Transcript Cultural Diversity and Health Care

Cultural
Diversity
Olga Usynska
Definition of terms
Cultural diversity is the differences
among people that result from ethic,
racial and cultural variables
Definition of terms
What is Culture?
- shared lifestyle, values, beliefs, ideals and behavior of a
particular group.
Picture it as a luggage that each of us carries
around for our lifetime. It is sum of beliefs,
practices, habits, likes, dislikes, norms,
customs, rituals and so forth that we learned
from our families during the years of
socialization. In turn, we transmit cultural
luggage to our children.
Dominant culture and minorities
Dominant culture is the group, whose
values prevail within a society
Minority group is composed of an
ethnic, racial, or religious group that
constitutes less than a numerical
majority of the population
“The United States, already one of the most
diverse societies in the world, is becoming
increasingly multicultural and multilingual”
Lester, 1998
The strength and
greatness of
America lies in the
diversity of its
people…
Growing Diversity in America
During the Past 20 years
White population increased 10%
African American population
increased 30%
Native American population
increased 58 %
Hispanic population increased
125%
Projected Demographics
In 2020 the population of AfricanAmericans is predicted to double and that
of Asian-Americans and Hispanic/Latinos to
triple
By the year 2050, white Americans’ share
of the total population will decline from
75% to under 50%
Multiculturalism in United States
The dominant culture is composed of white
middle-class Protestants of European
ancestry
The minorities are Native Americans,
African Americans, Asian Americans and
Hispanic Americans
But…
•“In many localities so-called minorities are
now, in fact, the majority”
(ANA, 1998)
In California
Population of 38 Million
1/3 of the population is of Hispanic origin
Over 10% Asian
Over 4% more than one race
Nearly 17% identify as “Other race”
In California
1 in 4 are foreign born, 37% of these
entered the US after 1990
Nearly 40% of the population over the
age of 5 speaks a language other than
English at home.
Food preferences and related
effects on health
African Americans
Food
Preferences
• Pork
• Greens
• Rice
• Fried foods
Nutritional
Related Health
Problem
•
•
•
•
• Obesity
• Cardiovascular
illnesses
(hypertension,
coronary heart
disease)
Calories
Cholesterol
Carbohydrates
Sodium
Food preferences and related effects
on health
Asian Americans
Food
Preferences
• Raw fish
• Rice
• Soy sauce
Nutritional
•
•
•
•
Related Health
Problem
Calories
• Coronary heart
disease
Cholesterol
Carbohydrates • Liver disease
• Stomach cancer
Sodium
• Ulcers
Food preferences and related effects
on health
Hispanic Americans
Food
Preferences
• Beans
• Fried foods
• Chili
• Carbonated
beverages
•Spicy food
Nutritional
•
•
•
•
Calories
Cholesterol
Carbohydrates
Sodium
Related Health Problem
• Obesity
• Coronary heart disease
• Diabetes
Food preferences and related effects
on health
Native Americans
Food
Preferences
•
•
•
•
Nutritional
Blue cornmeal • Calories
Fish
• Carbohydrates
Game
Fruits and
berries
Related Health
Problem
• Malnutrition
• Diabetes
Effects of biologic variations on
selected drugs
African Americans
Isoniazid (drug used to treat tuberculosis) is
rapidly metabolized, thus becoming inactive
quickly; occurs in approximately 60% of
population.
An enzyme deficiency interferes with metabolism
of primaquine (used to treat malaria); occurs in
approximately 35% of population.
Antihypertensive drugs (e.g., propranolol) need
to be administered in higher doses to produce
same effects as in European Americans
Effects of biologic variations on
selected drugs
Asian Americans
Isoniazid (drug used to treat tuberculosis)
is rapidly metabolized, thus becoming
inactive quickly; occurs in approximately
85%-90% of population.
Rapid metabolism of alcohol results in
excessive facial flushing and other
vasomotor symptoms.
Effects of biologic variations on
selected drugs
Asian Americans
Chinese men need only about half as much
propranolol (antihypertensive drug) as
European American men.
Asian people need smaller doses of
alprazolam (antianxiety drug) to achieve same
blood levels as their European American
counterparts; the drug is also metabolized
more slowly (remains in the bloodstream
longer) in Asian men.
Effects of biologic variations on
selected drugs
European Americans
Due to liver enzyme differences,
caffeine is metabolized and excreted
faster than by people of other cultural
groups.
Effects of biologic variations on
selected drugs
Native Americans
Isoniazid (drug used to treat tuberculosis)
is rapidly metabolized, thus becoming
inactive quickly; occurs in approximately
60%-90% of population.
Rapid metabolism of alcohol results in
excessive facial flushing and other
vasomotor symptoms.
Ethnic Health Disparities
African Americans
Highest death rate from colon and rectal
cancer of any ethnic group in the U.S.
African Am women, diagnosed with
breast cancer, have a 71% survival rate
vs. an 86% rate for white women.
Ethnic Health Disparities
Native Americans
2-3 times more likely to have diabetes
mellitus that the general population
Higher than average mortality rates
associated with heart disease, TB,
suicide, pneumonia, influenza,
homicide, and alcoholism
Differing Health Belief System
Magicoreligious HBS: people believe that
supernatural forces influence health and illness
Holistic Belief System: the forces of nature
must be kept in natural balance and harmony
Scientific or Biomedical HBS: health and
illness are controlled by a series of physical and
biomedical process that can be analyzed and
manipulated by humans. Disease and illness
are caused by microorganism or malfunction of
body
Factors that influence Health Beliefs and
Behaviors of Culturally Diverse Ind/Grp
Traditional health and illness practices:
Natural folk medicine
Magico-religious medicine
Use of food
Religious practicies
Use of Healers
Social organizations – refers to family unit; environment in
which people grow up and live.
- Description of family in this cultural group
- Gender and age roles that affect choice of whom to
communicate
Folk medicine: healers and practices
African Americans
Elderly women healers
"Community Mother"
or "Granny"
"Root doctor"
Voodoo healer
("Mambo" or "oungan")
Spiritualist
Herbs, roots
Poultices
Oils
Religious healing
through rituals, (e.g.,
laying on of hands)
Talismans are worn
around the wrist or neck,
or carried in a pouch to
ward off disease
Folk medicine: healers and practices
Asian Americans
• Herbalist • Physician
Use of hot and cold foods
Herbs (e.g., ginseng root, which is used as a
restorative potion)
Soups
Cupping, pinching, and rubbing
Meditation
Acupuncture
Acupressure
Application of tiger balm (a salve) to relieve
muscular pain
Folk medicine: healers and practices
European Americans
Nurse
Physician
Exercise
Medication (prescribed
and over-the-counter)
Modified diets
Amulets
Religious healing
rituals
Folk medicine: healers and practices
Hispanic Americans
Curandero – combinaiton of prayers, herbs, and other rituals to
treat traditional illnesses, especially in children
Espiritualista (spiritualist) - foretelling of future and
interpretation of dreams, combination of prayers, herbs,
potions, amulets for curing illnesses, including witchcraft)
Yerbero (herbalist) – consultation for herbal treatment of
traditional ilnesses
Sobadora (bonesetters) – massage and manipulation of bones
and joints used to treat a variety of ailments, including
musculoskeletal condition
Parteras (lay midwifes) – assisting for women in childbirth and
newborn care
Cultural Diversity and Health Care
We All Have It!
Obvious Manifestations:
Religion
Ethnicity
National Origin (language)
Gender
Cultural Diversity and Health Care
Less Obvious Manifestations:
Age
Education
Educational Status
Mobility (including handicaps)
Ethnicity
-
Sense of identification of a collective cultural
group
Characteristic of an ethnic group:
Common language
Same food preferences
Shared traditions
Religion
Shared values, symbols, literature, folklore,
music
AFRICAN-AMERICANS
Communication
Languages include English and Black English
Head nodding does not necessarily mean
agreement
Direct eye contact is often viewed as being rude
Nonverbal communication is very important
It is considered to be intrusive to ask personal
questions of someone on initial contact or
meeting
AFRICAN-AMERICANS
Time orientation and space
Oriented more to the present than the
future
Close personal space is important
Touching another's hair is sometimes viewed
as offensive
AFRICAN-AMERICANS
Social roles
Large extended-family networks are important
Many single-parent, female-headed households
Religion is usually Protestant (Baptist)
Strong church affiliation with community is
important
Social organizations are strong within com
munities
AFRICAN-AMERICANS
Health and illness
Harmony with nature
No separation of body, mind, and spirit
Illness is a disharmonious state that may
be caused by demons or spirits
Illness can be prevented by nutritious
meals, rest and cleanliness
AFRICAN-AMERICANS
Health risks
Sickle cell anemia
Hypertension
Coronary heart disease
Cancer (especially stomach and esophageal)
Lactose intolerance
Coccidioidomycosis
AFRICAN-AMERICANS
Implementation
Avoid stereotyping
Do not label Black English as an unacceptable
form of language
Clarify meaning of client's verbal and nonverbal
behavior
Be flexible and avoid rigidity in scheduling care
Encourage involvement with family
A folk healer or herbalist may be consulted before
an individual seeks medical treatment
ASIAN-AMERICANS
Communication
Languages include Chinese, Japanese, Korean,
Vietnamese, English
Silence is valued
Eye contact is considered rude
Criticism or disagreement is not expressed
verbally
Head nodding does not necessarily mean
agreement
The word "no" is interpreted as disrespect for others
ASIAN-AMERICANS
Time orientation and space
Oriented more to present
Social distance is important
Usually do not touch others during conversation
Touching is unacceptable with members of oppo
site sex
The head is considered to be sacred; therefore
touching someone on the head is disrespectful
ASIAN-AMERICANS
Social roles
Devoted to tradition
Large extended-family networks, loyalty to immediate
and extended family and honor are valued
Family unit is very structured and hierarchical
Men have the power and authority, and women
are expected to be obedient
Religions include Taoism (Buddhism), Islam,
Christianity
Social organizations are strong within the community
ASIAN-AMERICANS
Health and illness
Health is a state of physical and spiritual harmony with
nature and a balance between positive and negative
energy forces (yin and yang)
A healthy body is viewed as a gift from ancestors
Illness is viewed as an imbalance between yin and yang
Yin foods are cold, and yang foods are hot; cold foods are
eaten when one has a hot illness, and hot foods are eaten
when one has a cold illness
Illness is contributed to prolonged sitting or lying, or to
overexertion
ASIAN-AMERICANS
Health risks
Hypertension
Cancer (stomach and liver)
Lactose intolerance
Thalassemia
Coccidioidomycosis
ASIAN-AMERICANS
Implementation
Avoid physical closeness and excessive touching;
only touch a client's head when necessary,
informing the client before doing so
Limit eye contact
Avoid gesturing with hands
Clarify responses to questions
Be flexible and avoid rigidity in scheduling care
Encourage involvement with family
A healer may be consulted before an individual
seeks out traditional treatment
EUROPEAN (WHITE)-ORIGIN
AMERICANS
Communication
Languages include national languages,
English
Silence can be used to show respect or
disrespect for another, depending on
situation
Eye contact is viewed as indicating
trustworthiness
EUROPEAN (WHITE)-ORIGIN
AMERICANS
Time orientation and space
Future oriented
Aloof and tend to avoid close physical
contact
Handshakes are used for formal
greetings
EUROPEAN (WHITE)-ORIGIN
AMERICANS
Social roles
The nuclear family is the basic unit; the
extended family is also important
The man is the dominant figure
Religion includes Judeo-Christian
Community social organizations are
important
EUROPEAN (WHITE)-ORIGIN
AMERICANS
Health and illness
Health is usually viewed as an absence
of disease or illness
Have a tendency to be stoical when
expressing physical concerns
Primarily rely on modern Western
health care delivery system
EUROPEAN (WHITE)-ORIGIN
AMERICANS
Health risks
Breast cancer
Heart disease
Diabetes mellitus
Thalassemia
EUROPEAN (WHITE)-ORIGIN
AMERICANS
Implementation
Monitor and assess client's body
language
Respect client's personal space
HISPANIC-AMERICANS
Communication
Languages include Spanish and Portuguese, with various
dialects
Tend to be verbally expressive, yet confidentiality is
important
Eye behavior is significant; for example, the "evil eye" can
be given to a child if a person looks at and admires a child
without touching the child
Avoiding eye contact indicates respect and
attentiveness
Direct confrontation is disrespectful, and the expression of
negative feelings is impolite
Dramatic body language, such as gestures or facial
expressions, is used to express emotion or pain
HISPANIC-AMERICANS
Time orientation and space
Oriented more to present
Comfortable with close proximity to
others
Very tactile and use embraces and
handshakes
Value the physical presence of others
Politeness and modesty are essential
HISPANIC-AMERICANS
Social roles
The nuclear family is the basic unit; also, there are
large extended-family networks
The extended family is highly regarded
Needs of the family take precedence over individual
family members' needs
Men are the decision makers and breadwinners,
and women are the caretakers and homemakers
Religion includes Catholicism
Strong church affiliation
Social organizations strong within the community
HISPANIC-AMERICANS
Health and illness
Health may be a reward from God or a result of
good luck
Health results from a state of balance be
tween "hot and cold" forces and "wet and dry"
forces
Illness occurs as a result of God's punishment
for sins
Folk medicine traditions
HISPANIC-AMERICANS
Health risks
Lactose intolerance
Diabetes mellitus
Parasites
Coccidioidomycosis
HISPANIC-AMERICANS
Implementation
Communicate with male head of family
Protect privacy
Offer to call priest or other clergy because of
the significance of religious practices related to
illnesses
Always touch a child when examining him or her
Be flexible and avoid rigidity in scheduling care
NATIVE AMERICANS
Communication
Languages include English, Navajo, and other
tribal languages
Silence indicates respect for the speaker
Speak in a low tone of voice and expect others
to be attentive
Eye contact is avoided because it is a sign of
disrespect
Body language is important
NATIVE AMERICANS
Time orientation and space
Oriented more to present
Personal space is very important
Will lightly touch another person's hand
during
greetings
Massage is used for the newborn infant to
promote bonding between infant and mother
Touching a dead body is prohibited in some
tribes
NATIVE AMERICANS
Social roles
Very family oriented
Basic family unit is the extended family, which often
includes people from several households
In some tribes, grandparents are viewed as family leaders
Elders are honored
Children are taught to respect traditions
The father does all the work outside the home, and the
mother assumes responsibility for domestic duties
Sacred myths and legends provide spiritual
guidance
Religion and healing practices are integrated
NATIVE AMERICANS
Health and illness
Health is a state of harmony between the
person,
the family, and the environment
Illness is caused by supernatural forces and
disequilibrium between person and
environment
Traditional health and illness beliefs may
continue to be observed; natural and
magicoreligious folk medicine tradition
NATIVE AMERICANS
Health risks
Alcohol abuse
Accidents
Heart disease
Diabetes mellitus
Tuberculosis
Arthritis
Lactose intolerance
Gallbladder disease
NATIVE AMERICANS
Implementation
Clarify communication
Understand that the client may be attentive even
when eye contact is absent
Be attentive to own use of body language
Obtain input from members of extended family
Encourage client to personalize space in which health
care is delivered; for example, encourage client to
bring personal items or objects to the hospital
In the home, assess for the availability of running
water, and modify infection control and hygiene
practices as necessary
It is because we are different that
each of us is special!