Arab-American Culture and Health Care
Najeh M Ahmad, MD
April 15, 2004
1- Introduction and Objectives:
This chapter is intended to be a brief resource for health care professionals who are working with the Arab American community.
It will help practitioners in providing culturally appropriate health care by addressing some of the unique characteristics of the Arab-American culture and the implications of these characteristics on health care access and delivery; it is not in any way inclusive (17).
A. The definition of the term “Arab”:
term Arab is often associated with the region extending from the Atlantic coast
of Northern Africa to the
are 10 Arab countries in Africa (Algeria, Djibouti, Eritrea, Egypt, Libya,
Morocco, Mauritania, Somalia, Sudan, and Tunisia) and 11 countries in Asia
(Bahrain, Iraq, Kuwait, Jordan, Lebanon, Oman, Qatar, Saudi Arabia, Syria,
United Arab Emirates, and Yemen) and includes the Palestinian people.
(Palestinians are presently either living under Israeli rule, autonomy of
partial Palestinian Authority in the West Bank and
B. Language: An important aspect of the Arabic culture, 51 % of Arab Americans speaks language other than English at home.
The Arabic language can be divided into three categories:
- Classical Arabic, the language of the Qur’an; Modern Standard Arabic, used in newsprint and newscasts throughout the Arab World. While most people understand it, Modern Standard Arabic is not used in conversations. (3)
- Local dialects, which vary among countries and regions and are not easily understood by those who speak another dialect. (3)
- Other languages
spoken in the Arab World include Aramaic, an ancient language of
Figure 1: Map of the Arab countries
C. Arab Americans:
There are an estimated 2 to
3 million Arab Americans living in
Figure 2: Arab ancestry, from census 2000
The exact number of Arab
Americans is not known, because often they are reluctant to identify themselves
as being of Arabic descent out of a general fear of authority or out of concern
about possible negative social reactions (1). There are also problems with the
ways Arab immigrants to the
Approximately two thirds of
Arab Americans were born in the
The first wave of Arab
immigrants came mainly from Greater Syria, the geographic region now known as
The second wave of Arab
immigrants began coming to the
These immigrants also
settled in urban areas in the Northeast, as well as in Midwestern industrial
The third wave of Arab
immigration began after the Arab defeat in the Arab–Israeli war of 1967. This
wave is still occurring and is expected to continue for some time. These
immigrants often come to the
More than two-thirds of Arab Americans are employed. Of those, 73 percent hold managerial, professional, technical, or service positions. Seventy-two percent work in private sector, and 12 percent work in the public sector. Arab Americans have a higher median income than the average American family. About 11 percent of Arab Americans live in poverty, a number slightly higher than the overall population. (6)
Arab Americans are one of
the most diverse ethnic groups in the
3- Arabic Culture and Health Care:
A. Cultural communalities which have an impact on health care delivery may include (10) (17):
- Preferring to be treated by a medical provider of the same sex: this is especially true for female patients. That also applies when interpreting services are needed.
- Nurses are perceived as helpers, not health care professionals, and their suggestions and advice are not taken seriously. Doctors may need to explain the nurse's role to the patient.
- Arabs are not accustomed to the profession of social workers. They rely on their families, other relatives and close friends for support and help.
- Preferring medical treatment that involves prescribing pills or giving injections, rather than simple medical counseling.
- Among orthodox Muslims, following a halal (Muslim Diet), which prohibits some types of meat like pork and medications/foods that contain alcohol. For example you might have a diabetic Muslim patient refusing to take insulin or hospital pre prepared meals that contain Pork or pigs products.
- Among orthodox Muslims, strictly secluding women from men; in these societies, women may have little contact outside of the home. This is changing rapidly with women getting their rights in many Arab countries.
- Among devout Muslims, praying as many as five times a day, starting before sunrise and ending at night.
- Among devout Muslims, abstaining from alcohol is mandatory.
- Among devout Muslims, fasting during the holy month of Ramadan, with no food or drink consumed between sunrise and sunset, is required. The ill are supposed to be exempt from fasting, but among people who are fasting, oral medication and IV solutions are prohibited. Muscular injections are permitted. Women are exempt from fasting during menstruation and 40 days post partum. Despite their illness the Muslim patient may try to fast during Ramadan.
- When serving food or drink to Muslim patients in hospital, allow for receipt in the right hand. Muslims consider the left hand unclean since it is use to cleanse oneself after going to the toilet.
B. Some Health Care Issues in the Arab-Americans communities:
A major stressor for Arab Americans is stereotyping of the
Arab people, which has been exacerbated by recent world events. Arab-Americans
are classified as “White” by the
Honor (sharaf) is an important social aspect of the family. Under (sharaf), the actions of an individual can bring shame to the entire family. Thus, an individual might choose to ignore a potential health concern such as drug addiction, mental illness, venereal disease, or a pregnancy out of fear that the family would consider the condition to be shameful. Confidentiality of the patient-provider relationship and diagnosis and treatment of a potentially “shameful” condition could be of particular concern to the client in this type of situation, no matter what his or her age. Adolescents and unmarried women may be particularly vulnerable in this type of situation—for example, if a bill for services is sent to the home and opened by other family members. Another example: if unmarried woman is on contraceptives. Health care professionals must have high sensitivity to these issues (10) (17).
Lack of experience
is especially true with recent immigrants: Many Arab countries provide free
universal health care and private health care at costs much below those in the
- Mental Health is often considered a stigma:
Mental illness is often stigmatized in Arab communities, may be more
than other societies. A person with mental distress may not seek advice from
professionals, or even family members. Male family members are the major bread
winners for their families, and male unemployment can affect the mental health
of men more than women. In addition to
posttraumatic stress disorders resulting from war, dislocation, oppression, and
torture, many new Arab immigrants face other stressful events such as economic
hardship, assimilation into a new culture, racism, and other forms of
discrimination. Many immigrants may have held professional occupations in their
home countries but are unable to find comparable employment in the
- Access to Health care:
Many recent Arab Americans immigrants have language barriers, although many of them may hold part-time jobs that may prevent them from getting timely access to health care when needed. In addition, many part-time jobs do not provide health insurance or provide sick leave. Many recent immigrants don’t speak English fluently and that will limit their ability to seek medical care (11).
- Family, Marriage, Natality and Parenting:
Arabic societies was traditionally organized and governed by families or tribes, and the family remains an important institution. Families are generally patrilineal. This means that children strongly identify with the lineage of the father, and the paternal relatives hold primary responsibility for the children. In traditional Arab society, Christians prefer to give their children a Biblical name, followed by the father’s first name, then by the family name. Muslims commonly use the names of Mohammed and others in his family as well as “servant of God names” (Abdul-Rahman “Servant of the Compassionate”, Adbul-Aziz “servant of the Beloved”). Names may also carry secular meaning (e.g., Najeh, “successful”, Laila “night”). Ibn (bin) or bint means son or daughter of, respectively, and may follow the middle name. Last names may denote a person’s profession or their city of origin. (4)
Marriage is a highly stressed objective in the Arab culture, from the youngest age, people often wishes the child “farhatek”, your happiness on your wedding day. Premarital sex, though tolerated in secrecy with males, is totally shameful for the female and it can carry grave consequences on the individual female and her extended family. Natality is highly respected within the immediate family and infertility often considers a shame rather than a medical condition. Birth is considered a strictly feminine experience and the lack of male participation in the birth room should be expected. Children in the Arab family are often get a great deal of love and expectation. In Arab norm, light physical discipline of the child is considered proper parenting. In general, the general well being of the child is not neglected (17).
- Care for the elderly:
The elderly in the community are regarded with deep respect. They are given priority in all walks of life. An Arabic saying: “Heaven would be found under the feet of one's mother”. Therefore, the care of the elderly is regarded as an avenue to Heaven, another expression of worship. Whether they live together with their children or separately, parents are usually consulted in all decision making processes (17).
- Death, Dying and communicating bad news:
Arabic culture in general, regardless of being Christian or Muslim, believes in death as “the will of God” and nobody can stop it or delay it. So many Arabs are fatalistic where diseases are God punishment and only God can cure it. The words death, dying and cancer should be used with sensitivity and a feeling for others. Cancer is often referred to as “that” disease. This is usually followed by the sentence “God keep it away”. Arabs usually avoid discussing death, dying and how long a person is likely to live. In some Arab families, communication of diagnosis/prognosis is first given to the family – the closest member to the patient. The next of kin will advise the rest of the family. Euthanasia is forbidden. Autopsies are often considered disrespectful and get refused. Burying the dead as quickly as possible is expected. For a patient who just died, the face and body of the deceased must be covered by a sheet, the body must be handled as little as possible, and because Arabs in general believe that the body of the deceased feels the pain until burial (17).
4- Some Arab Americans resources:
Arab American Institute
American Arab Anti-Discrimination Committee/ National Association of Arab Americans
Council on American-Islamic Relations
1- Abraham, N. (1995). Arab Americans. In R. J. Vecoli, J. Galens, A.
Sheets, & R. V. Young (Eds.), Gale encyclopedia of multicultural America (Vol. 1, pp. 84–98).
2- United Nations
Development Program (UNDP) Human Development Report. Investing in
3. Douglass, Susan L. An Introduction to Islam and Arabs.
In Resources on Islam and Arabs.
5- Naff, A. (1980). Arabs. In S. Thernstrom (Ed.), Harvard encyclopedia of American ethnic groups
6- Arab American Institute, 2003 www.aaiusa.org.
7- Census Tract 2000. www.census.gov
8- El-Badry, Samia. "The Arab-American Market." American Demographics. 16:22-30. 1994
9- Census 2000, www.census.gov
10- Hammad, Adnan. Effectiveness and Efficiency in
the Management of Palestinian Health Services.
11- Laffrey, Shirley C., et. al. "Assessing Arab-American Health Care Needs." Social Science and Medicine. 29(7):877-883.1989.
12- Central Intelligence Agency (2003) World fact book. www.cia.gov
13- Said, E W (1979),
14- Simon, J. P. (1996). Lebanese families. In M. Mc-Goldrick, J. Giordano, & J. K. Pearce (Eds.), Ethnicity and family therapy.
15- American Arab anti discrimination committee. www.adc.org.
16- Washington Report on
17- This chapter also used several books and articles about Arabic culture which are written in the Arabic language only. For list in Arabic please email the author at Najeh.firstname.lastname@example.org.