European Patients in Urban and
Rural Areas
Essentials of Cultural Competence in Pharmacy
Practice: Chapter 16 Notes
Chapter Author: Dr. David M. Scott
Learning Objectives
1. Understand differences between early immigrants of the
Midwest.
2. Articulate how the etiology of some European migration
affects the health of Midwestern Americans.
3. Understand how cultural eating habits contribute to health
risks.
Health Care in Rural Areas
 All states in the U.S. have underserved rural and urban areas.
 Rural areas often have shortages of health professionals as
well as other difficulties accessing health care.
 Growing immigrant populations that may work in rural
areas.
 One solution to expand health care access:
 ND telepharmacy project
Immigrants to the Midwest
 Irish
 Swedish
 Norwegian
 German
Irish
 Communication: jokes, limericks, and storytelling; direct eye contact and
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space.
Family: traditional nuclear families, with traditional lifestyles and belief in the
Roman Catholic Church.
Workforce: Many 1st generation Irish Americans were sources of willing and
cheap labor and worked as fishermen, construction workers, and industrial
workers. Valuing education, 2nd and 3rd generation Irish Americans are well
represented in all occupations.
Nutrition: Food is an important part of celebrations for Irish Americans. Meat,
potatoes, and vegetables are staples, with lamb, port and poultry being
common. Traditional dishes include Irish stew, oatmeal, soda bread, broths, and
pudding.
High-risk health behaviors: Given the fair skin, they are at risk for skin cancer.
Alcohol and tobacco use are major problems among Irish Americans as are heart
disease and lung cancers.
Health care practices: many ignore symptoms and delay seeking medical
treatment until they interfere with carrying out activities of daily living.
Swedish
 Workforce: Like many immigrants, the 1st generation was
primarily employed in sawmills and flour mills and/or
became domestic servants or worked in textile plants. The
2nd and 3rd generations recognized the value of education and
became professionals in their communities.
 Spirituality: Most immigrants belonged to the Lutheran
church, though others have joined many other
denominations.
 Nutrition: Traditional cuisine includes Swedish meatballs,
rice pudding, cardamom bread and Swedish rye bread.
During the Christmas season, lutefish, a dried cod fish, may
be enjoyed
Norwegian
 Workforce: Immigrants initially worked as farmers, iron
miners, lumberjacks and commercial fishermen.
 Spirituality: Lutheran Church was the primary affiliation of
Norwegian immigrants.
 Nutrition: Lutefish and lefse (a potato pastry) are included in
holiday celebrations.
German
 Workforce: Traditionally Germans valued education and employment.
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Many immigrants were farmers, millers, construction workers,
shopkeepers, and brewers.
Family: Traditionally, a nuclear family with the father as the head of the
household. Family reputation is very important.
Nutrition: Cuisine is high fat and can lead to overeating and obesity.
Spirituality: About 90% of the population has some religious affiliation
including Roman Catholic, Methodist, and Lutheran.
Health care practices: Health care providers are awarded a high status.
Reflection Questions
1. How does having a historical understanding of the Midwest
help you understand contemporary American culture?
2. What is your heritage? How does it impact your health
behaviors?
3. How is diversity found in places where people look very
similar?
4. What can your pharmacy practice do to be culturally
sensitive even when cultural practices encourage unhealthy
behaviors?