+

African Americans

Cultural Presentation NUR 300Dr. Karen Roush

Dhondup DolmaAyo OguntoyeAkem Agbere

Kwaku BaidooJana Wilson

+Definition of African American?

African Holocaust – 16th to 19th centuries – The Middle Passage A New Ethnicity – fusion of cultures including traditional

African, European, Native American

New Generation African Americans

+Institute of Medicine Report (IOM) Commissioned by Congress, 2002. Report showed

pervasive racial and ethnic disparities in health care.

Identified a national context of social and economic inequality, as well as persistent discrimination based on race or ethnicity.

Influence of bias, stereotyping, prejudice, and clinical uncertainty on the part of health care providers.

Nursing Implication: nurses must be aware of cultural and financial barriers to health care for racial and ethnic minorities.

(Watts, 2003)

+Diversity Within the Black Community

“Prevailing assumptions regard the Black population as a monolithic entity that is largely poor and undereducated. Such stereotypes obscure the vast heterogeneity that characterizes this population…” (Baytops, Patton, & Day-Vines, 2003).

Nurses must remember this diversity and approach their clients as individuals, whose norms and values may not be what is expected.

+African American Culture

May be distrustful of government & social services Knowledge of Tuskegee Experiment (Carteret, 2011) U.S. Public Health Service conducted the Tuskegee Study of

Untreated Syphilis in the Negro Male, 1932 399 men with syphilis, no informed consent, 40 years Lack of ethical standards, no treatments given, some men

died, wives contracted the disease, children born with congenital syphilis

+African American Culture & Society Impact of poverty on education, self-esteem, quality of

life and lifestyle - across the lifespan

Strong sense of pride – may not admit when they need help

Seniors very respected – age represents respect, authority and wisdom

Lack of knowledge about available services and how the system works

Politically – overwhelmingly Democratic

Social problems: racial profiling, judicial system, poverty, institutional racism, less access to health care

+African American Kinship

Strong family bonds, adaptable family roles Social and emotional support, “take care of their own” Older family members pass on social and cultural traditions Broader concept of who is considered family- “fictive kin” Grandparents may provide childcare May use more authoritarian styles of discipline for children

Informal support network – church, community – collectivist

Nursing Implication: Importance of “family” – fictive or not Spirituality used to process & reconcile death Funeral services may be seen as “homecomings” – going

home to the afterlife (Carteret, 2011)

+Fictive Kinship vs. Mainstream American Fictive Kinship networks: collective over the

individual, kinship and affiliation, extended families, spirituality, connectedness, harmony with nature, and holistic thinking

Mainstream American culture: individualism, achievement, success, competition, material accumulation, nuclear families, religion distinct from other parts of culture, mastery over nature

Nursing Implication: African Americans in the middle class are more likely to adopt values that come from both African American and mainstream American cultural perspectives

(Baytops et al., 2003)

+Religion & Philosophy African Americans may have strong religious

affiliations, often Protestant

Many African Americans are Muslim – today about 1/3 of Sunni mosque attendees are African American

150,000 African Americans in the U.S. practice Judaism – this number is growing

Nursing Implication: Rather than a direct question about religion, ask a client

where they turn for support in times of need Learn how a client’s faith may affect their behavior and

ideas about health (Carteret, 2011)

+Miscegenation

Miscegenation – marriage or sexual relations between individuals of different races

“The politics of hair and skin color … stems back to slavery and the practice of miscegenation, when slave masters accorded preferential treatment and status to their bi-racial offspring who usually had lighter skin and straighter hair textures (Okazawa-Rey, Robinson, & Ward, 1987). Following the demise of slavery, African Americans continued to assign greater value to individuals who approximated a White European aesthetic. Even today, many African American youngsters endure teasing and ridicule because of their appearance, especially individuals who lie at either extreme along the skin color and hair texture continuum (Baytops et al., 2003).

+In Conclusion There is an underlying fabric of racism and bias in the

United States.

Nurses, and all health care providers, must work actively to change this.

African Americans are a unique ethnicity, of mixed and varied heritages. Approach clients as individuals, they may not conform to generally held cultural ideas about the group.

Be cautious of your own bias.

+References & More Info…

Baytops, J.L., Patton, J.M., & Day-Vines, N.L.. (2003) Counseling African American adolescents: the impact of race, culture, and middle class status. Professional School Counseling, 7(1), 40-51. http://isites.harvard.edu/fs/docs/icb.topic545403.files/Day%20Vines%20et%20al.pdf

Carteret, M. (2011). Health care for African American patients/families. Dimensions of Culture (posted under category African American Culture). Retrieved from http://www.dimensionsofculture.com/2011/05/health-care-for-african-american-patientsfamilies/

Watts, R.J. (2003). Race consciousness and the health of African Americans. Online Journal of Issues in Nursing, 8(1), Manuscript 3.

http://www.gourmet.com/magazine/2000s/2009/03/politics-of-the-plate-the-price-of-tomatoes

http://www.ushistory.org/us/6g.asp

http://www.nj-ptc.org/training/materials/Rutgers/SSW_SchoolSocWkrs/CulturalImpact%20Synopsis.pdf

+DISPARITY IN THE EDUCATIONAL SYSTEM:

Despite unprecedented efforts to improve minority education in the past decade, ethnic disparities in education still exist.

African Americans greatly out-number Caucasians in special education classes, in-school suspension and remedial classes. This same group of students are nearly non-existent on the class rosters of advanced level courses, in which Caucasians tend to dominate (Franklin, Waukechon and Timmer, 1995)

+DISPARITY IN THE EDUCATIONAL SYSTEM CONTINUED:

Some of the reasons for these disparities include:

Schools that have predominantly black populations often lack the necessary educational resources and qualified teachers that can be easily found at predominantly white schools and there is under-representation of minority students in gifted programs (Tatum, 2005).

More black children live in poverty, which is linked to array of problems, low birth weight, exposure to lead poisoning, too much TV watching, too little reading at home, less involvement by parents and frequent school changing

+ECONOMIC ACTIVITY:

African American economic conditions continue to lag behind mainstream populations, particularly European Americans.

A disproportionate number of African-Americans are poor and impoverished or ‘one pay check away’ from poverty.

For many African-Americans, the last 25 years have been a history of lost jobs and low wages (Darity and Mason, 1998)

A large wealth gap persists between African Americans and other racial groups even at the same educational, income and occupational levels.

+AFRICAN AMERICANS AND THE POLITICAL SYSTEM:

For a large part of U.S. history, African-Americans voters saw themselves as being disenfranchised either directly or through political practices.

Even today, the average participation of African-American voters is lower than other ethnic groups, even though there is a great variety within these voting patterns.

Most Africa- Americans still perceive much greater constraints on their political freedom than other ethnic group.

+AFRICAN AMERICANS AND HEALTHCARE DELIVERY:

Despite improvement, differences persist in healthcare quality among racial and ethnic minorities. People in low income families experience poorer quality care.

According to the 2010 population census, blacks people received poorer health care compared to the other ethnic group in 41% of quality measures.

+BARRIERS TO ACCESS QUALITY HEALTH CARE:

Health Insurance Status:

In 2009, African Americans under age 65 were less likely than the other ethnic group to have health insurance (81% compared with 83%).

In 2009, the percentage of people ages 25-64 with health insurance was about one-third lower for people with less than a high school education than for people with at least some college education (56% compared with 88%).

+SPECIFIC SOURCE OF ONGOING CARE:

In 2009, the percentage of people with a specific source of ongoing care was lower for African -America than for other ethnic group (85% compared with 86%.

In 2009, the percentage of people with a specific source of ongoing care was significantly lower for poor and low-income people than for high-income people (78% and 80%, respectively, compared with 92%)

+CONCLUSION:

Areas where disparities are worsening between African Americans and other ethnic groups and between poor and high-income populations: Maternal deaths in black population. Breast cancer diagnosed at advanced stage per 100,000 women

age 40 and over in black population. Children 0-40 pounds for whom a health provider gave advice about

using car safety seats in Asian population. Adults age 50 and over who ever received a colonoscopy,

sigmoidoscopy, or proctoscopy in AI/AN population and in poor population.

People with difficulty contacting their usual source of care over the telephone in AI/AN population.

Poor adults who did not have problems seeing a specialist they needed to see in the last year.

Poor people without a usual source of care who indicated a financial or insurance reason for not having a source of care.

+ REFERENCES

Disparities in Healthcare Quality Among Racial and Ethnic Groups: Selected Findings from the 2011 National Healthcare Quality and Disparities Reports. Fact Sheet. AHRQ Publication No. 12-0006-1-EF, September 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nhqrdr11/nhqrdrminority11.htm

Franklin, C., Waukechon, J., Larney, P.S., Timmer, D.F., Pennekamp, M. (1995). Indian Magnet School: Culturally relevant school programs for American Indian children and families. Social Work in Education, 17 (3), 183-193

Tatum, A.W. (2005). Teaching reading to black adolescent males: Closing the achievement gap. Portland, ME: Stenhouse Publishers

HEALTH BELIEFS OF AFRICAN AMERICANS

Akem Agbere

African Americans are the second largest

minority group in the United States

Compose more than 10 percent of the total U.S. population

Culture of African Americans

African Americans reflect cultural roots that

include elements of African healing -Anatomical folklore -West Indies Voodoo religion -Fundamentalist Christianity Directly or indirectly influence health care

behavior

Sensitivity on Health

Connection between the human body and the

forces of nature -Dates -Zodiac signs -Numbers

Folk Beliefs

The Farmer's Almanac- Used by many African Americans and Whites in

the South - The phases of the moon- The position of the planets- The seasons of the year and natural phenomena

Folk Beliefs (continued)

Spiritual healers Grannies, herbalists, and physicians Supernatural healers Folk healing methods Hypnosis for hexed believed people

Folk Healers

HEALTH PRACTICES

DHONDUP DOLMA

DEMOGRAPHICSIn 2012, the population of African Americans was estimated at 44.5 million, making up 14.2% of the total U.S. population.

The US Census Bureau projects that by the year 2060, there will be 77.4 million African Americans making up 18.6 % of the total U.S. population

Source: http://www.cdc.gov/minorityhealth/populations/remp/black.html

Insurance CoverageIn 2012, 50.4 percent of African-Americans in

comparison to 74.4 percent of non-Hispanic whites used private health insurance.

In 2012, 40.6 percent of African-Americans in comparison to 29.3 percent of non-Hispanic whites relied on Medicaid, public health insurance.

Finally, 17.2 percent of African-Americans in comparison to 10.4 percent of non-Hispanic whites were uninsured.

African American Health Practices

Distrust with American health care system therefore issue of noncompliance

Less likely to use preventive health services

Delays seeking treatment for serious disease which results in a poorer prognosis and fewer more expensive treatment options

African Americans use emergency departments as a major health care resource

They tend to rely on informal helping networks in the community particularly those associated with church until problem becomes crisis.

Health Risks Hypertension morbidity and mortality rates are three to five times higher

than for whites.

Diabetes is 33 percent more prevalent than in whites.

African Americans have a higher rate of coronary heart disease than whites.

Cancer remains a major health problem.

Greater risk for HIV and AIDS

Sickle cell anemia is a genetically inherited disorder found almost exclusively in African Americans.

Lactose intolerance is common in African Americans

Adolescent pregnancy

LEADING CAUSE OF DEATH ARE HEART DISEASE, CANCER AND STROKE

Historical influence on health practice

Health practices are influenced by history

Develop their own healing traditions using readily available resources- herbs, stones, roots

HEALTH PRACTICESAfrican American church participation and health

care practicesChurches are central places in the lives of many

African AmericansReligious participation and religiousness are

related to improvement in quality of life indicatorsOptimistic life orientationGreater perceived social supportImproved life satisfactionHigher resilience to stressLower levels of anxiety

AFRICAN HEALING- Healing power is a gift from God

Grannies, herbalist and physician: They have the lowest status because of the belief that anyone may learn a healing trade

Spiritual healers: Higher in status. Profound religious experience involve prayer, laying on of hands, and the use of holy oil or holy water with supernatural powers.

Supernatural Healers: These are the healers of highest status, generally called sorcerers, voodooists, or root doctors. Believed to have been selected by God at birth. The bones are linked to physical attributes or body parts; the patient arranges the bones on the floor and the healer interprets the arrangement.

Implications for Nursing Behaviors/Interventions

Recognize the presence of many individual and subgroup variations

Building a relationship based on trust crucial

Encourage family involvement by engaging extended family system, particularly grandmothers in providing support and health teaching

Alternative modes of healing may include herbs, and prayers

References Carteret, M. (2011, January 1). Health Care for African American Patients/Families |

Dimensions of Culture. Retrieved October 19, 2014, from http://www.dimensionsofculture.com/wp-content/uploads/2011/05/Cross-cultural-News-African-American-Health2.pdf

Arnold, E. & Boggs, K. (2011). Interpersonal relationships: Professional communication skills for nurses (6th ed.). Philadelphia: W.B. Saunders Co

Aaron, K., Levine, D., & Burstin, H. (2003, January 1). African American Church Participation and Health Care African American Church Participation and Health Care Practices. Retrieved October 19, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494942/pdf/jgi_20936.pdf

Nutritional PracticesDisclaimer: the following may not

represent all African Americans. The word “African American” refers to

black people in the U.S whose sociocultural roots are rooted in the North American experience. This is

different from new generation Americans. Nurses beware.

Soul Food

http://www.itvs.org/films/soul-food-junkies

History of African American Cuisine

The word “soul food” originated in the ‘60s.

Influenced by European, African , and native American culture

Originated in the south (slavery era)

Consisted of:

Discarded meat

New kinds of greens

New recipes for native crops

Dietary value of Soul foodHigh starch

High fat content

High cholesterol

High calories

Potential health problemsHigh Blood pressure

Diabetes

Atherosclerosis

Stroke

Heart attack

Memory problems

Factors affecting nutritional choices

Lifestyle

Environment

Living distance from suitable healthy choices

Culture

Poor food choices

Poor physical

and mental health

Poor outcome

Next generation

Social, cultural, religious, political,

and economic

factors

Positive trends

Implications for Nursing Intervention

Do not make assumptions based on group affiliation

See the individual in every encounter

Explore nutritional alternatives with clients

Educate

Advocate

Be a role model

Group the Following into Healthy or Unhealthy Choices

Watermelon vs Iced tea

Collard greens vs Mac n cheese

Peach cobbler vs fresh peaches

Candied yams vs steamed sweet potato

Brisket vs smoked turkey

Fried chicken vs baked chicken

Table salt vs sea salt

Sugar vs honey

Benefits of making healthy choices

Watermelon: Excellent thirst quencher. Lower in sugar

Collard greens: High in minerals, fiber, and phytonutrients (linked to prevention of ovarian and breast cancer)

Steamed sweet potato: Beta carotene, trace elements. Anti diabetic food.

Black eyed peas: High in protein and fiber

Lifestyle/Social Patterns

https://www.youtube.com/watch?v=7U-et8qOXLs

Family StructureFather and mother present

Mother as bread winner

Extended family

TheoriesPoverty

Decline in black marriage

Rise in divorce rates

Fathers MIA – Issue of serial fatherhood

Impact of LifestyleHygiene

Physical fitness

Diet Regulation

Consequences of excessive TV watching?

African Americans account for 87% of total U.S retail spending

Influenced by targeted advertising and TV programsHighest consumer of health and beauty product

Potential Problems for children

Lack of discipline

Apathy and antisocial behavior

Helplessness and frustration

Low self esteem

StrengthsBlack women report highest increase in per

capita income

Strong religious orientation

Extended family

Motivation to work hard

Strength and athleticism

Big brother

Implications for Nursing Intervention

Cultural awareness

Counseling

Advocacy