CULTURAL
DIVERSITY
Aging, Health and Care
Jennifer May Licardo
Education Coordinator
AGING POPULATION
● seniors  65 y/o make up 13.7% of
Canada’s population

senior population
—
in 2005 - 4.2 million
—
between the year 2005 to 2036 4.2 to 9.8 million; will account for
about 25% of the total population
- Statistics Canada
CULTURAL DIVERSITY
% of seniors
immigrants
Aboriginal
visible
minority
Canada
Manitoba
 28%
 20%
1%
1%
7.2%
• in 2001 census - > 200 ethnic groups reported
• in 2006 census -  150 languages identified
- Statistics Canada
CULTURE
● a health determinant
- attitudes of the predominant culture
influence the well being of other
cultural groups:
• marginalization
• stigmatization
• loss or devaluation of language
• lack of access to culturally
appropriate health care services
- Public Health Agency of Canada
HEALTH
● ‘a state of complete physical, mental,
and social well-being and not merely
the absence of disease, or infirmity’
- World Health Organization
● healthy aging
- ‘a lifelong process of optimizing
opportunities for improving and
preserving health and physical, social and
mental wellness, independence, quality of
life and enhancing successful life-course
transitions’
- Health Canada
aging
culture
Cultural
competency
health
care
CULTURAL COMPETENCY
- “a set of behaviors, attitudes, and
policies that come together in a system,
agency, or among professionals and
enables that system, agency, or those
professionals to work effectively in
cross-cultural situations”
-
(Cross et al 1989)
CULTURAL COMPETENCY
-“in health care describes the ability of
systems to care for patients with diverse
values, beliefs and behaviors, including
tailoring delivery to meet patients’ social,
cultural and linguistic needs”
- (Betancourt et al 2002)
-“is a process in which healthcare providers
continually strive to work effectively within
the cultural context of a patient”
- (Brown & Rhymes, 2006)
CULTURAL COMPETENCY
In our setting:
Organizations and healthcare
providers need to recognize and
value cultural diversity among
seniors.
CULTURAL COMPETENCY
CHALLENGES
Organizations:
● Policies - mission statements
- staffing
● involve community, families, and person in
meetings and assessments
● use of interpretation services and
community health workers
● culturally and linguistically friendly
physical environment (interior design,
pictures, posters, art works)
CULTURAL COMPETENCY
CHALLENGES
Organizations:
● Policies
- mission statements
e.g. Christianity – belief that Jesus Christ
was the son of God and He came to
earth as a man to restore the
relationship between humans and God
- staffing
e.g. French speaking staff in a long-term
care facility
CULTURAL COMPETENCY
CHALLENGES
Organizations:
● involve community, families,
and person in meetings and
assessments
CULTURAL COMPETENCY
CHALLENGES
Organizations:
● use of interpretation services and
community health workers
e.g. Language Access Interpreter
Services
(204) 788-8585
free services
Winnipeg Health Region
CULTURAL COMPETENCY
CHALLENGES
Organizations:
● culturally and linguistically friendly
physical environment (interior
design, pictures, posters, art works,
food and celebrations)
CULTURAL BELIEFS/ISSUES
● Judaism – Kosher symbols
● Southeast Asian refugees
● India – leather
● Hinduism – beef
● Islam – pork, Ramadan
● Buddhism - vegetarian
CULTURAL COMPETENCY
CHALLENGES
Healthcare providers:
• become familiar with core cultural
issues of the groups with whom you
work
• assess your own attitudes and values,
knowledge and skills
— recognize that people from other cultures
may not share your own beliefs
CULTURAL COMPETENCY
CHALLENGES
Healthcare providers: con’t.
• enhance person-provider
communication and trust
— build skills that enhance communication
• promote mutual respect
CULTURAL COMPETENCY
CHALLENGES
Healthcare providers:
● become familiar with core
cultural issues of the groups
with whom you work
CULTURAL BELIEFS/ISSUES
- CHINA
 role of Confucianism
- filial piety (“xiao”)
- father - undisputed head of the family
 role of Buddhism
- emphasize “face” & dignity
 role of Taoism
- selflessness, cleanliness, emotional calm
 illness as an imbalance of Yin & Yang
CULTURAL BELIEFS/ISSUES
- BUDDHISM
 pain and suffering can provide
valuable lessons in life
- AFRICA
 elders believed as representatives
of ancestors & mediators between
them and kin-group
- ABORIGINAL
 in many communities, age is not
defined by chronology
CULTURAL COMPETENCY
CHALLENGES
Healthcare providers:
● assess your own attitudes and
values, knowledge and skills
CULTURAL BELIEFS/ISSUES
- SOUTHEAST ASIA
 traditional remedies:
‒ herbal medicine
‒ therapeutic burning
‒ coin rubbing
‒ acupuncture
‒ cupping
CULTURAL BELIEFS/ISSUES
- PAKISTAN
 does not require much personal
space
- ABORIGINAL
 women expected to be primary
caregivers
- BUDDHISM
 strive for deep insight into true
nature of life
CULTURAL BELIEFS/ISSUES
- HINDUISM
 belief that every soul is trapped
in a cycle of birth and then death
and then rebirth; aim is to be
better
than the life before
 belief in “Karma”
CULTURAL BELIEFS/ISSUES
-
ISLAM
 heart of faith for all Muslims is
obedience to Allah’s will
 upon death: prefer that body not be
touched by non-Muslims
 important to wash in running water
(face, ears, forehead, feet, arms to
the elbows) and rinse nose and
mouth before prayer
CULTURAL COMPETENCY
CHALLENGES
Healthcare providers:
● enhance person-provider
communication and trust
CULTURAL BELIEFS/ISSUES
- INDONESIA
 touching head of an elder is rude
- JAPAN
 direct eye contact may be intimidating
or sexual
- PAKISTAN
 generally enjoy close interpersonal
relationship
 do not appreciate discussing about
women in public
CULTURAL BELIEFS/ISSUES
- INDIA
 winking, whistling , pointing with fingers,
touching someone’s ears or pointing
your feet at someone considered rude
 feet are considered unclean - if feet
make contact, expect to apologize
 use of first name is considered impolite
 left hand considered unclean, use right
hand for eating
- ABORIGINAL
 tend not to use direct physical or eye
contact when speaking to another person
CULTURAL COMPETENCY
CHALLENGES
Healthcare providers:
● promote mutual respect
CULTURAL COMPETENCY
CONSIDERATIONS
● avoid generalizations or
stereotypes
● maintain a non-judgmental
attitude
● practice person-centered care
CULTURALLY COMPETENT
HEALTHCARE PROVIDER
WARMTH
- acceptance, liking, commitment,
and unconditional regard
EMPATHY
- ability to perceive and communicate,
accurately and with sensitivity, the
feelings of an individual and the
meaning of those feelings
GENUINENESS
- openness, spontaneity, and congruence
REFERENCES:
Statistics Canada. 2007. Detailed Mother Tongue (186), Knowledge of Official Languages (5),
Age Groups (17A) and Sex (3) for the Population of Canada, Provinces, Territories, Census
Metropolitan Areas and Census Agglomerations, 2001 and 2006 Censuses - 20% Sample Data
(table). Topic-based tabulation. 2006 Census of Population. Statistics Canada catalogue no. 97555-XCB2006015. Ottawa. Released December 04, 2007.
http://www12.statcan.ca/english/census06/data/topics/Print.cfm?PID=89201&GID=837928&D1
=0&D2=0&D3=0&D4=0&D5=0&D6=0 (accessed February 20, 2008).
Statistics Canada. 2007. Manitoba (table). 2006 Community Profiles. 2006 Census. Statistics
Canada Catalogue no. 92-591-XWE. Ottawa. Released March 13, 2007.
http://www12.statcan.ca/english/census06/data/profiles/community/Index.cfm?Lang=E
(accessed February 22, 2008).
Public Health Agency of Canada. Population Health. What Determines Health? Key
Determinants.
www.phac-aspc.gc.ca/ph-sp/phdd/determinants.html#culture
Statistics Canada. 2007. “A Portrait of Seniors in Canada” Catalogue no. 89-519-XIE.
www.statcan.ca/english/freepub/89-519-XIE/2006001/findings.htm
REFERENCES:
Public Health Agency of Canada(PHAC). “Healthy Aging in Canada: A New Vision, A Vital
Investment.” Division of Aging and Seniors.
www.phac-aspc.gc.ca/seniors-aines/pubs/haging-newvision/pdf/vision_rpt_e.pdf
National Advisory Council on Aging (2005). “Seniors on the Margins: Seniors from
Ethnocultural Minorities.” Minister of Public Works and Government Services Canada.
Achieving Cultural Competence: A Guidebook for Providers of Services to Older Americans
and their Families. January 2001
Manitoba’s Office of Rural and Northern Health. Multicultural Reference Guide: Etiquette &
Religion. October 2006.
Brown, D. and Rhymes, J. 2006. Cultural Competence for Primary health Care in Nova
Scotia: A DVD and Discussion Guide
Wieland, D. et al. 1994. Cultural Diversity and Geriatric Care.
Kratiuk-Wall, S. et al. 1997. Cultural Diversity and Dementia.