Post on 24-Dec-2015
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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.