Shaping America's health care professions: the dramatic rise of multiculturalism.

Fifty years ago, for the question on the US census form, “What is your race?”, 89% of participants checked the box for “White,” 10% checked “Negro,” and 1% checked the box for the phrase “or what race?”1 Most experts agree that this census report is largely inaccurate because of the methods employed in its data collection. However, it provides a rough sketch of a United States that would be unrecognizable today. The racial and ethnic composition of the US population is changing at its most dramatic rate since the great wave of immigration at the turn of the 20th century. Persons neither white nor African American constitute almost 18% of the US population today, and this demographic change is escalating.2 Consider the following: The nonwhite US population will reach 32% by 2010 and 47.2% by 20502 Since 1990, the number of foreign-born residents has increased by 6 million and is currently about 25 million (9.3% of the general population)3 The United States adds 1 million immigrants to its population each year (70% legal, 30% illegal)2 Recent-immigrant and nonwhite populations have a birth rate 50% higher than that of the US white population3 By 2025, the Hispanic population of California will be about 33% greater than its white population4 The US Asian population is expected to grow almost 25% in the next decade4 It could be argued that the effect of America's evolution toward multiculturalism will outstrip all other social, economic, and technologic trends. The US health care system will not be exempt from these changes, and it is currently not prepared to manage this increase in racial and ethnic diversity. Our shifting demography threatens to expose the ways in which our nation's medical establishment has failed its nonwhite residents. Three primary criteria for the evaluation of any health care system are the overall health of the population it serves, the accessibility it provides, and the quality of care it delivers. By these standards, the US health care industry is failing its nonwhite communities.