Social and Cultural Influences on Health

1. Social and CulturalInfluences 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 • Define diversity and its impact on health and health care • 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. Race Ethnicity Genetic determinants Physical characteristics Common heritage Customs Characteristics Language Common history National origin Definitions

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

8. 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.

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

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

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

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

13. 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

14. Belief Systemsand Language Semantics • Hypertension vs. • “High blood” • “High pertension” or “tension”

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

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

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

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

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

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

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

25. 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

26. 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

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

28. DISCUSSION Why is cultural competence necessary?

29. 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

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

31. 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

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

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

34. Adaptation of Services • Cross-cultural relationship of patient and provider • Culturally sensitive health care system • Accessible • Respectful • Knowledgeable • Sensitive

35. Cultural Competency Continuum Negative Positive Cultural Cultural Cultural Destructiveness Awareness Proficiency Cultural Cultural Indifference Competence

36. 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

37. 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

38. 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.

39. 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.