Cultural Diversity & Disparities in Healthcare Study Guide 1 ➔ Balance ◆ Health ● Balance of person ● Physical, mental, spiritual (within) ● Natural, communal, metaphysical (outside world) ◆ Illness ● Imbalance of person ● Within and/or outside ◆ Healing ● Restoration of balance ● Within and/or outside ➔ Culture ◆ Culture ● Metacommunication system ● Not only spoken words have meaning, everything else too ◆ Characteristics of Culture 1. Medium of personhood + social relationships 2. Complex whole where each part is related to another 3. Learned by each person in family/social community 4. Dependent on underlying social matric ➔ Culturally Competent ◆ Within delivered care ◆ Provider understands + attends total context (patient situation) ◆ Combination of knowledge, attitudes + skills ◆ 5 Steps to Cultural Competence 1. Personal heritage (you) 2. Heritage of others (demographics) 3. Health, health beliefs + practices 4. Healthcare culture + system 5. Traditional healthcare systems ➔ Culturally Appropriate ◆ Provider applies underlying background knowledge ● Must be possessed to provide patient w/ best possible health ➔ Culturally Sensitive ◆ Provider possesses some basic knowledge + constructive attitude ◆ Knowledge toward health traditions among diverse cultural groups ● Groups in setting in which he/she is practicing ➔ Culturally + Linguistically Appropriate Services (CLAS) ◆ Set of 15 standards ◆ Created by office of minority health (1997) ◆ Must be met by healthcare agencies ➔ Cultural Conflicts ◆ Events when there is polarization between 2 groups ◆ Their differences are intensified by the way they are perceived ◆ Variables leading to cultural conflict ● ● ● ● ● ● Decade of birth Generation Class + income Language Education Literacy ➔ Trivia ◆ What act declared all recipients of federal funding must take reasonable steps to steps to provide access to people w/ limited English proficiency (LEP) ● Title VI of the Civil Rights Act of 1964 ◆ Official language of the US? ● English ◆ % of US residents over age 5 speaking English at home? ● 79.2% ◆ % of US residents over age 5 speaking no English at all? ● 9% ◆ # of US residents speaking Spanish (over age 5)? ● 37.5 million ◆ What % of Spanish speaking residents over age 5 w/ no English? ● 62.9% ➔ Heritage ◆ Heritage Consistency ● Degree to a person’s lifestyle ● Reflects his/her traditional heritage ◆ Heritage ● Determine how deeply a person identifies w/ a traditional heritage ● Or acculturated into modern, dominant culture ◆ Components of Heritage Consistency 1. Socialization (extended family, hometown) 2. Culture (language, folkways) 3. Religion (historic beliefs, religious membership + participation) 4. Ethnicity (socialize w/ members of same ethnic group + participates in folkways ➔ Ethnicity ◆ Large groups of people classed ◆ Classed by common racial, national, tribal, religious, linguistic, or cultural origin/bg ➔ Ethnocentrism 1. Belief in superiority of their nation/ethnic group 2. Overriding concern w/ race ➔ Fears ◆ Xenophobia ● Fear/hatred of foreigners/strangers ◆ Xenophobe ● Person fearful of strangers of foreign origin ➔ Ethnic Groups ◆ # of ethnic groups of Native Americans? ● 106 ◆ # of federally recognized Native American tribes? ● 567 ◆ US rank in weekly church attendance? ● 7th ◆ % of US are Christian? ● 70.6% ◆ % of US are Jewish? ● 1.9% ◆ % of US are Buddhist? ● 0.7% ◆ % of US are Muslim? ● 0.9% ◆ % of US religiously unaffiliated? ● 22.8% ➔ Religion ◆ Belief in and worship of a superhuman controlling power ● Especially personal God/gods ➔ Acculturation ◆ Process of adapting and being absorbed into dominant culture ● Involuntary process ◆ Usually takes 3 generations to fully acculturate ➔ Socialization ◆ Process of being raised in a culture, acquiring characterizations of the group ● Often through schooling ➔ Assimilation ◆ Becoming in all ways like members of dominant culture ➔ Generations ◆ Silent Generation ● Born in 1938-1945 ● Believe in community service + conforming to society standards ◆ Boomer Generation ● Born in 1946-1964 ● Like to work hard play hard; often closer to friends than family ◆ Gen X ● Born in 1965-1980 ● Only work hard if not interfered w/ having a good time ◆ Millennials ● Born in 1977-1994 ● Very dependent on technology ◆ Gen Z ● Born in 1995-2012 ● Independent + are eager to jump into life ● Prefer personal interaction over technology ● Proficient with technology ➔ Trivia ◆ Women’s earnings are what % of men’s? ● 74-80% ◆ Percentage of students completing high school between 1980 and 2009 went from __% to __%? ● 69% to 85.3% ◆ # of American adults scoring below basic on an English literacy test? ● 11 million ◆ In 2010 POC represented what % of population? ● 36.3% (continually growing) ◆ Median age of population? ● 37.2 years old ◆ People aged 16-64 make up what % of the population? ● 62.9% ◆ People 65 and older make up what % of the population? ● 13% ● % is projected to grow as baby boomers grow older ➔ Environmental Control ◆ Ability of members of a cultural group to plan activities ● To control nature/ direct environment factors ➔ Space/Territory ◆ Personal space ● People’s behaviors + attitudes towards space surrounding themselves ◆ Territoriality ● Behavior + attitude people exhibit around area ● Area they claimed + defended ● Or react emotionally to when others encroach on it ➔ US Residency ◆ Naturalization ● Foreign born people aged 18+ can become US citizens ◆ Refugees ● People who seek residence in US to avoid persecution in their country of origin ◆ Lawful Permanent Resident (LPR) ● Not US citizens residing in US under legally recognized + lawfully recorded ● Have permanent residence as immigrants ➔ US Residency Trivia ◆ 3 leading countries of origin for LPRs? 1. Mexico (13.6%) 2. China (6.9%) 3. India (6.6%) ◆ Largest % of naturalized people origin? ● Asia (39%) ◆ Top 3 cities of residence for LPRs 1. New York (16.9%) 2. LA (8.1%) 3. Miami (6.7%) ◆ Top 3 states of residence for undocumented people 1. California 2. Texas 3. New York ◆ Top 3 states of residency for LPRs 1. California 2. New York 3. Florida ➔ Poverty ◆ Physical poverty ● Substandard housing, limited access to healthcare, poor nutrition, etc. ◆ Spiritual poverty ● Despair, experience of being disparaged + disenfranchised ○ Disparaged: being of little worth ○ Disenfranchised: deprive of right/privilege ➔ Poverty Trivia ◆ % of black people impoverished? ● 26.2% ◆ % of Hispanics impoverished? ● 23.6% ◆ % of white people impoverished? ● 10.1% ◆ % of children under 18 impoverished? ● 21.1% ◆ # of federal programs to provide aid to impoverished individuals? ● 80+ ◆ Largest government program to fight poverty? ● Medicaid, SNAP and Supplemental Security Income (SSI) ➔ The Health People Series ◆ Science based 10 year national objectives ◆ Designed to improve health of all people (made by surgeon general) ➔ Health + Wellbeing ◆ Health equity ● Attainment of highest level of health for all people ◆ Health disparity ● Particular type of health difference ● Closely linked to social, economic, and/or environmental disadvantage ◆ Physical wellbeing ● Relates to vigor + vitality ● Feeling very healthy + full of energy ◆ Mental wellbeing ● Being satisfied w/ life, accepting oneself, balancing positive + negative emotions ◆ Social wellbeing ● Providing + receiving quality support from friends, family, + others ◆ Main components of sick role 1. Sick person is exempted from performance of certain normal social obligations 2. Exempted from certain responsibility of their own state (not blamed for being sick) 3. Legitimization of sick role is only partial (attempt to recover quickly) 4. Being sick except in mildest of cases is being in need of help ➔ Illness + Care ◆ Phases of illness 1. Onset: when first symptoms appear 2. Diagnosis: disease is identified and sick role is now socially accepted 3. Patient status: person adjusts to social aspects of being ill 4. Recovery: relinquishing of sick role + assumption of pre-illness roles ◆ 5 phases of illness 1. Symptom experience 2. Assumption of sick role: ask friends + family for advice 3. Medical care contact stage: go to health professionals for official diagnosis 4. Dependent patient stage: person under control of healthcare providers + expected to comply w/ their demands 5. Recover/rehabilitation phase ◆ Primary care ● Clinics + local doctors offices ● Usually stable condition ◆ Secondary care ● Surgery, specialty care, mental health care ● Unstable status ◆ Tertiary care ● Extensive surgery, radiation, other high tech care ● Deteriorating patient ◆ Health Maintenance ● Everyday ways to go about living + attempting to stay well/healthy + ordinarily function within family, community, or society ● Ex. wearing jacket in the cold, eating balanced diet ◆ Health Protection ● Ability to understand cause of certain illnesses/symptoms + prevent them ● Ex. getting vaccinated, wearing red ribbon to protect from evil eye ➔ Evil Eye ◆ Belief that someone can project harm by gazing/staring at other’s property or person ◆ Oldest + most widespread superstition ◆ Common beliefs 1. Power emanates from eye/mouth + strikes victim 2. Injury/misfortune is sudden 3. Person who cast evil eye may not be aware 4. Afflicted may or may not know source 5. Injury may be prevented/cured w/ rituals + symbols ◆ German term: aberglobin or abergläubisch ◆ Polish term: szatan ◆ YIddish term: kayn aynhoreh ◆ Expression used by Jewish people after giving compliments/statements of luck to prevent ● Kineahora ➔ Cultural Beliefs ◆ Dybbuk: wandering, disembodied soul that enters another’s body and holds fast ◆ Traditional practices used in protection of health 1. Use of protective objects 2. Use of ingested substances, removal of item from diet, hanging of substances around body/house 3. Practices of religion ◆ Amulets ● Sacred objects worn on string/chain around neck, wrist, or waist ● Protect wearer from evil spirits ◆ Mano milagroso ● “Miraculous hand” ● Worn by many people of Mexican origin ● For luck and to ward off evil spirits ◆ Mano negro ● Placed on babies of Puerto Rican descent ● Wards off the evil eye ● Place on wrist or pinned to diaper during early years of life ◆ Bangles ● Open silver bracelets ● Open to let evil spirits out and close to prevent evil from entering ● Tinkle when wearer moves to scare away evil spirits ● Worn from infancy onwards by people from west indies ● Tarnishes and leaves black ring on wrist when wearer is becoming ill
