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Social and CulturalSocial and CulturalInfluences on HealthInfluences on Health

Laurine T. Charles, M.H.S.

D. Beth Kennedy, M.S.

S.C. Area Health Education Consortium

19 Hagood Avenue Suite 802

P.O. Box 250814

Charleston, SC 29425-0814

charlelt@musc.edu

kennedyb@musc.edu

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Developed as part of an Developed as part of an Enhanced AHEC Community Enhanced AHEC Community

Partnership for Health Partnership for Health Professions Workforce and Professions Workforce and Educational Reform project Educational Reform project

funded by the Health funded by the Health Resource and Service Resource and Service Administration (HRSA) Administration (HRSA)

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OBJECTIVESOBJECTIVES

Define diversity and its impact on health and health care

Demonstrate an understanding of cultural competency

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Global DemographicsGlobal Demographics

If only 100 people lived in the world, there would be: 57 Asians. 21 Europeans. 14 people living in North & South America. 8 Africans. 52 women. 48 men. 70 persons of color. 30 Christians.

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Global Demographics

Of these same 100 people: 6 would own 59% of the entire world’s wealth.

All 6 would be citizens of the United States. 70 would be unable to read 50 would suffer from malnutrition 80 would live in sub-standard housing 1 would be near death, 1 would be near birth 1 would have a college education 1 would own a computer

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DefinitionsDefinitions

Race

Ethnicity

Genetic determinants Physical

characteristics Common heritage

Customs Characteristics Language Common history National origin

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CultureCulture

Shared system of values, beliefs, history, and patterns of behavior

Learned and practiced Generate meaning Influence behavior and decision-making

Elements

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DISCUSSIONDISCUSSION

Discuss the ways in which health care providers share a common culture.

Discuss the ways in which members of your health discipline share a culture.

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Cultural VariationCultural Variation

Ethnicity Age Socioeconomic status Religion Education Language Gender Ability

Sexual orientation Length of time in

South Carolina Urban vs.. rural

residence Amount and type of

contact with elders Degree of

acculturation

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MulticulturalismMulticulturalism

The practice of acknowledging, valuing and respecting all cultures, religions, ethnicities, attitudes, and opinions within an environment

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Diversity and Its Diversity and Its Stumbling BlocksStumbling Blocks

Language and Literacy

Class-related values

Culture-related values

Communication Stereotypes Racism Ethnocentricity Collusion

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LanguageLanguage

Essential for making sense of the world Basic reading and writing skills Stress or emotional trauma Limited English Proficiency

Barriers to care

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LiteracyLiteracy

40 to 44 million Americans are functionally illiterate

50 million have only marginal literacy skills

72 million cannot read technical reports or news magazines

One-half of the adult population has basic deficiencies

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Belief SystemsBelief Systemsand Language Semanticsand Language Semantics

Hypertension vs. “High blood” “High pertension” or “tension”

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Class- and Culture-Class- and Culture-Related ValuesRelated Values

Class Related Values

Socioeconomic status Marginalization

Culture Related Values

Macroculture Microculture Culturally based beliefs Cross-cultural differences

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Cross-Cultural DifferencesCross-Cultural Differences

“The Spirit Catches You and

You Fall Down:

A Hmong Child,

Her American Doctors,

and the Collision of Two Cultures”

Anne Fadiman

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CommunicationCommunication

Personal experience, family attitude, group beliefs

Explanatory models Folk illnesses

Empacho

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CommunicationCommunication

Multiple sources of careComplementary careSpiritual practices

Health-related beliefs and practices

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Stereotypes & RacismStereotypes & Racism

Stereotypes Stigmatize Homogenize Marginalize

Racism Discrimination

based on an ideology of racial superiority

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Ethnocentricity and CollusionEthnocentricity and Collusion

Ethnocentricity Judging Superiority Contempt Centrality

Collusion Destructive

cooperation Perpetuates bias and

exclusion

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Diversity Building BlocksDiversity Building Blocks

Cross-Cultural Understanding Linguistic Pluralism Attention to Ethnically/Culturally

Appropriate Learning & Problem Solving Styles

Cultural Competence

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Cross-Cultural UnderstandingCross-Cultural Understanding

Transcultural Illness, health careHealing

Cultures in community Patient- and community-centered care

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Linguistic PluralismLinguistic Pluralism

1990 Census 14% speak a language other than

English at home 45% of those had trouble speaking

English 1 in 10 people in U.S. are foreign born Multiple language proficiency

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Ethnically/Culturally Appropriate Ethnically/Culturally Appropriate Learning & Problem Solving StylesLearning & Problem Solving Styles

Understanding of common cultural values of populations represented in the community

Detecting when values across cultures are in conflict

Negotiating successful resolutions

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Cultural CompetenceCultural Competence

DefinitionAwarenessSensitivityUnderstandingCommitmentEthical valuesAutonomy vs. social justice

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DISCUSSIONDISCUSSION

Why is cultural competence necessary?

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Demographic ChangesDemographic Changes

By 2000, 30 % of the U.S. population will be foreign-born or children of foreign-born

By 2100, 50% of all Americans will be Black, Hispanic, or Asian in origin

By 2030, about 20 % of population will be over 65 years of age; now it is about 13 %

The 85+ population is expected to double its current size by 2025

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Elements of a Cultural Elements of a Cultural Competence ModelCompetence Model

Valuing Diversity Cultural Self-assessment Dynamics of Difference Institutionalization of Cultural

Knowledge Adaptation of Services

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Valuing DiversityValuing Diversity

Explanatory system for world view Sense of challenge by diversity Lack of threat from differences Comfortable with the fact that people

think and behave differently based on their culture

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Cultural Self-AssessmentCultural Self-Assessment

Knowledge of one’s own background and culture

Acknowledgement of biases Managing differences

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Elements of Cultural Elements of Cultural CompetenceCompetence

Dynamics of Difference

Interaction between different cultures

Based on assumptions, behaviors and expectations

Institutionalization ofCultural Knowledge

Knowing clients Disseminating

information Activity modification

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Adaptation of ServicesAdaptation of Services

Cross-cultural relationship of patient and provider

Culturally sensitive health care systemAccessibleRespectfulKnowledgeableSensitive

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Cultural Competency Cultural Competency ContinuumContinuum

Negative Positive

Cultural Cultural CulturalDestructiveness Awareness Proficiency

Cultural CulturalIndifference Competence

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Essentials of Cultural Essentials of Cultural CompetenceCompetence

Culturally competent care is care that: Is sensitive to differences Understands how responses formed Elicits pertinent information Recognizes important differences Negotiates acceptable plan

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Resolving Cross-Cultural Resolving Cross-Cultural Discrepant Models of SicknessDiscrepant Models of Sickness

Know commonly held folk beliefs and behaviors

Assess the likelihood of acting on beliefs

Negotiate between the two belief systems

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SummarySummary

The world is becoming increasingly diverse. Social and cultural beliefs, values, attitudes

and behavior figure significantly in the health of communities and their individual members.

Cultural competence is essential to the health of individuals and communities.

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Discussion TimeDiscussion Time

Discuss the challenges of implementing the proposed standards for Culturally & Linguistically Appropriate Health Care Services, particularly as it relates to managed care and controlling costs.