1. Lesson 1
A Diverse Nation

2. "Culture is a cluster of intangible and tangible aspects of life passed down from generation to generation."
Discuss with students what they think this quote means.
Dr. Felipe Korzenny, Professor

3. Objectives In this lesson, you will:
Define culture and cultural diversity
Recognize the scale of diversity in the United States
Define demographics
Investigate personal biases
Compare generalizations and stereotypes

4. Culture
Culture is the system of shared attitudes, values, and beliefs that are common among a group of people.
Culture includes societal aspects, such as language, customs, values, art, and social norms, that are taught and passed down from generation to generation.
Have students give examples of different cultures. Examples: In Gina’s household, everyone who enters the house removes their shoes at the front door. At Cliff’s school, there is a culture of being polite and holding the door open for others. Businesses often have company cultures of shared values and attitudes in place.
It can be as large as a society or as small as the culture within a household.

5. Culture Our culture affects:
our behavior, including how we think, act, and feel.
how we communicate and interact with others.
how we feel about things like pain, medicine, healthcare, illness, and disability.
In order to give our patients the best possible care, we must first understand the importance of culture and its influences.

6. Iceberg Analogy
In 1976, American anthropologist Edward T. Hall developed what he called the iceberg analogy of culture.
He said that if the culture of a society was an iceberg, some aspects of culture would be easy to see, above the surface.
However, below the water, there is a much larger portion of culture, hidden beneath the surface.
Ask students how the iceberg model applies to cultural differences and healthcare. For example, when we study cultural differences, we need to refrain from judgment based solely on what we see on the surface.
Ask students to list aspects of culture that are found above the surface. Then do the same for below.
Examples of above could include items that are more observable and more self-aware: Religious rituals, gestures, eating habits, literature, paintings, music, food, styles of dress, work ethic, facial expressions.
Examples of below could include items that are less observable and less self-aware: Religious beliefs, concept of leadership, concept of fairness, notion of modesty, child-raising beliefs, connection with natural world, importance of time, nature of friendship, concept of personal space, rules of social etiquette, values, concept of self, world view.

7. Cultural Diversity
Cultural diversity is the cultural differences and variety that exist in the world, a society, or an institution.
Including, but not limited to:
race
religion
socioeconomic status
gender
place of residence
disability
health status
sexual orientation
age
geographic origin

8. Properly Handling Cultural Diversity
Properly handling cultural diversity significantly affects:
how patients respond to medical services and interventions
the type of quality care that patients receive
Healthcare professionals must be sensitive to the cultural practices of patients and take these practices into consideration in their communication and the delivery of treatment.
Cultural diversity not only exists among your patients, but also among your co-workers.

9. United States Census
The United States government collects an official count of the population, or census, every 10 years.
Respondents self-identify their race and ethnicity.
Race - a person’s physical characteristics, such as their skin color, hair color, or eye color.
Ethnicity - cultural factors, such as nationality, regional culture, and language.
The data collected is used to inform many federal programs and policy decisions, especially related to civil rights and equal opportunities, including healthcare.

10. Demographics
Demographics - the statistical data of the population in a specific area.
Demographics can help you identify the type of diversity you may encounter most often in your local area.
Ask students why a knowledge of demographics could be helpful for a healthcare professional. Two examples are: earning a positive rapport by demonstrating interest in a patient’s culture, and learning about (and being able to share with patients) local services available to different cultural groups.

11. Personal Bias Biases - feelings that lead to certain behaviors.
Personal bias - allowing your own feeling about a particular person or thing affect your actions or decisions.
Even the most enlightened, intelligent, and caring professionals have some personal biases, even if they are completely unintentional.
Ask students: As a healthcare professional, what happens if personal biases get in your way? One main answer is that the patient’s needs are no longer front and center. Your students may come up with others.
Recognizing and understanding your own personal biases can help you more easily avoid unfair judgments.

12. Personal Bias Here are a few examples of personal bias:
1. Treating patients differently because of their weight
2. Prejudice related to a person’s sexual preference
3. Discrimination based on race or religion
4. Beliefs that someone who cannot afford health insurance should receive less care
5. Gender discrimination
6. Assuming a patient with broken English is uneducated
Ask students if they can think of any other examples of personal bias.

13. Generalizations vs. Stereotypes
A cultural generalization is made by looking at the majority of people in a cultural group and using their societal norms to make a generalization about the group’s behavior and patterns.
Stereotypes are made by automatically applying generalizations to every member of a group, or making generalizations about a group based on the behavior of a few individuals.
Used as a guide for studying and understanding culture.
Often incorrect, and in many cases are hurtful or derogatory.
Often use the words “some” or “many”.
Explore differences in people and are not used for comparison or judgment.
Some athletes like to celebrate and unwind after a game.
All athletes are party animals.

14. Generalizations vs. Stereotypes
Which statement is a generalization, and which is a stereotype?
Latinos are always closed to outsiders; they only do business among themselves.
Stereotype
Trust is important in the Latino community; to do business, you first need to build relationships.
Generalization
Have students respond before revealing the answers.

15. No individual is an exact generalization of their culture of origin.
People are a unique blend of the diversity from within their culture and an accumulation of personal experiences.

16. Summary In this lesson, you: Defined culture and cultural diversity
Recognized the scale of diversity in the United States
Defined demographics
Investigated personal biases
Compared generalizations and stereotypes
Have students share something they learned in this lesson.