Message from the Editor


Minority Health: "Culture is Everything"

Elaine Sorensen Marshall, PhD, RN
Professor & Bulloch Healthcare Foundation Endowed Chair
School of Nursing
Georgia Southern University

“Culture is everything.”1 Nurses are leaders in recognizing the power of culture and its influence on health and health care.

Culture represents the great gestalt of human social phenomena. It is the whole: the constellation of values, knowledge, beliefs, and attitudes. It includes patterns of behavior, ways of living, roles, language and ways of communicating, myths, and meanings. It is time and space, objects and artifacts, traditions, stories, symbols, and metaphors. It is the whole of who we are in our families, ethnicities, regions, religions, and work. It embodies the entire portfolio of who we are as individuals in human communities.1

One of the greatest tragedies of American health care is the fact that quality and outcomes are inferior for specific racial and ethnic minority groups.2 Members of American ethnic and racial minorities of African Americans, American Indians, Alaska Natives, Asian Americans, Hispanics/Latinos, Native Hawaiians, and other Pacific Islanders continue to suffer enormous health disparities in cancer, diabetes, heart disease, stroke, HIV/AIDS, infant mortality, and child immunization rates.3 African American men are twice as likely to have prostate cancer as White men, Hispanics are twice as likely to have diabetes than Whites, Vietnamese-American women are five times more likely to have cervical cancer than White women,4 and African American women are less likely than White women to survive breast cancer. All minorities are less likely to receive preventive screenings then their White counterparts.1,5,6 Those states with greatest racial diversity also have greatest disparities in health across the lifespan.

Though cultural competence and cultural sensitivity have long been significant to nursing practice,7,8 there is a continued need for attention to culture and representation of all cultures, ethnicities, and races in health care research. One of the challenges toward greater cultural sensitivity is the very nature of the health care workforce. Nurses continue to be over 94% women and 89% White.9 As we recognize the need to eliminate health disparities among minority populations, we must move to acquire more than competence, but cultural humility. Cultural humility requires a willingness to reflect on the limits of our abilities to fully understand the culture of another, to recognize imbalances of power, and to cultivate sensitivity in its best sense. It means to embrace full inclusion while acknowledging differences and resolving disparities. Research in health care must reflect such cultural inclusion and humility.1 Culture is everything.


  1. Marshall, E. S. (2011). Transformational leadership in nursing: From expert clinician to influential leader. New York: Springer.
  2. Alliance for Health Reform (AHR). (2006, November). Racial and ethnic disparities in health care. Washington DC: AHR.
  3. Office of Minority Health, U.S. Department of Health & Human Services (USDHHS). Minority populations. Washington DC: USDHHS. Retrieved April 1, 2010 from
  4. Brewington, K. (2009, 18 September). Cost of racial disparities in health care put at $229 billion between 2003, 2006. The Baltimore Sun. Retrieved February 15, 2010 from
  5. Agency for Healthcare Research & Quality (AHRQ). (2000, February). Addressing racial and ethnic disparities in health care [fact sheet]. Rockville, MD: AHRQ. AHRQ publication No. 00-P041.
  6. Lee, C. (2006, October 25). Studies look for reasons behind racial disparities in health care. The Washington Post. Retrieved February 15, 2010 from
  7. Ballantyne, J. E. (2008). Cultural competency: Highlighting the work of the American Association of Colleges of Nursing-California Endowment advisory group. Journal of Professional Nursing, 24(3), 133-134.
  8. Watts, R. J., Cuellar, N. G., & O’Sullivan, A. L. (2008). Developing a blueprint for cultural competence education at Penn. Journal of Professional Nursing, 24(3), 136-142.
  9. Minority Nurse (2009). Minority nursing statistics. Retrieved January 27, 2010 from

Elaine Sorensen Marshall, PhD, RN
Interim Editor, Southern Online Journal of Nursing Research