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Social and Cultural Influences on Health

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					      Social and Cultural
     Influences 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 AHEC
                         SOUTH
                         CAROLINA
  Developed as part of an
Enhanced AHEC Community
   Partnership for Health
 Professions Workforce and
 Educational Reform project
   funded by the Health
   Resource and Service
   Administration (HRSA)
                   SOUTH
                   CAROLINA   AHEC
             OBJECTIVES

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




                                SOUTH
                                CAROLINA   AHEC
       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.

                                        SOUTH
                                        CAROLINA   AHEC
    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

                                  SOUTH
                                  CAROLINA   AHEC
                Definitions

   Race                 Genetic determinants
                         Physical
                          characteristics
   Ethnicity            Common heritage
                             Customs
                             Characteristics
                             Language
                             Common history
                             National origin
                                 SOUTH
                                 CAROLINA   AHEC
                        Culture

   Shared system of values, beliefs,
    history, and patterns of behavior
        Learned and practiced
        Generate meaning
        Influence behavior and decision-making
   Elements



                                         SOUTH
                                         CAROLINA   AHEC
             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.




                               SOUTH
                               CAROLINA   AHEC
           Cultural Variation

   Ethnicity          Sexual orientation
   Age                Length of time in
   Socioeconomic       South Carolina
    status             Urban vs.. rural
   Religion            residence
   Education          Amount and type of
   Language            contact with elders
   Gender             Degree of
                        acculturation
   Ability                   SOUTH
                              CAROLINA   AHEC
             Multiculturalism

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




                                 SOUTH
                                 CAROLINA   AHEC
          Diversity and Its
          Stumbling Blocks
   Language and         Communication
    Literacy             Stereotypes
   Class-related        Racism
    values               Ethnocentricity
   Culture-related      Collusion
    values

                              SOUTH
                              CAROLINA   AHEC
                   Language

   Essential for making sense of the world
   Basic reading and writing skills
   Stress or emotional trauma
   Limited English Proficiency
       Barriers to care




                               SOUTH
                               CAROLINA   AHEC
                  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
                                SOUTH
                                CAROLINA   AHEC
             Belief Systems
        and Language Semantics
   Hypertension vs.
       “High blood”
       “High pertension” or “tension”




                                     SOUTH
                                     CAROLINA   AHEC
            Class- and Culture-
              Related Values
Class Related Values Culture Related Values

   Socioeconomic status      Macroculture
   Marginalization           Microculture
                              Culturally based beliefs
                              Cross-cultural differences



                                     SOUTH
                                     CAROLINA   AHEC
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

                         SOUTH
                         CAROLINA   AHEC
SOUTH
CAROLINA   AHEC
             Communication

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




                               SOUTH
                               CAROLINA   AHEC
SOUTH
CAROLINA   AHEC
              Communication

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




                               SOUTH
                               CAROLINA   AHEC
       Stereotypes & Racism

      Stereotypes            Racism
   Stigmatize         Discrimination
   Homogenize          based on an
   Marginalize         ideology of racial
                        superiority




                              SOUTH
                              CAROLINA   AHEC
    Ethnocentricity and Collusion

     Ethnocentricity           Collusion
   Judging               Destructive
   Superiority            cooperation
   Contempt              Perpetuates bias and
   Centrality             exclusion




                                SOUTH
                                CAROLINA   AHEC
      Diversity Building Blocks

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


                             SOUTH
                             CAROLINA   AHEC
Cross-Cultural Understanding

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



                               SOUTH
                               CAROLINA   AHEC
          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
                                SOUTH
                                CAROLINA   AHEC
 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


                               SOUTH
                               CAROLINA   AHEC
          Cultural Competence

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

                                      SOUTH
                                      CAROLINA   AHEC
          DISCUSSION

Why is cultural competence necessary?




                           SOUTH
                           CAROLINA   AHEC
     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

                                 SOUTH
                                 CAROLINA   AHEC
        Elements of a Cultural
         Competence Model
   Valuing Diversity
   Cultural Self-assessment
   Dynamics of Difference
   Institutionalization of Cultural
    Knowledge
   Adaptation of Services


                                  SOUTH
                                  CAROLINA   AHEC
           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


                               SOUTH
                               CAROLINA   AHEC
     Cultural Self-Assessment

   Knowledge of one’s own background
    and culture
   Acknowledgement of biases
   Managing differences




                            SOUTH
                            CAROLINA   AHEC
           Elements of Cultural
              Competence
     Dynamics of          Institutionalization of
      Difference           Cultural Knowledge
   Interaction between      Knowing clients
    different cultures       Disseminating
   Based on                  information
    assumptions,             Activity modification
    behaviors and
    expectations

                                     SOUTH
                                     CAROLINA   AHEC
         Adaptation of Services

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

                               SOUTH
                               CAROLINA   AHEC
          Cultural Competency
               Continuum
            Negative         Positive


   Cultural             Cultural         Cultural
Destructiveness        Awareness        Proficiency

             Cultural           Cultural
            Indifference       Competence


                                   SOUTH
                                   CAROLINA   AHEC
      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




                              SOUTH
                              CAROLINA   AHEC
       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


                             SOUTH
                             CAROLINA   AHEC
                  Summary

   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.

                                  SOUTH
                                  CAROLINA   AHEC
            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.




                               SOUTH
                               CAROLINA   AHEC

				
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