m1l2.1 2.2 culture society health

8/13/2019 M1L2.1 2.2 Culture Society Health

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HCR230 Week 2, Lectures 2.1&2.2

Culture, Society and Health

Dr. Michael Winkelman, M.P.H., Ph.D.


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Overview

Managing differences

National CLAS Standards

Conceptualizing Differences

Importance of culture

Roles of culture in health

Developing Culturally Responsive Care

Culture Care Bases for Transcultural Care

Race, Ethnicity, Class and Poverty Effects


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Managing Differences

Problem with treating everyone the same

What is the same?

Problems with self-reference

Do you treat everyone the same? Or Not?

The same as unconscious ethnocentrism

The same as requiring different treatment

e.g., how to show respect


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Why right to cultural respect?

Relationship to nursing careculture care

Cultural Responsiveness

Roles of ethnomedical concepts in healthbehaviors and communication

Role of culture in effective diagnosis and

healing


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Cultural and Linguistic Competence

Understanding and responding effectively tocultural and linguistic needs affecting healthcare experiences

National Standards DHHS CLASCulturally and Linguistically

Appropriate Services

See Blackboard


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CLAS Standards

On-going Training for all staff

Providers, support personnel, administrators

Provision of qualified interpreter services and

language-specific materials

Community Inclusion

Advisory boards

Collect data on community and needs


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Conceptualizing Differences: Societies, Cultures,

Subcultures and Ethnicity

Cultural Pluralism and Multiculturalism

Societies as Geopolitical

Cultures as Learned Patterns Subcultures and Ethnic Groups

Ethnicity as Identity

Ethnicity as inclusive and contrastive Concept of Race as distracter (more later)


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Using Concepts of Culture to Adapt

Generalizations versus stereotypes

Typical patterns versus oversimplifications

Stereotypes as rigid, judgmental, prejudical

Cultural characterizations as norms

Ideals, normative expectations, typical patterns

Cultural characterizations as flexible

points of departure

Importance of recognizing Intra-cultural variation


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Internal Variation

Processes of Cultural Change

Acculturation and Assimilation

Dimensions and forms of assimilation

Biological, marital, economic/structural, cultural,psychological**

Heritage Consistency

Congruence of lifestyle with traditional culturalbackground

Forms of Biculturalismsee Chapters 2 & 6*


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Importance of Culture

Culture Definitions- learned behavior

Behaviors, Organization and Thoughts

Material, Social and Mental

Meta-communication:

Attitudes, Beliefs, Ideology

Socialization and Psychocultural Development

Socialization of Human Biology


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Features of Culture

Unconscious

Determines behavior

Seems normal Symbolic

Softwarebrain program


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Cultural Effects

Factors affected by culture

Food and self-care

Personhood and Identity

Social relations

Communication

Health and health behavior

Everything? What not?


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Cultural Phenomena Affecting Health

Systems Perspectives

Environment Distribution of causes of disease

Risk behaviors and exposures/protections

Social Organization Economic, social and political effects Utilization of lay/popular and folk resources

Health resources and provider responses

Mental

Communication Systems Concepts of maladies, recognition of symptoms

Symbolic effects on health and maladies Emotional and psychological influences on physiological responses


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L 2.2 Developing Culturally Responsive

Care

Awareness and SELF-awareness

Sensitivity- behavioral modification

Competence- participate in culture Responsiveness- competence in health care

arena-- culture care

All Involve Personal Developments/Change Attitudes, Behaviors, Knowledge, Skills

Maybe even identity


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Culture Care

Culture Care Diversity and Universality Theory . . .

Madeline Leininger, Grandmother of Transcultural Nursing

Used for discovering care and health needs of differentcultures

Guide to thinking, practice and research on human care

Why is human care mode important?

Care is essence of nursing

Necessary for recovery from illness and maintaining well-

being Provides therapeutic care to diverse cultures


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Care as Biological and Cultural

Care as part of the totality of human behavioralresponses to health and illness Broadest, most comprehensive, holistic and universal

feature of human beings (p. 3)

Care as health, curing, well-being, + Action modes related to care are culturally based

Care is embedded in culture

Specific cultural values, beliefs and lifeways are essential toexpression of care

Essential part of how humans deal with illness, disability,death and recovery


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Nursing as Care

Leiningers definition of nursing emphasizes its focuson human care phenomena and activities . . . tomaintain health in culturally meaningful ways (p. 7) Care as the essence and central construct of nursing

Care as an essential perspectives for development oftranscultural nursing *necessary to meet societal and global needs produced by

cultural diversity

Health characterized as a state of well-being that isculturally defined (p. 10) Care and caring actions as leading to health


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Nature of Care

Care as assistive, supportive and enabling

experiences to improve human condition

Care as symbolic, protective, respectful

Culturally congruent care

Sensitive, knowledgable, meaningfully fit with

cultural values, expectations, beliefs of client


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Summary: Bases for Cultural Care

Emic and etic data both have profound influence on care andhealth outcomes

Emic as local, indigenous insider

Etic as institutional knowledge and professional views

May be imposed (imperialistic) or cross-culturally valid

Culture Care Universalitycommonly shared care features ofhuman beings

Sunrise Enabler as cognitive map for discovering the specific

cultural factors affecting health and care


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HCR230

Week 2.2, Lectures 2.3 & 2.4

Concepts of Race, Ethnicity, Class and

Poverty and Effects on Health


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Overview

2.3 The Race Concept

History of the Racial Color Concepts

Race and Human Biological Variation

Ethnicity

Concepts of Personhood and Identity

2.4 Class and Poverty

Mechanisms of Povertys Effects on Health


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Understanding Human Differences: Race,

National Origins, Ethnicity and Class

Race, Ethnicity and National Origin

Historical Sources Diversity in the U.S.

Contemporary Persistence

Nature of differences? Biology or culture?


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The Concept of Race

Historical Beliefs

biologically unique groups

biologically homogeneous groups

basis for differences in groups behavior

Political motivations

Pseudoscientific Approaches- not true science

but designed to confirm prior belief


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Modern Concepts of Race

Anthropological Approaches

Continuity in human variation

Most genes shared in common

Cline as variation in single traits

Contemporary Uses

Social, Legal and Geographic

Race as Racism and Ideology


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Race

& Skin Color

Skin Color

all except red formed by melanin

found in other animals besides humans

difference in distribution within skin

Sunlight Interaction

needs for differential absorption

environmental adaptation


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Human Biological Differences

Individual and Group Differences

Greater within group variation than betweengroup variation

Population similarities and genetic profiles


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Human Biological Differences and

Nursing Care

Nature of differences

Statistical not categorical

Often rare in target populations

Significance in assessment


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Ethnicity

Socially recognized groups

Collective Sense of identity

In-group vs. out-group differentiation

Personal identity with group

Situationaly and personally variable


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Perspectives on Ethnicity

Classic Perspectives on Ethnicity

Ethnic Categories are like races

Modern Views

A Construction of Ethnicity

Ethnicity as socially relational/contrastive

Ethnicity as variable within groups

Ethnicity as Relational

Included and Excluded other


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Anthropological Approaches to Ethnicity

Indigenous Psychologies

Cultural concepts of person, internal dynamics & capabilities

as manifested in expressive culture

Personality and Self in Religion, Myths, Stories and Legends

Personality: concepts of person and psychological

processes

Basic Personality Structures and Models

Self as identity embodied in roles

Involve relations with others

Social models for the person


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Social Roles as Ethnicity

Social Status and Roles as Cultural Personalities

Bases of Ethnic content

Social Positions (status)

parts to be played, positions in society

Roles

normative expectations about characteristic

behaviors of people in certain status/positions

Social positions and associated roles serve as themodels ethnicity in ideals for behavior

Also play roles in intergroup and class relations


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Stages of Ethnic Identity

Development Multiple Models

Types of Intercultural Adaptation

Ghettoization

Passing

Nativistic

Marginality

Mediators

Multicultural


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Minority and Majority Differences

Minority Ethnic Identity Development

Conformity

Dissonance

Resistance

Introspection

Internalization

Changes with ethnic revival and reassertion


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Dominant Groups Ethnic Awareness

Pre-exposure

Contact

Defensive/zealot

Psuedo-independence

Autonomy


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L2.4 Sociocultural Effects on Health

Concept of Class

Access to resources, power, connections,

knowledge

Poverty as manifestation of deprived class

status

Numerous health problems associated with

poverty Issues of Access


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Social Class and Health

Social Conditions as Fundamental Causes of

Disease

Increase in diseases and morality following

economic recessions (infant mortality, cardiac

arrest, mental illness) Alameda Co. CA Study

Effects of economic hardship on health

functioning3Xs for poorest group Independent of controls for age, sex, smoking, drinking,

activity, BMI


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General Class Associations with

Multiple Health Measures

Evidence of general impact of economic status

on health

Effects of macrolevel on microlevel

Persistence of class differences in spite of

proximate/microlevel changes in lifestyle

E.g., hygiene/sanitation, housing, working

conditions, general diet


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Characteristics of Culture

Culture as totality of socially transmitted behavior

patterns-- learned

Most (everything?) that humans do (or how they do it)

Explicit and implicitmostly unconscious

Impact in clients and providers expectations

Determinant of behavior

Including beliefs and practices affecting health behaviors

and care expectations

Societal influences- may appear as cultural


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Summary:

Race, Ethnicity, Class & Culture

Culture- learned beliefs and behaviors

may be embraced or accepted

Race- falsely presumed biology actually social category

Ethnicity- group identity

may or may not reflect culture

Class/Poverty/Social Stratification

Effects of resources on well-being

m1l2.1 2.2 culture society health

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