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 AHEC SOUTH CAROLINA 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) SOUTH CAROLINA AHEC OBJECTIVES Define diversity and its impact on health and health care Demonstrate an understanding of cultural competency SOUTH CAROLINA AHEC 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. SOUTH CAROLINA AHEC 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 SOUTH CAROLINA AHEC Definitions Race Ethnicity Genetic determinants Physical characteristics Common heritage Customs Characteristics Language Common history National origin SOUTH CAROLINA AHEC Culture Shared system of values, beliefs, history, and patterns of behavior Learned and practiced Generate meaning Influence behavior and decision-making Elements SOUTH CAROLINA AHEC 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. SOUTH CAROLINA AHEC Cultural Variation 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 SOUTH CAROLINA AHEC Multiculturalism The practice of acknowledging, valuing and respecting all cultures, religions, ethnicities, attitudes, and opinions within an environment SOUTH CAROLINA AHEC Diversity and Its Stumbling Blocks Language and Literacy Class-related values Culture-related values Communication Stereotypes Racism Ethnocentricity Collusion SOUTH CAROLINA AHEC Language Essential for making sense of the world Basic reading and writing skills Stress or emotional trauma Limited English Proficiency Barriers to care SOUTH CAROLINA AHEC 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 SOUTH CAROLINA AHEC Belief Systems and Language Semantics Hypertension vs. “High blood” “High pertension” or “tension” SOUTH CAROLINA AHEC Class- and CultureRelated Values Class Related Values Culture Related Values Socioeconomic status Marginalization Macroculture Microculture Culturally based beliefs Cross-cultural differences SOUTH CAROLINA AHEC 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 SOUTH CAROLINA AHEC SOUTH CAROLINA AHEC Communication Personal experience, family attitude, group beliefs Explanatory models Folk illnesses Empacho SOUTH CAROLINA AHEC SOUTH CAROLINA AHEC Communication Multiple sources of care Complementary care Spiritual practices Health-related beliefs and practices SOUTH CAROLINA AHEC Stereotypes & Racism Stereotypes Stigmatize Homogenize Marginalize Racism Discrimination based on an ideology of racial superiority SOUTH CAROLINA AHEC Ethnocentricity and Collusion Ethnocentricity Judging Superiority Contempt Centrality Collusion Destructive cooperation Perpetuates bias and exclusion SOUTH CAROLINA AHEC Diversity Building Blocks Cross-Cultural Understanding Linguistic Pluralism Attention to Ethnically/Culturally Appropriate Learning & Problem Solving Styles Cultural Competence SOUTH CAROLINA AHEC Cross-Cultural Understanding Transcultural Illness, health care Healing Cultures in community Patient- and community-centered care SOUTH CAROLINA AHEC 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 SOUTH CAROLINA AHEC 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 SOUTH CAROLINA AHEC Cultural Competence Definition Awareness Sensitivity Understanding Commitment Ethical values Autonomy vs. social justice SOUTH CAROLINA AHEC DISCUSSION Why is cultural competence necessary? SOUTH CAROLINA AHEC 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 SOUTH CAROLINA AHEC Elements of a Cultural Competence Model Valuing Diversity Cultural Self-assessment Dynamics of Difference Institutionalization of Cultural Knowledge Adaptation of Services SOUTH CAROLINA AHEC 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 SOUTH CAROLINA AHEC Cultural Self-Assessment Knowledge of one’s own background and culture Acknowledgement of biases Managing differences SOUTH CAROLINA AHEC Elements of Cultural Competence Dynamics of Difference Interaction between different cultures Based on assumptions, behaviors and expectations Institutionalization of Cultural Knowledge Knowing clients Disseminating information Activity modification SOUTH CAROLINA AHEC Adaptation of Services Cross-cultural relationship of patient and provider Culturally sensitive health care system Accessible Respectful Knowledgeable Sensitive SOUTH CAROLINA AHEC Cultural Competency Continuum Negative Cultural Destructiveness Positive Cultural Awareness Cultural Indifference Cultural Proficiency Cultural Competence SOUTH CAROLINA AHEC 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 SOUTH CAROLINA AHEC 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 SOUTH CAROLINA AHEC 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. SOUTH CAROLINA AHEC 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. SOUTH CAROLINA AHEC