M1L2.1 2.2 Culture Society Health
Transcript of 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