CC BY-NC-ND 4.0 · Avicenna J Med 2018; 8(01): 1-13
DOI: 10.4103/ajm.AJM_134_17

The Islamic tradition and health inequities: A preliminary conceptual model based on a systematic literature review of Muslim health-care disparities

Aasim I. Padela
Department of Medicine, The University of Chicago, Chicago, IL, USA
Danish Zaidi
Wake Forest School of Medicine, Winston-Salem, NC, USA
› Author Affiliations
Financial support and sponsorship Nil.


Objective: The objective of this study was to identify mechanisms by which Islamic beliefs, values, and Muslim identity might contribute to health inequities among Muslim populations. Methods: A systematic literature review of empirical studies in Medline from 1980 to 2009 was conducted. The search strategy used three terms covering health-care disparities, ethnicity, and location to uncover relevant papers. Results A total of 171 articles were relevant based on titles and abstracts. Upon subsequent full-text review, most studies did not include religious identity or religiosity as explanatory variables for observed health disparities. Of 29 studies mentioning Islam within the text, 19 implicated Muslim identity or practices as potential explanations for health differences between Muslim and non-Muslim groups. These 19 studies generated six mechanisms that related the Islamic tradition, Muslim practices, and health inequities: (1) Interpretations of health and/or lack of health based on Islamic theology; (2) Ethical and/or cultural challenges within the clinical realm stemming from Islamic values or practices; (3) Perceived discrimination due to, or a lack of cultural accommodation of, religious values or practices in the clinical realm; (4) Health practices rooted within the Islamic tradition; (5) Patterns of health-care seeking based on Islamic values; and (6) Adverse health exposures due to having a Muslim identity. Conclusion: While there is scant empirical research on Muslim health-care disparities, a preliminary conceptual model relating Islam to health inequities can be built from the extant literature. This model can serve to organize research on Muslim health and distinguish different ways in which a Muslim identity might contribute to the patterning of health disparities.

Publication History

Article published online:
12 August 2021

© 2018. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

  • References

  • 1 Bender R, Jöckel KH, Trautner C, Spraul M, Berger M. Effect of age on excess mortality in obesity. JAMA 1999; 281: 1498-504
  • 2 Engels F. The Condition of the Working-Class in England in 1844. Harmondsworth: Penguin; 1845.
  • 3 Smith GD, Chaturyedi N, Harding S, Nazroo J, Williams R. Ethnic inequalities in health: A review of UK epidemiological evidence. Crit Public Health 2000; 10: 375-408
  • 4 Alexander GR, Kogan MD, Himes JH, Mor JM, Goldenberg R. Racial differences in birthweight for gestational age and infant mortality in extremely-low-risk US populations. Paediatr Perinat Epidemiol 1999; 13: 205-17
  • 5 Cooper R, Cutler J, Desvigne-Nickens P, Fortmann SP, Friedman L, Havlik R. et al. Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: Findings of the national conference on cardiovascular disease prevention. Circulation 2000; 102: 3137-47
  • 6 Lu MC, Chen B. Racial and ethnic disparities in preterm birth: The role of stressful life events Am J Obstet Gynecol 2004; 191: 691-9
  • 7 Ward E, Jemal A, Cokkinides V, Singh GK, Cardinez C, Ghafoor A. et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 2004; 54: 78-93
  • 8 Wise PH, Kotelchuck M, Wilson ML, Mills M. Racial and socioeconomic disparities in childhood mortality in Boston. N Engl J Med 1985; 313: 360-6
  • 9 Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med 2002; 347: 1585-92
  • 10 Geronimus AT. Black/white differences in the relationship of maternal age to birthweight: A population-based test of the weathering hypothesis. Soc Sci Med 1996; 42: 589-97
  • 11 Geronimus AT. The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethn Dis 1992; 2: 207-21
  • 12 Brown TN, Williams D, Jackson J, Neighbors H, Torres M, Sellers SL. et al Being black and feeling blue: The mental health consequences of racial discrimination. Race Soc 2000; 2: 117-31
  • 13 Hovey JD, King CA. Acculturative stress, depression, and suicidal ideation among immigrant and second-generation Latino adolescents. J Am Acad Child Adolesc Psychiatry 1996; 35: 1183-92
  • 14 Finch BK, Vega WA. Acculturation stress, social support, and self-rated health among Latinos in California. J Immigr Health 2003; 5: 109-17
  • 15 Lee J, Koeske GF, Sales E. Social support buffering of acculturative stress: A study of mental health symptoms among Korean international students. Int J Intercult Relat 2004; 28: 399-414
  • 16 Wrobel NH, Farrag MF, Hymes RW. Acculturative stress and depression in an elderly Arabic sample. J Cross Cult Gerontol 2009; 24: 273-90
  • 17 Herman AA. Toward a conceptualization of race in epidemiologic research. Ethn Dis 1996; 6: 7-20
  • 18 Merchant A, Husain SS, Hosain M, Fikree FF, Pitiphat W, Siddiqui AR. et al. Paan without tobacco: An independent risk factor for oral cancer. Int J Cancer 2000; 86: 128-31
  • 19 Ahmed S, Atkin K, Hewison J, Green J. The influence of faith and religion and the role of religious and community leaders in prenatal decisions for sickle cell disorders and thalassaemia major. Prenat Diagn 2006; 26: 801-9
  • 20 Carroll J, Epstein R, Fiscella K, Volpe E, Diaz K, Omar S. et al Knowledge and beliefs about health promotion and preventive health care among Somali women in the United States. Health Care Women Int 2007; 28: 360-80
  • 21 Al SuwaidiJ, Bener A, Suliman A, Hajar R, Salam AM, Numan MT. et al A population based study of Ramadan fasting and acute coronary syndromes. Heart 2004; 90: 695-6
  • 22 Padela AI. Rodriguez del Pozo P. Muslim patients and cross-gender interactions in medicine: An Islamic bioethical perspective. J Med Ethics 2011; 37: 40-4
  • 23 Yehya NA, Dutta MJ. Health, religion, and meaning: A culture-centered study of Druze women.. Qual Health Res 2010; 20: 845-58
  • 24 Koenig HG. Research on religion, spirituality, and mental health: A review. Can J Psychiatry 2009; 54: 283-91
  • 25 Koenig HG. Religious practices and health: Overview. Washington DC: The Heritage Foundation 2008.
  • 26 Larson DB, Larson SS, Koenig HG. Mortality and religion/spirituality: A brief review of the research. Ann Pharmacother 2002; 36: 1090-8
  • 27 Obama B. Remarks by the President on a New Beginning. Cairo, Egypt: 2009.
  • 28 Smith TW. The Muslim population of the United States: The methodology of estimates. Public Opin Q 2002; 66: 404-17
  • 29 CAIR: U.S. Muslims to Count Population, Council on American-Islamic Relations; 2015. Available from: [Last retrieved on 2017 Aug 07].
  • 30 Demographic Portrait of Muslim Americans, Pew Research Center; 2017. Available from: [Last Retrieved on 2017 Aug 07].
  • 31 Mapping the Global Muslim Population. Pew Research Center; 2009.
  • 32 Ba-Yunus I. Muslims of Illinois, A Demographic Report. Chicago, East-West University; 1997. p. 9.
  • 33 Curlin F OB-GYNs Approaches to Sexual and Reproductive Health Care: A National Survey, Survey Methodology Report. Chicago, IL, Program on Medicine and Religion; 2010. p. 1-61.
  • 34 Laird LD, de MarraisJ, Barnes LL. Portraying Islam and Muslims in MEDLINE: A content analysis. Soc Sci Med 2007; 65: 2425-39
  • 35 Gatrad AR, Sheikh A. Hajj: Journey of a lifetime BMJ 2005; 330: 133-7
  • 36 Padela AI. Can you take care of my mother? Reflections on cultural competency and clinical accommodation. Acad Emerg Med 2007; 14: 275-7
  • 37 Vu M, Azmat A, Radejko T, Padela AI. Predictors of delayed healthcare seeking among American Muslim women. J Womens Health (Larchmt) 2016; 25: 586-93
  • 38 Athar S, Ahmed WD, Amine AR, Fadel HE, Haque M, Nagamia HF, et al. Our position: The position of Islamic medical association of North America on issues of medical ethics. Islamic Medical Association North America 2005.
  • 39 Hoodfar E, Teebi AS. Genetic referrals of Middle Eastern origin in a Western city: Inbreeding and disease profile. J Med Genet 1996; 33: 212-5
  • 40 Hutchinson MK, Baqi AzizM. Nursing care of the childbearing Muslim family. J Obstet Gynecol Neonatal Nurs 1994; 23: 767-71
  • 41 Johnson JL, Bottorff JL, Balneaves LG, Grewal S, Bhagat R, Hilton BA. et al. South Asian womens' views on the causes of breast cancer: Images and explanations. Patient Educ Couns 1999; 37: 243-54
  • 42 Padela AI, Gunter K, Killawi A, Heisler M. Religious values and healthcare accommodations: Voices from the American Muslim community. J Gen Intern Med 2012; 27: 708-15
  • 43 Jan R, Smith CA. Staying healthy in immigrant Pakistani families living in the United States. Image J Nurs Sch 1998; 30: 157-9
  • 44 Reitmanova S, Gustafson DL. “They can't understand it”: Maternity health and care needs of immigrant Muslim women in St. John's, Newfoundland. Matern Child Health J 2008; 12: 101-11
  • 45 Padela AI, Killawi A, Forman J, DeMonner S, Heisler M. American Muslim perceptions of healing: Key agents in healing, and their roles. Qual Health Res 2012; 22: 846-58
  • 46 Padela AI, Raza A. American Muslim health disparities: The state of the Medline literature. J Health Dispar Res Pract 2015; 8: 1-9
  • 47 Beine K, Fullerton J, Palinkas L, Anders B. Conceptions of prenatal care among Somali women in San Diego. J Nurse Midwifery 1995; 40: 376-81
  • 48 Morioka-Douglas N, Sacks T, Yeo G. Issues in caring for Afghan American elders: Insights from literature and a focus group. J Cross Cult Gerontol 2004; 19: 27-40
  • 49 Shah SM, Ayash C, Pharaon NA, Gany FM. Arab American immigrants in New York: Health care and cancer knowledge, attitudes, and beliefs. J Immigr Minor Health 2008; 10: 429-36
  • 50 DeShaw PJ. Use of the emergency department by Somali immigrants and refugees. Minn Med 2006; 89: 42-5
  • 51 Davidson JE, Boyer ML, Casey D, Matzel SC, Walden CD. Gap analysis of cultural and religious needs of hospitalized patients. Crit Care Nurs Q 2008; 31: 119-26
  • 52 Matin M, LeBaron S. Attitudes toward cervical cancer screening among Muslim women: A pilot study. Women Health 2004; 39: 63-77
  • 53 Simpson JL, Carter K. Muslim women's experiences with health care providers in a rural area of the United States. J Transcult Nurs 2008; 19: 16-23
  • 54 Robinson T, Raisler J. “Each one is a doctor for herself”: Ramadan fasting among pregnant Muslim women in the United States. Ethn Dis 2005;15:S1-99-103.
  • 55 Ghaemi AhmadiS. Attitudes toward breast-feeding and infant feeding among Iranian, Afghan, and Southeast Asian immigrant women in the United States: Implications for health and nutrition education. J Am Diet Assoc 1992; 92: 354-5
  • 56 Islam SM, Johnson CA. Correlates of smoking behavior among Muslim Arab-American adolescents. Ethn Health 2003; 8: 319-37
  • 57 Luna L. Care and cultural context of Lebanese Muslim immigrants: Using Leininger's theory. J Transcult Nurs 1994; 5: 12-20
  • 58 Raza A, Shanawani H. Padela AI. Healthcare disparities in immigrant Muslims in US & Canada: A systematic literature review 2010.
  • 59 Anuforo PO, Oyedele L, Pacquiao DF. Comparative study of meanings, beliefs, and practices of female circumcision among three Nigerian tribes in the United States and Nigeria. J Transcult Nurs 2004; 15: 103-13
  • 60 Amer MM, Hovey JD. Socio-demographic differences in acculturation and mental health for a sample of 2nd generation/early immigrant Arab Americans. J Immigr Minor Health 2007; 9: 335-47
  • 61 El-Sayed AM, Galea S. Explaining the low risk of preterm birth among Arab Americans in the United States: An analysis of 617451 births. Pediatrics 2009; 123: 438-45
  • 62 Singh GK, Hiatt RA. Trends and disparities in socioeconomic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979-2003.. Int J Epidemiol 2006; 35: 903-19
  • 63 Younis M. Muslim Americans Exemplify Diversity, Potential; 2009. Available from: [Last retrieved on 2010 Nov 12].
  • 64 Amer MM. Hood Jr. RW. Special issue: Part II. Islamic religiosity: Measures and mental health. J Muslim Ment Health 2008; 3: 1-5
  • 65 Raiya HA, Pargament K, Stein C, Mahoney A. Lessons learned and challenges faced in developing the psychological measure of Islamic religiousness. J Muslim Ment Health 2007; 2: 133-54
  • 66 Ali OM, Milstein G, Marzuk PM. The imam's role in meeting the counseling needs of Muslim communities in the United States. Psychiatr Serv 2005; 56: 202-5
  • 67 Freij LS. ES Model: Mobilizing Muslim Imams and Religious Leaders as “Champions” of Reproductive Health and Family Planning. T. E. S. D. Project; 2010.
  • 68 Padela AI, Killawi A, Heisler M, Demonner S, Fetters MD. The role of imams in American Muslim health: Perspectives of Muslim community leaders in Southeast Michigan. J Relig Health 2011; 50: 359-73
  • 69 Inhorn MC, Fakih MH. Arab Americans, African Americans, and infertility: Barriers to reproduction and medical care. Fertil Steril 2006; 85: 844-52