Since 1965, with the passage of an immigration act reversing decades of exclusionary policy, Latin American and Asian immigration has been on the rise. In 1960 seven of the top ten countries of immigrant origin were European; in 1997 only one was European. (The top ten countries sending immigrants to Chicago, for example, in 1997 were Mexico, Poland, India, Philippines, People's Republic of China, Ukraine, Pakistan, Russia, Vietnam, and Korea.) Today, one in five American children is an immigrant or the child of an immigrant.
In their book, Immigrant America, scholars Alejandro Portes and Ruben Rumbaut observe, "Never before has the United States received immigrants from so many countries, from such different social and economic backgrounds, and for so many reasons." This new diversity defies the easy generalizations made about classical American immigration waves: "There are today first-generation millionaires who speak broken English, foreign-born mayors of large cities, and top-flight immigrant engineers and scientists in the nation's research centers; there are also those, at the other extreme, who cannot even take the first step toward assimilation because of the insecurity linked to an uncertain legal status."
The new immigration has made its mark on religion. "The religious landscape of America is changing," we learn from a recent CD-ROM entitled On Common Ground: World Religions in America, produced by Harvard University's Pluralism Project. "In every state and major city in the U.S. there are new religious neighbors today. People of other faiths are not just metaphorical neighbors around the world, but often next-door neighbors. A Lutheran church and a Buddhist temple are right across the street from one another in Garden Grove, California. A Muslim Community Center, a Ukrainian Orthodox church, a Disciples of Christ church and a Gujarati Hindu temple are virtually next-door neighbors on New Hampshire Avenue in Silver Spring, Maryland."
And neighbors tend to influence each other. One of the more intriguing social dynamics since the 1960s has been the relationship between immigrant religions and new American-born religious movements. American spiritual seekers sometimes gravitate toward immigrant religious centers and teachers, for instance meditating at a local temple or joining a Falun Gong group that blends traditional Chinese religious and health practices (Falun Gong's founder now lives in New York City).
In addition, American adherents began practicing immigrant religious traditions years before the arrival of the immigrant faithful. Such "American cousins," to borrow a term from one scholar, include Black Muslims and White Buddhists. Long before an immigrant Hindu community was established in Chicago, for instance, White Hindu converts worshiped at the Vivekenanda Vedanta Society in Hyde Park. Today that congregation includes both Indian Hindus by birth and American Hindus by conversion.
This ethnic and religious diversity has also changed the face of U.S. health care. Staff or patients at big-city hospitals who adhere to religions other than Judaism or Christianity have steadily increased over the past thirty-five years. Staff and patients are more likely to be Latino and Asian Christians than was true thirty-five years ago because the new immigration has swelled their ranks among the faithful.
Moreover, immigrant physicians and nurses may find themselves treating fellow immigrants who are uninsured and dissatisfied with their health care. A recent report from the Center for Immigration Studies examining the impact of immigration policy on the national health insurance crisis cited significantly higher percentages of uninsured foreign-born Americans. Critics of the report noted that the key factor determining lack of insurance was not immigration, but rather poverty and low wages, which affect native-born Americans as well as recent immigrants and refugees. An ongoing study in Chicago found that Asian Americans were significantly less satisfied with their health care than other groups. Areas of dissatisfaction included wait time, treatment, courtesy, and quality of service.
Studies have been conducted on the special health care needs of certain new immigrant populations, such as Southeast Asian refugees and others who suffer from various post-traumatic stress disorders. Increasing attention is being paid to the sometimes difficult negotiation process between the Western medical model and traditional health and healing practices within some immigrant communities, as we see in the case study of Hmong shamanism in Minnesota reported in this issue.
But we do well to remember that this negotiation between the traditional and the modern is not an exclusively American phenomenon. With the ever-widening effects of globalization and modernization, different medical models meet, compete, clash, and sometimes complement each other all over the world. The quaint notion that all immigrants bring only traditional medical practices with them, which then clash with modern science in America, must be abandoned for a more sophisticated understanding of our global village. "In a world contracted in time and space by modern communications technologies, no people, however isolated or underdeveloped, can remain impervious to medical knowledge," writes Edmund D. Pellegrino in Transcultural Dimensions in Medical Ethics. As that book illustrates, Western and traditional medical models interact wherever they meet—whether in Argentina, Japan, India, Thailand, or the U.S.
Across America, initiatives within the health care system and in interfaith circles seek to address this growing cultural and religious diversity. Handbooks and other resources are being produced for health care professionals, chaplains, and others interested in the practical implications of this trajectory. The Park Ridge Center's series on religious beliefs and health care decisions, for instance, has expanded to cover Islam (available) and Buddhism (forthcoming). The Metropolitan Chicago Healthcare Council (www.mchc.org) and the Council on American-Islamic Relations in Washington, D.C. (www.cair-net.org) have also produced practical guidelines for health care providers working with Muslim patients and families. The Texas Medical Association is revising its 1978 handbook, Faith of Our Patients, to reflect a more religiously diverse constituency (www.texmed.org).
A manual prepared by the Council of Churches of Greater Springfield and the Visiting Nurse Hospice of Pioneer Valley, Massachusetts, entitled Knowing My Neighbor, includes a section on religious groups and a section on cultural traditions (phone (413) 733-2149). Such an approach demonstrates the complexity of America's social mosaic, formed in large part by our history of immigrant religious groups. For instance, Catholic and Protestant Americans originate from numerous countries around the world. At the same time, some countries have supplied multiple religious groups: German immigrants have included Protestants, Catholics, and Jews; Indian immigrants now include Hindus, Muslims, Sikhs, Jains, and Christians.
"Thus a nurse who does not recognize the value and importance of culturally appropriate care cannot possibly be an effective care agent in this changing demographic society," as Joyce Giger and Ruth Davidhizar write in Transcultural Nursing: Assessment and Intervention. "When nurses consider race, ethnicity, culture, and cultural heritage, they become more sensitive to clients." Those in the American health care system are becoming more attentive to the role played by religion and spirituality in many clients' lives. Among many new immigrant communities, religious identity forms an integral part of a larger ethnic identity.
Scholarship generally has been slow to catch up with the religious dimension of the new immigration. The Pew Charitable Trusts have begun a massive effort in this area, funding studies in seven "gateway" immigration cities (America's "gates" now stand at international airports rather than Ellis Island). Entitled the Religion and the New Immigrants Initiative, this research will examine the role of religion in the current immigration experience and how it can work for the social good.
Certainly, more research is needed on the intersection of health and faith in America's newest immigrant communities, despite the difficulties inherent in cross-cultural research. The Park Ridge Center has scheduled a one-day conference entitled "New Religious Diversity and Health Care: The Buddhist Case," to be hosted by a local immigrant Buddhist temple. The Center has also proposed a study of congregations as mediating institutions between immigrant communities and the American health care system. Chicago's living ethnic laboratory, offering an intriguing mix of both old (European) and new (Asian and Latin American) immigrant groups, provides a marvelous venue for such a study. Of course, health care teams in Chicago-area hospitals could have told you that.
