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 Charleston, SC

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)

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

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.

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

Definitions l Race l Ethnicity l Genetic determinants l Physical characteristics l Common heritage s Customs s Characteristics s Language s Common history s National origin

Culture l Shared system of values, beliefs, history, and patterns of behavior s Learned and practiced s Generate meaning s Influence behavior and decision-making l Elements

DISCUSSION l Discuss the ways in which health care providers share a common culture. l Discuss the ways in which members of your health discipline share a culture.

Cultural Variation l Ethnicity l Age l Socioeconomic status l Religion l Education l Language l Gender l Ability l Sexual orientation l Length of time in South Carolina l Urban vs.. rural residence l Amount and type of contact with elders l Degree of acculturation

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

Diversity and Its Stumbling Blocks l Language and Literacy l Class-related values l Culture-related values l Communication l Stereotypes l Racism l Ethnocentricity l Collusion

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

Literacy l 40 to 44 million Americans are functionally illiterate l 50 million have only marginal literacy skills l 72 million cannot read technical reports or news magazines l One-half of the adult population has basic deficiencies

Belief Systems and Language Semantics l Hypertension vs. s “High blood” s “High pertension” or “tension”

Class- and Culture- Related Values Class Related Values l Socioeconomic status l Marginalization Culture Related Values l Macroculture l Microculture l Culturally based beliefs l Cross-cultural differences

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

Communication l Personal experience, family attitude, group beliefs l Explanatory models l Folk illnesses s Empacho

Communication l Multiple sources of care s Complementary care s Spiritual practices l Health-related beliefs and practices

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

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

Diversity Building Blocks l Cross-Cultural Understanding l Linguistic Pluralism l Attention to Ethnically/Culturally Appropriate Learning & Problem Solving Styles l Cultural Competence

Cross-Cultural Understanding l Transcultural s Illness, health care s Healing l Cultures in community l Patient- and community-centered care

Linguistic Pluralism 1990 Census l 14% speak a language other than English at home l 45% of those had trouble speaking English l 1 in 10 people in U.S. are foreign born l Multiple language proficiency

Ethnically/Culturally Appropriate Learning & Problem Solving Styles l Understanding of common cultural values of populations represented in the community l Detecting when values across cultures are in conflict l Negotiating successful resolutions

Cultural Competence l Definition s Awareness s Sensitivity s Understanding s Commitment s Ethical values s Autonomy vs. social justice

DISCUSSION Why is cultural competence necessary?

Demographic Changes s By 2000, 30 % of the U.S. population will be foreign-born or children of foreign-born s By 2100, 50% of all Americans will be Black, Hispanic, or Asian in origin s By 2030, about 20 % of population will be over 65 years of age; now it is about 13 % s The 85+ population is expected to double its current size by 2025

Elements of a Cultural Competence Model l Valuing Diversity l Cultural Self-assessment l Dynamics of Difference l Institutionalization of Cultural Knowledge l Adaptation of Services

Valuing Diversity l Explanatory system for world view l Sense of challenge by diversity l Lack of threat from differences l Comfortable with the fact that people think and behave differently based on their culture

Cultural Self-Assessment l Knowledge of one’s own background and culture l Acknowledgement of biases l Managing differences

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

Adaptation of Services l Cross-cultural relationship of patient and provider l Culturally sensitive health care system s Accessible s Respectful s Knowledgeable s Sensitive

Cultural Competency Continuum NegativePositive CulturalCultural Cultural Destructiveness AwarenessProficiency Cultural Cultural Indifference Competence

Essentials of Cultural Competence Culturally competent care is care that: l Is sensitive to differences l Understands how responses formed l Elicits pertinent information l Recognizes important differences l Negotiates acceptable plan

Resolving Cross-Cultural Discrepant Models of Sickness l Know commonly held folk beliefs and behaviors l Assess the likelihood of acting on beliefs l Negotiate between the two belief systems

Summary l The world is becoming increasingly diverse. l Social and cultural beliefs, values, attitudes and behavior figure significantly in the health of communities and their individual members. l Cultural competence is essential to the health of individuals and communities.

Discussion Time l 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.