Puerto Rico is a carribean island that became territory of the United States in 1898, after the Spanish-Cuban-American War. Puerto Ricans became United States citizens in 1917, allowing them to legally migrate to any state. An influx of Migration to the US began after the Second World War in 1945. It is reported 13,000 Puerto Ricans lived in New York City in 1945, 50,000 in 1946 and by 1955 they were nearly 700,000 (Library of Congress). There are several different speculations for the cause of the sudden influx. It’s is believed that Puerto Rican’s were in search for education, political refuge, and maintaining family ties. Perhaps the combination of the depression in Puerto Rico and recruitment process by U.S. factory owners was what encouraged Puerto Ricans who were in search of employment and economic opportunities. The U.S. Census Bureau reports Puerto ricans are the second largest hispanic group with over 5.6 million residing in the United States in 2017 (Noe-Bustamante, Flores, & Shah, 2019). It is possible the number of Puerto Ricans living in the U.S. today may have increased dramatically after September 2017 when Hurricane Maria hit the island causing the worst natural disaster in history. Hurricane Maria caused massive devastation destroying homes and many of the island’s agriculture.
Puerto Ricans are not allowed to vote in Congress, causing a misconception of their citizenship status. This can create internal tension because of the unresolved issues between Puerto Rico and U.S. political affiliations. Another conflict Puerto Ricans face is the difference of racial perception by non-hispanics Americans versus their own. In the U.S. they are asked to be identified as Black or White, however their identity in Puerto Rico is based more on ethnicity and described between two polarities based on shades of color and physical characteristics (McGodrick et al., 2005). Their feelings of exclusion and inability to identify themselves in comparison to American’s has created communities and social networks within the U.S. that allow them to exhibit pride and freedom for expression of their heritage. Their ability to commute between Puerto Rico and the Unites States without restriction, has also allowed them to maintain powerful family ties and preserve their native linguistics. This resulted in PuertoRican’s cultural representations of community to transcend geographical and national boundaries (Torres, Marquez, Carbone, Stacciarini, & Foster, 2008).
Family is the most dominant contributor of social interaction and influence within the Puerto Rican culture (Torres et al., 2008). The concept of Familism instills mutual emotional and economic support, reciprocity, and maintenance of the Puerto rican culture (Torres et al., 2008). The definition of family is not inclusive to those related by blood or marriage but depend heavily on the extended family structure. Extended family can include Godparents, Godchildren, neighbors and close friends. Traditionally family’s gender roles are patriarchal and machismo is prevalent. Men are expected to serve as protectors and providers and make all family decisions without consulting their counterpart. Women’s commitment is focused more on domestic duties, bearing the health and well-being of the family members, and holding the family together. The rising rates of divorce and homes with single mothers are creating reconstruction of the family structure to matrifocal (Torres et al., 2008).
Protestant denominations, Pentecostal sects and Roman Catholics are among the several different religions observed by Puerto Ricans in the United States. Puerto Ricans mostly identify themselves as Roman Catholics, however their beliefs and practice are different than United States Catholicism. They do not completely trust the Catholic Church and primarily rely on the church for special occasions such as christenings, weddings, and funerals. They believe that priests are unessential in making connections with God and the supernatural. Their relationship with God is personalized through special relationships with saints. Prayers are directed to the saints with promises and offerings in attempts to show gratitude and faith (McGodrick et al., 2005). These beliefs and practices are not identified as a religion but focuses more of the belief of spiritualism. Spiritism is a belief that there is a world where good and evil saints and spirits influence human behavior (McGodrick et al., 2005).
Food is a critical element in Puerto Ricans cultural heritage. It is used to unite friends and family, and to prevent and treat illnesses. Food is used to honor friends and family members; as an escape from everyday pressures; and to prevent and treat. Each meal usually begins with “frituras”, fried appetizers, which includes sorullitos, bacalaitos, empanadillas, and alcapurrias. A staple dish is the Puerto Rican Stew called sancocho, which is made with several different meats including beef short ribs, chicken, smoked ham, pork feet and pork sausage. Another common meal is mofongo, which is made with fried plantains and deep fried pork skin. Dietary patterns of the Puerto Rican people are a contributing factor to the common health issues they experience. Heart disease and hypertension can correspond with the large consumption of fried foods and the common practice of using salted cod fish as a seasoning condiment.
Among all Latino subgroups in the United States, Puerto Ricans have the worst indicators of general health status (Torres, Marquez, Carbone, Stacciarini, & Foster, 2008). According to the Center of Puerto Rican Studies at Hunter College the leading cause of death of Puerto Ricans are heart disease, diabetes, chronic respiratory disease related complications, and perinatal conditions (Torres-Pagan, 2016). Lack of access to services such as primary care and health insurance; educational and economic opportunities; contribute to the poor health outcomes (Torres et al., 2008). Strong cultural identity and representation influence their learning processes, preferences, actions and decision making (Torres et al., 2008). In order to assure more consistent health outcomes it is imperative that culturally appropriate interventions are provided in health promotion. Materials should also include layman's term language due to Puerto Rican’s poor health literacy and decrease proficiency in the English language.
Ethnomedical ideologies and practices highly influences health and health care outcomes of the Puerto Rican people. Their belief is illness and disease can occur when there is an imbalance in harmony and equilibrium in the internal body; psychological, socially and spiritually (Patcher, 1995). This ideology is illustrated with their belief that illness can be brought on by a deviation of balance of the humoral concept, where diseases and conditions are classified as hot or cold. Food, medications and actions can disrupt or restore the hot/cold balance and therefore can either retard or help the healing process (Masi, 1988). Based on these principal treatment regimens such as medications, remedies, and foods used should have the opposite properties of the illness being treated. A cold diseases should be treated with hot remedy and vice versa. Penicillin, Aspirin, and most western medicines are considered hot medicine and all herbal medicines are considered cold (Masi,1988). Illness classified as hot are constipation diarrhea, ulcers infection, ear infections and rashes; Cold illness are arthritis, colds and menstrual periods (Masi,1988).
Due to their strong spiritualism many may perceive that illnesses can be brought on by disturbances in this spiritual realm as spirits have potential to protect or harm individuals. They believe they each have their own spirits of protection. The protection by the spirits are determined by their actions; protection can be increased with good deeds or decreased with evil actions. Spiritual protection is also influenced by providing light to the spirits through the use of incense, candles, and powders, which also help to ward off the “evil eye” (McGodrick et al., 2005). Illnesses is also believed to be caused by envy known as mal de ojo, those most vulnerable are infants and children because of their purity. They believe it is caused by a malevolent person who may covet a child or may be jealous of the parent (Pachter, 1995). The adult places a spell on a child by excessively praising or admiring the baby and the infant may become irritable, have failure to thrive and lethargic. To prevent this from occurring the infant will wear an amulet called Azabache, a gold bracelet with black or red charms and a black fist which metaphorically fights all evil doings. If an azabache accidentally breaks it is an indication that someone has cast an evil spell and it is advised that one should see a spiritual leader. When health issues occur Puerto Ricans may visit a spiritist, a medium who have powers that can influence the spiritual world and communicates with the spirits of dead relatives or ancestors (McGodrick et al., 2005). The spiritist can help give messages to spirits, receive answers, and can also diagnose and treat illnesses that are considered to be spiritual in nature (McGodrick et al., 2005).
Puerto rican also believe staying healthy requires maintaining a balanced mental state. Uncontrolled and overwrought emotions can cause physical and emotional illness (Patcher, 1995). It is believed that stress, asthma and hypertension may be brought on by a phenomenon called “ataque de nervios” nerve attack. Compared to other major groups in the U.S. Puerto Ricans exhibit highest prevalence of psychological distress (Torres-Pagan, 2016), however they are known to underutilize mental health and social services (McGodrick et al., 2005). Their cultural expectations is they can rely on the support of family members in time of stress. The majority are uncomfortable with discussing personal matters or marital issues such as addictions and domestic violence in a setting of psychotherapy. Enlisting outside help would be of last resort and they would typically seek care from folk healers, or medical doctors, rather than to therapist (McGodrick et al., 2005).