Social and Cultural

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Part III

• Social and Cultural
• Influences on Health

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OBJECTIVES

• Define diversity and its impact on health and
  health care
• Demonstrate an understanding of cultural
  competency

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Global 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 worlds 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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Definitions

• Race
• Ethnicity

• Genetic determinants
• Physical characteristics
• Common heritage
• Customs
• Characteristics
• Language
• Common history
• National origin

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Culture

• 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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DISCUSSION

• 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 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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Multiculturalism

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

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Diversity and Its Stumbling Blocks

• Language and Literacy
• Class-related values
• Culture-related values

• Communication
• Stereotypes
• Racism
• Ethnocentricity
• Collusion

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Language

• 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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Literacy

• 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 Systemsand Language Semantics

• Hypertension vs.
• High blood
• High pertension or tension

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Class- and Culture-Related Values

• Class Related Values
• Socioeconomic status
• Marginalization

• Culture Related Values
• Macroculture
• Microculture
• Culturally based beliefs
• Cross-cultural differences

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Cross-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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Communication

• Personal experience, family attitude, group
  beliefs
• Explanatory models
• Folk illnesses
• Empacho

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Communication

• Multiple sources of care
• Complementary care
• Spiritual practices
• Health-related beliefs and practices

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Stereotypes Racism

• Stereotypes
• Stigmatize
• Homogenize
• Marginalize

• Racism
• Discrimination based on an ideology of racial
  superiority

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Ethnocentricity and Collusion

• Ethnocentricity
• Judging
• Superiority
• Contempt
• Centrality

• Collusion
• Destructive cooperation
• Perpetuates bias and exclusion

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Diversity Building Blocks

• Cross-Cultural Understanding
• Linguistic Pluralism
• Attention to Ethnically/Culturally Appropriate
  Learning Problem Solving Styles
• Cultural Competence

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Cross-Cultural Understanding

• Transcultural
• Illness, health care
• Healing
• Cultures in community
• Patient- and community-centered care

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Linguistic 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 Learning
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 Competence

• Definition
• Awareness
• Sensitivity
• Understanding
• Commitment
• Ethical values
• Autonomy vs. social justice

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DISCUSSION

• Why is cultural competence necessary?

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Demographic 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 Competence Model

• Valuing Diversity
• Cultural Self-assessment
• Dynamics of Difference
• Institutionalization of Cultural Knowledge
• Adaptation of Services

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Valuing 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-Assessment

• Knowledge of ones own background and culture
• Acknowledgement of biases
• Managing differences

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Elements of Cultural Competence

• Dynamics of Difference
• Interaction between different cultures
• Based on assumptions, behaviors and expectations

• Institutionalization of
• Cultural Knowledge
• Knowing clients
• Disseminating information
• Activity modification

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Adaptation of Services

• Cross-cultural relationship of patient and
  provider
• Culturally sensitive health care system
• Accessible
• Respectful
• Knowledgeable
• Sensitive

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Cultural Competency Continuum

• Negative Positive
• Cultural Cultural Cultural
• Destructiveness Awareness Proficiency
• Cultural Cultural
• Indifference Competence

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Essentials of Cultural Competence

• 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 Discrepant 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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Summary of Module 4, Part 3

• 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 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.

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Module Authors

• D. Beth Kennedy, M.S.
• Director of Education
• Laurine T. Charles,M.H.S.
• Associate Professor
• S. C. Area Health Education Consortium

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