English-speaking countries such as Australia, Canada, New Zealand, United Kingdom, the United States, and perhaps India and South Africa, either have initiated or renewed their interests in multicultural diversity with a focus on decreasing minority, racial and ethnic disparities in health. The use of the word ‘minority’ is inappropriate in this context because of the way it is defined and used. The United States government definition of the word minority, ‘a group differing, especially in race, religion, or ethnic background from the majority’, not only includes race, religion and ethnic background as qualification for minority status, but also other more controversial sub-groups, such as those characterized by a distinctive alternative lifestyle (Office of Minority Health 2004). These minorities have become well recognized and therefore established. Accordingly, some groups are excluded as a minority and members of some minorities are not easily recognized as being part of other groupings. Moreover, ordering groups of people as ‘minorities’ carries the connotation of lesser than, or not as important as, the majority. Inevitably this has an adverse affect on education endeavours and government policy, and more importantly on health care.
Using the word ‘minority’ in this way, with established meanings that are embedded in healthcare practices and encoded in laws, regulations, contracts and especially communications, is too simplified. It excludes, mis-defines, or distorts the very focus directed at ‘minority’ interests. The term minority is simply not useful for identifying all groups that need special attention in health care delivery. Take, for example, the early years of the acquired immunodeficiency syndrome (AIDS) crisis. All the stress on prevention and education was directed to the ‘minority’ gay subculture, resulting in a very large segment of the population believing that other groups were not affected. Only years later after a major pandemic was occurring, education about HIV and AIDS was finally directed at all vulnerable groups.
In health care, and perhaps especially in nursing, we must be more visionary and recognize that we must group people according to their vulnerabilities. Any group, regardless of ethnicity or race but given the right context and circumstances, can become a vulnerable population and it is those groups that need to be more accurately defined. Consider the possible groups in my definitions of the primary and secondary characteristics of culture. These include age (young or old), nationality, race, colour, gender, religious affiliation, educational status, intellectual ability, socioeconomic status, political beliefs, marital status, parental status, disability and chronicity, sexual orientation, urban vs. rural status, lack of social power, and immigration status such as legal immigrant, sojourner, or undocumented (Purnell 2003, pp. 1–7) As one can see from the above examples, an individual, family, or group from the dominate culture can fall into a vulnerable population. With current usage of the term ‘minority’, the chance of many groupings being adequately addressed is greatly decreased.
If we can accept a wider view of grouping people based on health disparities, which certainly includes ethnic and racial groups, we could work more effectively towards eliminating barriers to effective and equitable healthcare for many ethnocultural groups. Common barriers for any group include language abilities of the client and healthcare providers; availability of health and social services; accessibility of healthcare services to the client and family; affordability, appropriateness, adaptability, and acceptability of services; attitudes and approachability of healthcare providers; alternative and complementary practices and practitioners; and additional services that support the care of children or aging parents while accessing health care (Purnell 2003, pp. 8–53).
The time has come to stop using the term ‘minority’ and replace it with the more correct word ‘vulnerable’ so that all groups in need get their deserved attention. Such groups need to be recognized, regardless of whether or not they are a recognized ‘minority’. Communities, healthcare organizations, and the nursing profession must re-develop healthcare services in ways that meet the needs of all citizens, regardless of culture or racial, ethnic, or minority status.