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					       Promoting Medicare Fraud Prevention
                 Among Ethnic Populations

                                                    Drs. Mark Grey and Michele Yehieli
                                                                       University of Northern Iowa

This presentation was supported in part by a grant from the Administration on Aging, Department of Health & Human Services. Grantees
under government sponsorship are encouraged to express freely their findings & conclusions. Therefore, points of view or opinions do not
                                     necessarily represent official Administration on Aging policy.

 Dr. Mark Grey
  Professor and Executive Director
  Iowa Center on Immigrant Leadership and Integration
  University of Northern Iowa

 Dr. Michele Yehieli
  Associate Professor and Executive Director
  Iowa EXPORT Center on Health Disparities
  University of Northern Iowa
   Outline of Topics

 A Rapidly Changing America
 What Makes an Ethnic Group “Ethnic”?
    What are the Differences that Make a Difference?
    Cultural Filters
 Graphic Design 101: The Visual Language
    Color Traditions
    Meaningful Icons
 Ethnic-Specific Examples (Non-Latino/Hispanic)
    Eastern Europeans
    Asian Americans
 Selected Bibliography
America’s Changing Ethnic
America’s Changing Ethnic Landscape

 The nation’s white population continues to grow,
  but at a much slower rate than minorities.

 Between 1980 and 2000, the U.S. white
  population grew by only 12.3%

 The nation’s Asian and Pacific Islander
  population grew much faster by 204%, and the
  Hispanic population grew by 142%.
America’s Changing Ethnic Landscape

 During the same period, the nation’s
  black population grew by 30.8%.

 Between 1980 and 2000, U.S. minority
  populations grew eleven times faster
  than the white, non-Hispanic
America’s Changing Ethnic Landscape

The result:
  In 1900, one in eight Americans were
  In 2000, one in four Americans were
Already in 2005: 1 in 3 U.S. residents
 were non-white minorities!
America’s Changing Ethnic Landscape

  This trend is already occurring in many
   larger states. Three states—California,
   Hawaii, and New Mexico—and the District
   of Columbia had “majority minority”
   populations in the 2000 Census.

  Texas was deemed a “majority minority”
   state in October, 2004.
America’s Changing Ethnic Landscape

 By the year 2050, demographers predict that minorities together
  will comprise more than 50% of the US population, with no single
  group representing a majority

 It may be even sooner:
   According to 2005 Census estimates:
      • Whites accounted for only 19% of the nation’s total
        population growth
      • Hispanics continue to be fastest growing group,
        representing almost half of the nation’s total population
        growth 2004-2005
      • Asian population grew by 3%
      • Black population grew by 1.3%
      • Native Hawaiians and Pacific Islanders grew by 1.5%
What Makes an Ethnic Group “Ethnic”?
 What Makes an Ethnic Group “Ethnic”?

“Minority” versus “Ethnic Group”
  “Minority” generally refers to the size of a
   designated population relative to a
   predominate, “majority” population.
  Usually based on “race” or “non-white”
  This promotes the idea that all populations
   are monolithic.
    But there is a great deal of diversity within
  What Makes an Ethnic group “Ethnic”?

 We discourage the term “race”
 We emphasize “ethnicity”
  Ethnicity has to do with how people identify
   themselves in terms of their culture, language,
   heritage, national origin, etc.
  Ethnicity does not rely on physical traits.
      A person with black skin might identify herself as Somali
       or Sudanese and would dislike being called an “African-
      Likewise, not all people with light colored skin like to be
       called “white,” perhaps preferring to think of themselves
       as Italian or Jewish or Irish.
    What Makes an Ethnic Group “Ethnic”?

      The danger in relying on race to categorize people
        is that it contributes to stereotypes.
      There is always a great deal of ethnic diversity
        among people who otherwise share physical
 An “ethnic group” is a group of people recognized
  as a distinct sub-population on the basis of certain
  distinctive characteristics such as religion, language
  spoken at home, ancestry, culture or national origin.
What are the Differences that Make a

Thinking in terms of ethnicity is critical
 because it reflects how people understand
 their own identity, rather than using their
 appearance to impose an artificial identity
 on them.
  “Identity” is the key…
  How does one identify with certain symbols,
   colors, photo images, etc.?
Cultural Filters

 Cultural filters are used to understand and
  interpret visual and other phenomena.
 Cultural filters are influenced by experience,
  language, values, etc.
 The importance of cultural filters are often
  underestimated or misunderstood.
 “How will it play in Peoria” may target Middle
  (White) America, but it leaves out entire
   Classic Mistakes!
 The history of marketing is replete with
  examples of how assumptions about one-size-
  fits-all marketing campaigns have failed:
  Trying to sell the Chevrolet Nova in Mexico:
      In Spanish, “nova” means “doesn’t go”
  Trying to sell life insurance in Asian countries that
   have multi-generation mortgages
  In the US, Harley-Davidson tattoos are as American
   as apple pie
      But in Asia, they are associated with gangsters
      In Europe, these images evoke a negative response because
       of biker gang and neo-Nazi problems
“Target” Marketing Works

 Many in the Medicare Fraud prevention
  business believe they are doing something
  different from (or more important than)
 But convincing people to pay attention to
  their MSNs and report suspicious claims
  takes the same sort of tools and approaches
  as convincing someone to buy something. It
  has to appeal to people at their “gut” cultural
  and ethnic level.
 Think Target Marking Doesn’t Work?

•A Legacy of Targeting the African American Alcohol Market

               Star Wars star Billy Dee Williams, 1980’s
      More Examples: Targeting the African American Alcohol Market

Source: National Association of African Americans for Positive Imagery
      Effective Design Can Also Dissuade
 This Anti-Smoking advertisement targets African Americans

 Of particular interest is the name of the sponsor: Not only
  do the image (the dreaded rat) and text (..poison) attempt to raise
  awareness of the dangers of smoking, but this ad also plays on widespread
  mistrust of White dominated institutions (Tuskeegee, etc.)
Translation is Fine…But it’s not
Ethnic Marketing
Sample: 12 Tips to Protect Yourself
from Health Care Fraud
Sample: 12 Tips in Chinese
Sample: 12 Tips in Russian
Sample: “Who Pays?”
More Fraud Samples
Graphic Design 101:
The Visual Language

Color Traditions
Meaningful Icons and
Different Colors Often Mean Different
 Things to Different People
Colors Often Have Cultural Meaning
Marketers and Advertisers Use Color to
 Attract and Motivate Consumers and
  So Can You!
For Example: For the Predominately
 White Population in the US and
 Canada, here are examples of colors
 and their meanings:

  Red is a “loud” color that can both attract
   and warn us. Red can be sexy and
   passionate. Often used for safety and
   rescue vehicles like fire trucks. Americans
   prefer red apples to green.
Yellow is often cautionary (police tape
 around a crime scene). Most taxies are
 yellow. A “happy” color that can signify the
 sun, warmth, and ripe grains.
Blue is often used by companies and
 organizations to convey reliability and
 trustworthiness, thus the phrase “true
 blue.” “Blue ribbon” means winning, while
 “feeling blue” means depression.
Brown is often considered a “non color.”
 But it can be associated with reliability
 (UPS) and the earth (NPS signs). Brown
 paper (cardboard) is perceived to be
 stronger than white paper.
Black is often associated with death.
 Black also means business, very adult,
 chic. Matte black is sturdy and industrial.
 Gloss black indicates power.
Compare colors used by nations that
 reflect the flag of newcomers’ home

Flags will reflect ethnic and historic values
 of the people who created them.
Argentina        Belarus            China            India            El Salvador

        Lithuania          Mexico           Poland           Israel

  Keep In Mind:
  Even though many of these flags use the same
  colors, they may have different meanings in
  different cultures and nations. Here are some
  Hint: Need flags from any county in the world? Visit
Colors in Flags
       The light orange color in the Indian flag represents
       saffron, the color of Hindu monk’s robes.

       Blue in the Israeli flag is the color of God. In Exodus, when
       the Jewish elders see God, the path underneath them was
       paved “of sapphire stone.” God also commanded Moses
       that the Jews add blue fringe to borders of their clothing
       convey glory.
       Red in the Chinese flag means more than
       communism and Mao’s Little Red Book. Red also
       means fire, summer, good luck, good fortune, and
       fertility. Traditional Chinese wedding dresses are red.

        Red in the Russian flag also means more than
        communism. Red and yellow are traditional
        wedding colors. Blue symbolizes hope, purity,
        and virtue.
Meaningful Icons
Recent Ad Council Campaigns
Ad Council Advertisement RE: Cancer

             Simple, meaningful image. Black
             and white. Handwriting portrays
             graffiti. Or, the “handwriting is on
             the wall.”
What has been the Ad Council’s most
successful campaign?

 McGruff the Crime Dog:
 “Take a Bite Out of Crime.”

                               McGruff is now taking a bite out of
                               Telemarketing Fraud among Seniors…
Ethnic-Specific Examples

Soviet-Era Anti-Alcohol Campaign Posters
Soviet-Era Anti-Alcohol Campaign Posters
Soviet-Era Anti-Alcohol Campaign Posters
Soviet-Era Anti-Alcohol Campaign Posters
Contemporary Russian-American

Use of images that hearken      “Code-switching” ad that
back to Soviet poster images.   uses English and Russian
Contemporary Russian-American

                  A spicy that will   Cover from a
A reference to
                                      Russian magazine
keeping warm on   set your romance    in NY that uses a
cold Siberian     on fire.            famous cover from
nights.                               Time magazine
                                      about Soviet
Contemporary Russian-American

 1995. Note use of Soviet poster imagery and
 emphasis on “freedom” in the few years after the fall
 of the Berlin wall. Appeals to Russian and American
 Vodka drinkers.
Ad that uses a classic Soviet icon
Note the use of red and Cyrillic
letters of mixed size
What about Cartoons?

Cartoons are an effective way to
 communicate stories to audiences with
 low literacy.
Can be effective conveying emotion.
Often used to explain complex
Cartoons Can Be Effective

  •Here is an
  used by the
  of Justice
Bilingual Cartoon Stories
The Stories of Masha, Dasha and Grisha
Ethnic-Specific Examples


There are some similarities among
 Asian-American cultures in the U.S.
  But avoid making assumptions about
   these commonalities.
  For example, Chinese, Japanese, Korean
   and Vietnamese cultures believe in the
   power of numbers.
    But each culture has different ideas about the
     meaning of numbers.
      Asians and Numbers
 In China, Positive Numbers are 3, 8
  Negative Numbers are 4,(9) (Mistake: In China 9 is positive)
 In Japan, a Positive Number is 8
  Negative Numbers are 4,9
 In Korea, Positive Numbers are 3,7
  A Negative Number is 9
 In Vietnam, 9 is a Positive Number
  10 is a Negative Number
   Asians and Numbers
Why do numbers have different meanings
 in Asian cultures?
  3 in Chinese (a phonetic language) is
   pronounced like “life”
    But the Vietnamese avoid photos with 3 people in
  4 in Korean and Chinese is pronounced like
  9 in (Chinese), Japanese and Korean is
   pronounced like “suffering”
    But in Vietnamese, 9 means “good luck”
 Asians and Colors: China
 Red in China means more than Communism.
  It also means fire, summer, good luck and
  fertility. Weddings are “red” ceremonies.
  Packages wrapped in red paper are given on
  happy occasions.
 Yellow in China was used exclusively by the
  royal family and means power and wealth.
 Orange in China is the color of love and
  happiness. Orange is the color of saffron
  robes worn by Buddhist monks. Orange also
  represents yin-yang because it is the
  combination of yellow and red.
Hennessy ad for the Chinese Market
    Asians and Colors: India
 Brides in India wear red as a symbol of a new
  birth and for fertility. Red rubies are associated
  with royalty, dignity, zeal and power.
 Yellow represents the sun and its power and is
  used extensively during spring festivals. It is also
  the color associated with working class.
 The skin of the Hindu God Krishna is blue,
  symbolizing the heavens, love, and mercy. It
  also represents the mysterious nature of truth.
  The darker the color, the deeper the mystery. In
  Sanskrit “Krishna” means “dark blue.”
Tobacco company advertisement in
     Japanese and English
Chinese ad that shows flexibility of the
          written language
Alzheimer’s Association, Malaysia
                       Insert symbol of

Greenpeace “Invoice”
India: Polio Awareness
 L.K. Peterson and C.D. Cullen (2000). Global Graphics:
  Color. A Guide to Design with Colors for an International
  Market. Rockport Publishers.

 R. Lipton (2002). Designing Across Cultures: How to
  Create Effective Graphics for Diverse Ethnic Groups.
  HOW Design Books.

 J. Krause (2001). Layout Index. HOW Design Books.

 A.R. Miller, J.M. Brown and C.D. Cullen (2000). Global
  Design: Symbols. Designing with Symbols for an
  International Market. HOW Design Books.
References, continued

C. Tappenden, L. Jefford, and S. Farris (2004).
  Graphic Design. Cassell Illustrated.

 G. D. Finke and C. Warmke (2002). Powerful
  Page Design. HOW Design Books.

 D.E. Carter (2003). The Little Book of Layouts:
  Good Designs and Why They Work. Collins
Thank you!

Dr. Mark Grey
Dr. Michele Yehieli
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