experts advise hypertension patients to adhere strictly to healthful lifestyles by ensuring that they eat nutritiously and exercise well for their circulatory system and heart to remain healthy. Unhealthy diet and low social economic status are factors that are responsible for the hypertension among Mexican-Americans. Therefore, to help in preventing occurrence of hypertension in the community of Mexican-Americans, change in eating and exercising lifestyles is critical. Eamranond and Patel argue that, “lifestyle of Mexican-Americans that increases the prevalence of obesity and diabetes is the cause of hypertension” (2007, p.671). To improve health status of Mexican-Americans, change in eating and exercising lifestyles is very crucial in preventing obesity and diabetes, which in turn leads to prevention of hypertension.
Medical experts recommend on the increased consumption of potassium, magnesium, calcium, and vitamin D for they are very important elements in regulation of osmotic pressure in the blood. They also recommend on reduction of sodium intake because it increases osmotic pressure of the blood and thus hypertension. Among Mexican-Americans, obesity and diabetes are two major health disorders that predispose them to hypertension. Proper treatment and prevention of hypertension requires concomitant treatment of diabetes and obesity. According to Vijayaraghavan and Stoddard, “Mexican Americans comprehensive hypertension prevention and control efforts should also address obesity prevention and treatment. Additional efforts should involve reducing dietary salt consumption, a major risk factor” (2010, p.171). Thus, prevention and treatment of diabetes and obesity provides a milestone in controlling hypertension among Mexican-Americans.
Change in lifestyle provides a basis of using medication to prevent and control hypertension among patients. Medications cannot be effective if patients continue with unhealthy lifestyles such as eating unhealthy diet and failing to do physical exercises as well. Taking antihypertensive drugs is only effective when patients adhere to healthy lifestyles that help in preventing obesity and diabetes. “Efforts to improve blood pressure control should focus not only on increasing access to treatment and preventing hypertension but also on educating patient and health care providers to intensify treatment regimens for high blood pressure among adults with diabetes” (Vijayaraghavan & Stoddard, 2010, p.172). Hence, creating awareness on the nature of the disorder, treatment, and prevention of hypertension among Mexican Americans is going to help in controlling occurrence of hypertension in the population.
Cultural Beliefs
Mexican-Americans strongly believe in folk medicine practiced by natural healers popularly known as curanderos and santeros who give comprehensive treatment of all diseases. The folk system of healing consists of both medical and spiritual aspects of healing. Curanderos use herbal extracts when curing diseases while santeros invoke divine healing powers. Mexican-Americans believe that health is a gift from God and thus good or bad health depends on the relationship of a person with God. Galarraga argues that, “Mexican-Americans commonly perceive health as a gift from God regardless of whether they take part in the folk system of healing for health can be a reward for good behavior, and illness can sometimes be a punishment for wrongdoing” (2007, p.4). Hence, for the case of hypertension, they also view it as a punishment from God. To them, people suffering from a condition such as hypertension must have done something wrong against God and therefore deserve punishment. Although such beliefs are against medical perception of illness, Mexican-Americans believe strongly that their folk system of healing is very effecting in curing all diseases.
According to Mexican-Americans, substances that cause disease fall into two categories, ‘hot’ and ‘cold’ substances. The imbalance between ‘hot’ and ‘cold’ substances is responsible for the illness and thus folk healers need to balance the two. Galarraga asserts that, “an imbalance between hot and cold is considered a source of illness, with hot and cold not strictly referring to temperature but referring to the cultural classification of a particular substance or illness” (2007, p.5). Folk healers give guidelines to the people on how to balance ‘cold’ and ‘hot’ substances and failure to comply with the guidelines results into illness for example hypertension. ‘Pasmo’ is paralysis of the body due to failure to comply with the guidelines of balancing ‘hot’ and ‘cold’ experiences of life.
Mexican Americans also believe that illness can result from supernatural evil forces such as ‘mal de ojo’, which originate from envy. According to them, evil envy can befall anyone due to success in life or good health. For instance, a person can suffer from hypertension due to envy from other people or supernatural evil forces. “A supernatural cause of illness that comes from outside the body is “mal de ojo” and is caused by excessive admiration” (Galarraga, 2007, p.7). Hence, envy and evil forces are responsible for the illness that affects Mexican-Americans.
Since Mexican Americans believe that, their folk system of healing provides comprehensive physical and spiritually healing, they anchor onto it even in the contemporary society of technology. Curanderos employ herbal extract in treating diverse diseases like hypertension that they perceive as a heart condition while santeros use divine powers in praying for the sick and casting out evil spirits that are source of illness. Galarraga explains that, “treatments by curanderos and santeros include massages, herbs, counseling based on their spiritual capacities and cleanings that are performed as baths with a particular mix of plants. Santeros may also prescribe herbs, ointments, lighting of candles for saints and incense” (2007, p.8). For the case of hypertension, folk healing system treats both physical and spiritual aspect of the disease by use of herbs and spiritual powers respectively.
Health Care Barriers
Since Mexican-Americans are one of the ethnical minorities in the United States, social and economic marginalization causes them to stick to their cultural beliefs despite the fact that the mainstream society is advancing in modern medicine.
“Mexican-Americans fall far short of the white population in both income and health status because investigation of the Los Angeles health system showed the morbidity and mortality rates among Mexican-Americans to be two to three times higher than in the white population” (Salcido, 1979, p.372). Analysis of the economic and social status of the Mexican-Americans shows that the white majority has marginalized and sidelined them in terms of economic, political, and social spheres of life. The mainstream society has neglected Mexican-Americans leaving them to continue in their traditional ways of life since they have not adapted modern culture.
Historically, Mexican-Americans were a minority ethnical group that experienced racial discrimination during the colonial period and Mexican-Americans have since experienced racial discrimination causing them to ‘shy’ away from the modern civilization and advancement in technology. Salcido argues that, “stereotypes of Mexican-Americans provide an excuse for the health care system to ignore Mexican-American health care needs … because they prefer their traditional folk culture practices, such as use of curanderos and brujas and herbal remedies, to modern medical practice” (1979, p.374). Thus, stereotyping Mexican-Americans has created a barrier that prevents them from seeking medical attention concerning hypertension and hence they resort to folk system of healing that involves the use of herbs and divine powers.
Education is another barrier that prevents Mexican-Americans from accessing health care services equally as other races and ethnic groups. The mainstream society has neglected Mexican-Americans in terms of education and thus majority does not speak English language that is essential in communicating effectively. Research done to ask Mexican Americans why they do not go for the health care services revealed that language differences, dehumanizing experience of seeking health care services and difficulties in associating with the medical professional are the main barriers. This shows that educational system has not done much in ensuring that Mexican-Americans speak English as national language. “Language barriers may be an important cause of lack of awareness and under diagnosis of hypertension among Mexican Americans and this would imply that educating Mexican Americans through Spanish television, radio, and/or publications may possibly improve awareness and understanding of hypertension” (Eamranond & Patel, 2007, p. 703). Improving educational standards for Mexican-Americans to speak English and creating more awareness about modern medicine would significantly enhance their perception of the society and health matters. Moreover, preventive measures and treatment of hypertension requires some educational knowledge to demystify traditional beliefs and superstitions about causes and treatment of the disorder.
Cultural Communication and Treatment plan
Mexican Americans portray their emotions quietly in public, as they are very secretive and are very shy in that, they cannot maintain direct eye contact because they consider it disrespectful. Moreover, they are very expressive in terms of gestures as they consider that effective communication should entail use of culture. In Mexican-Americans, touching is a normal act of association between same sexes for it has no negative connotation as in the case of other racial ethnical groups in the United States. In terms of thought patterns, they are literal and direct in their arguments or explanation. They strongly believe in their family lineage, traditional healing system, and family values that keep them together as community. Mexican-Americans are also culturally sensitive to gender issues as female and male normally are distinct members of the society. Galarraga argues that, “the oldest man in the household holds the greatest power publicly and will often be in charge of making healthcare decisions and women are expected to adhere to the man’s opinion as a form of respect in the public sector” (2007, p.12). Thus, communication in the family follows hierarchy in the family structure of Mexican Americans.
Culturally sensitive treatment plan should incorporate communication patterns and cultural beliefs of Mexican-Americans in order to enhance treatment of the hypertensive disorder. For instance, treatment of a young man suffering from hypertension requires the medical professionals to understand the communication patterns of the patient and cultural beliefs regarding treatment to enhance diagnosis and treatment of hypertension. Since Mexican-Americans highly respect family protocol in the issues of health, the use of elders to convince the young man to accept modern medicine is paramount as a plan to incorporate modern medicine into their cultural set up. Moreover, medical professionals should talk friendly, use gestures, and probe quietly to increase compliance of the patient. The elders should have their opinion concerning treatment of hypertension so that they can give confidence to the patient and family members to accept modern medicine.
In addition, incorporation of therapeutic modalities and modification of traditional treatment will enhance cultural sensitivity to the treatment of hypertension. Medical professionals should adopt cultural names of referring herbalists and spiritual healers and use them in professional settings. For example since Mexican-Americans refer to herbalists as curanderos, adoption of the name to refer to the physicians can significantly change perception of the young man because he will perceive that he is going to see a modern curanderos. Likewise referring to psychotherapist as santeros would help in changing perception of modern medicine from traditional point of view. Thus, incorporation of cultural names into modern medicine can significantly encourage Mexican-Americans to seek treatment of hypertension and comply with the most neglected conditions of treatment due to negative attitudes or traditional beliefs.
Conclusion
Hypertension is a heart disorder due to increased blood pressure in the arteries. Unhealthy eating habits, lack of exercise, and hormonal imbalances are the major causes of the disorder. Prevention and treatment of the disease entails practicing healthy lifestyles and use of antihypertensive drugs. The prevalence of hypertension disorder is very high among Mexican-Americans because they deeply believe in the folk system of healing that is ineffective in treating the disorder. Moreover, since Mexican-Americans are one of the ethnical minorities in the United States, they do endure racial discrimination and marginalization by the mainstream races and ethnic groups that dominate the United States. Low social and economic statuses are the major causes of hypertension since Mexican-Americans are unprivileged and cannot access proper nutrition and healthcare services because they are very expensive. Moreover, marginalization has created language barrier that prevents Mexican-Americans from interacting effectively with the mainstream society, hence they shy away from seeking medical services from the available healthcare systems.
References
Galarraga, J. (2007). Hispanic-American Culture and Health. National Academic Press, 1-34
Eamranond, P., & Patel, K. (2007). The Association of Language with Prevalence of Undiagnosed Hypertension among Older Mexican Americans. Ethnicity & Disease, 17, 699-705.
Pickering, T. (2004). Hypertension in Hispanics. The Journal of Clinical Hypertension, 6(5), 279-282.
Salcido, R. (1979). Needed: Hypertension Research for Mexican Americans. Public Health Reports, 94(4), 372-375.
Vijayaraghavan, M., & Stoddard, P. (2010). Blood Pressure Control, Hypertension, Awareness and Treatment in Adults with Diabetes in the United States-Mexico Border Region. Rev Panam Salud Publica, 28(3), 164-173.