HPRF 135
Jerry M. Kaiser
jkaiser@casa.sjsu.edu
www.schoolrack.com/jkaiser/files
924-7480
1.
Check and sign the roster: Name, preferred name, e-mail
2.
Adding the class: Graduating seniors first (with letter from advisor); seniors next (first, if
you were here last week, and then by lottery). There are not enough spaces for all
seniors and none available for juniors. If you were not here last week (unless you are a
graduating senior), there is no space available.
3.
Required: 3x5 cards at beginning and end of class. Put them in the box on the desk.
1.
Beginning: 3 comments and/or questions about the assignment
2.
End: 1 comment and/or question about the class
4.
If you are miss class or arrive late, you are responsible for work and assignments. See
Greensheet for late policies.
5.
Course reader is in the bookstore - not print shop. Ignore content which does not relate.
Cultural Concepts:
• Attitude
– State of mind or feeling about some matter of a culture
– Attitudes are learned
• Belief
– Accepted as true
– Tenet or body of tenets accepted by people in an
ethnocentric group.
– Do not have to be proven
• Ideology
– Thoughts and beliefs which reflect social needs and
aspirations of an individual or an ethno-cultural group
Activity
• In groups of 4, discuss one of your
– Attitudes
– Beliefs
– An ideology that you share
Culture
• The totality of socially transmitted behavioral patterns, arts,
values, customs, lifeways and all other products of human work
and thought characteristics of a population of people that guide
their worldview and decision-making.
• May be explicit or implicit.
• Primarily learned and transmitted in family
• Shared by most members of the culture
• Emergent phenomena that change in response to global
phenomena
• Largely unconscious and has powerful influences on health and
illness.
• Discuss: Cultural Climate at SJSU
Cultural awareness
• Appreciation of signs of diversity
Cultural sensitivity
• Attitudes, behaviors, possibilities
Cultural competence
• Developing an awareness of one’s own existence, sensations,
thoughts and environment without letting it have an undue
influence on those from other backgrounds.
• Demonstrating knowledge and understanding of the client’s
culture, health-related needs and meanings of health and illness
• Accepting and respecting cultural differences
• Not assuming that the healthcare provider’s beliefs and values
are the same as the client’s
• Resisting judgmental attitudes such as “different is not as good.”
• Being open to cultural encounters
• Adapting care to be congruent with the client’s culture. Cultural
competence is a conscious process and not necessarily linear.
The progression toward cultural
competence
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Unconscious incompetence
Conscious incompetence
Conscious competence
Unconscious competence
• “To be even minimally effective, culturally competent care must
have the assurance of continuation after the original impetus is
withdrawn; it must be integrated into, and valued, by, the culture
that is to benefit from the intervention.”
Ethnocentrism
• “The universal tendency of human beings to think that their
ways of thinking, acting, and believing are the only right, proper,
and natural ways.
Values
• Principles, and standards that have meaning and worth to an
individual, family, group, or community
• The extent to which one’s cultural values are internalized
influences the tendency toward ethnocentrism.
Primary Characteristics of Culture
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Nationality
Race
Color
Gender
Age
Religious Affiliation
Secondary Characteristics of Culture
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Educational status
Socioeconomic status
Occupation
Military experience
Political beliefs
Urban v. rural residence
Enclave identity
Marital status
Parental status
Physical characteristics
Sexual orientation
Gender issues
Reason for migration
Length of time away from country of origin
Immigration Status and Worldview
• Voluntary immigrants acculturate more willingly
• Assimilate more easily
12 domains of culture
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
Overview, inhabited localities, and topography
Communication
family roles
workforce issues
biocultural ecology
high-risk behaviors
nutrition
pregnancy and childbearing practices
death rituals
Spirituality
health care practices
health care practitioners
Overview, inhabited localities,
and topography
1. Country of origin
2. Current residence
3. The effects of the topography of country of origin and current
residence on health
4. Economics
5. Politics
6. Reasons for migration
7. Education status
8. Occupations
Communication
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Dominant language
Dialects
Cultural communication patterns
Personal space
Body language
Touch
Temporal relationships
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Format for names
Family roles and organization
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The head of the household
Gender roles
Family goals and priorities
Developmental tasks of children and adolescents
Roles of the aged
Roles of extended family members
Individual and social status in the community
Acceptance of alternative lifestyles
Single parenting
Nontraditional sexual orientations
Childless marriages
Divorce
Workforce issues
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Autonomy
Acculturation
Assimilation
Gender roles
Ethnic communication styles
Individualism
Health care practices from the country of origin
Biocultural ecology
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Skin color
Body type
Diseases that are genetic, hereditary, topographic or endemic
How the culture metabolizes drugs
High-risk behavior
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Drug use
Alcohol use
Nicotine use
Dangerous behaviors
Use of safety equipment (seat belts, helmets)
High risk behaviors (sexually or otherwise)
Degree of sedentary lifestyle
Consumption of unhealthy food
Nutrition
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Availability of food
Rituals and taboos associated with food
The meaning of food to the culture
How food is used in sickness and in health
Pregnancy and childbearing practices
• Fertility practices
• Labor and delivery practices
• Practices that are considered taboo, prescriptive or restrictive
during pregnancy
• Labor and postpartum
Death rituals
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How death is viewed
Euthanasia
Preparation for death
Burial practices
Bereavement practices
Spirituality
• Practices that give strength and meaning of life to a
individual
• Religious practices
• How prayer is used
Health care practices
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Does the culture seek preventative or acute treatment?
Magicoreligious healthcare beliefs
Traditional practices
Individual responsibility for health
Self medicating practices
Views towards issues such as
– Organ donation
– Mental illness
– Rehabilitation
• How pain is expressed
• The sick role
• Barriers to health care
Health care practitioners
• Type of practitioners the culture uses
– Traditional, or folk
– Biomedical
• Does gender of the practitioner comes in to play?
• What is the status the practitioner has in this culture?
Ethnicities
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White
African American
American Indian and Alaskan Native
Asian
Native Hawaiian and other Pacific
Islander
• “some other race”; I.e., unable to
identify with other categories.
Nation
American Indian/Alaska
native
1%
Other Race
0.17%
Two or More Races
2%
Asian
4%
Hispanic
13%
Pacific Islander
0.13%
African American
12%
White
68%
California
American Indian/Alaska
native
1%
Other Race
0.17%
Two or More Races
3%
Asian
11%
White
47%
Hispanic
32%
African American
6%
Pacific Islander
0.13%
SJSU Student Body
Pacific Islander
1%
Filipino
7%
Other Hispanic
4%
White
25%
Not stated
17%
African American
4%
American
Indian/Alaskan
1%
Mexican American
10%
Asian
31%
Comparative Demographics
70
60
50
40
Nation
California
SJSU**
30
20
10
0
**17% not stated
White
Hispanic
Asian
African
American
Determinants of Health
Percent of U.S. Deaths
45
40
35
30
25
20
15
10
5
0
40
30
20
10
Behavioral Patterns
Social
Circumstances and
Environmental
Exposures
Genetics
Inadequacies in
medical care
Influences on the Health of Individuals
QuickTime™ and a
TIFF (LZW) decompressor
are needed to see this picture.
Life Expectancy, in years, at birth
American
Indian
Hispanic
Asian/Pacific
Islander
Black
White
60
65
70
75
80
Life expectancy for an African American baby boy born today
is about the same as for a white born in 1950
85
Hispanic Health Differences
(deaths per 100,000)
32
10
Puerto Rican
women
32
Puerto Rican Men
Cuban Women
1
217
57
291
11
Diabetes
HIV/AIDS
Heart disease
92
10
24
Cuban Men
Mexican Women
12
13
Mexican Men
10
16
0
170
85
110
100
200
300
400
Percent of men who smoke
Laotian
Korean
Vietnamese
Filipino
Chinese
Japanese
Asian and pacific Islander
0
20
40
60
80
Immigration History and Policy
1882 The Chinese Exclusion Act of 1882 suspends immigration of Chinese laborers under
penalty of imprisonment and deportation.
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1898 Philippines became American possession, and Filipinos were designated “nationals”.
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1907 The United States and Japan form a “Gentleman’s Agreement” in which Japan ends
issuance of passports to laborers and the U.S. agrees not to prohibit Japanese immigration.
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1913 California’s Alien Land Law rules that aliens “ineligible to citizenship” were ineligible
to own agricultural property.
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1917 Immigrants required to pass a literacy test, excluded virtually all Asians.
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1922 The Supreme Court rules in Ozawa v. United States that first-generation Japanese
are ineligible for citizenship and cannot apply for naturalization.
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1924 Immigration Act of 1924 establishes fixed quotas of national origin and eliminates Far
East immigration.
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1934 U.S. Supreme Court ruled the “White persons” meant Caucasian, and excluded
Chinese, Japanese, East Asians (Hindus), American Indians, and Filipinos. These groups
were excluded from citizenship. Also, quotas were placed on Filipino entries and some were
repatriated.
Immigration History and Policy
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1942 Bracero program initiated, allowed temporary workers
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1943 Quota system changed to allow a few restricted aliens to enter. For example, 100
Chinese a year were allowed. The Chinese Exclusion Act was repealed
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1950 Aliens required to register
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1952 Immigration of a few additional Asians allowed; also some refugees were allowed.
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1964 End of Bracero program
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1965 Old quotas based on country of origin were dropped; Asians no longer restricted and
Europeans no longer favored. Preference categories favored entry of family members and of
professionals, effective 1968. Allowed admission of refugees.
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1970’s-80’s Most immigrants have been from Latin America and Asia: Vietnam, S.E. Asia,
Cuba, and Haiti. In addition, many illegal immigrants enter every year; especcially from
Mexico.
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1986 Amnesty for undocumented workers in U.S. since 1982
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1990 Increased immigration ceiling from 500,000 to 700,000 annually until 1995
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2001 Patriot Act creates significant new restrictions on immigration procedure in an effort to
combat terrorism.
• Discuss: Effects of immigration on U.S.
Asssignments:
For February 6
• Ch. 2, p. 14-21, 21-23
• 1-2 pages: Who am I, related to 12
domains.
• Course adds:
– add number by department
Worldmapper:
Maps of Inequalities
Public Health Spending
Private Health Spending
Early Neonatal Mortality
HIV/AIDS Prevalence
Malaria Cases
Medical Myths:
Kurdistan
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1.
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9.
medical myths common among our local populations, having no
sound scientific basis & include:
Acidic food as lemon are good for hypertension.
Bitter food are good for diabetes.
Honey & dates are safe for diabetics.
Typhoid & measles patients should not eat yougurt.
Typhoid, measles & infleunza patients should not have a bath untill
cured.
Jaundice clears by looking at moving fish in water.
Whooping cough can be cured by passing through tunnels.
Inhalers for asthma are addicting.
Garlic prevents heart disease & lowers blood pressure.