1. 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

2. 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)

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

4. 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.

5. 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

6. 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

7. 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

8. 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.

9. 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

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

11. 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

12. 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

13. 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

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

15. 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

16. 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

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

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

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

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

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

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

25. 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

26. 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

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

28. DISCUSSION Why is cultural competence necessary?

29. 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

30. 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

31. 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

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

33. 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

34. 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

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

36. 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

37. 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

38. 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.

39. 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.