cultural competence, culture safety and social class

define

• culture

• ethnicity

• race

• society

Culture 

• Shared way of life – belief, customs, language, traditions learned by a group of people 

Ethnicity

• People with the same ancestry, heritage, language, historical background 

Race

• Skin colour, facial features 

 Society 

• Structural community of people living together, under shared laws, systems 

what are some cultural situations a person may encounter in a healthcare setting

• language barrier

• health belief and practice

• different expressions of pain and illness

• gender roles/hierarchies

• decision making styles

• body language differences

• disease related stigma

what does the cognitive behavioural model include 3 (a lack of cultural competence)

cognitions (stereotyping), emotions (prejudices), behaviour (discrimination)

what is cultural competency

• Process where HP’s strive to achieve he ability to work effectively within the cultural context of the client, family or community 

what 4 things surround CULTURAL DESIRE in the cultural competency diagram

CULTURAL DESIRE:

• cultural awareness

• cultural skill

• cultural knowledge

• cultural encounters

when can cultural competence be problematic

• Culturalisation: compromising patient care, release from responsibility, empower stigmas and mistaken stereotypes

• Using the system for oppressing vulnerable communities (gender, disability, elderly)

• Some cultural health behaviours can be risky 

• Might empower stereotypes 

criticising cultural competency triangle

• culturalisation (discrimination/behaviour)

• utilisation - oppression (prejudice/affect)

• source of knowledge (stereotype/knowledge)

what is cultural safety

• what does it focus on

• what do HCPs have to do to make sure they are doing this

• what should they not let affect patient interactions

• Focus on creating an environment where patients feel safe, valued, respected enough to express their cultural identity without fear of discrimination/judgement 

• HPs have to examine themselves and the potential impact of their own culture on clinical interactions 

• They must not let their own beliefs/prejudices contribute to patients care 

Difference between cultural safety and competence:

Competence: when you learn about other cultures 

Safety: when you reflect on your own culture and potential biases 

what is culture humility

• Continuous self reflection on potential biases and learning from each patient 

• Ongoing relationship and mutual respect 

name 4 CULTURAL blind spots though ED

• ethnocentrism - under pressure, they may rely on own cultural norm assuming it works for everyone

• overlooking diversity - may overlook cultural differences

• stereotyping - quick judgement might lead to not understanding cultural differences

• ignoring local context - may skip consultation causing cultural insensitivity

explain the ethical blind spots during ED:

• ends justify means thinking

• reduced empathy

• confirmation bias

• accountability gaps

• ends justify means thinking - may prioritise efficiency over ethical processes (ignoring consent)

• reduced empathy - may neglect fairness or moral considerations

• confirmation bias - rely on existing beliefs and may ignore contradicting decisions

• accountability gaps - rushed decisions can blur who is responsible for potential harms

what things lead to health inequalities

• Poverty

• Social class 

• Stigma 

• Unequal power 

define:

• social class

• social stratification

• social mobility

• Social class - a group of people who have the same amount of wealth, status,power in society 

• Social stratification – a system which a society ranks categories of people in a hierarchy 

• Social mobility – change in position in a social hiererchy 

health inequalities

• what are they

• what is it affected by (social determinants of health)

• what can health inequalities affect

• what is it caused by

• Unfair and avoidable differences in health across the ppn, and between different groups within society 

• Shaped by the conditions in which we are born, grow, live, work and age can impact our health and wellbeing = social determinants of health 

• can affect life expectancy, access to care, quality and experience to care, behavioural risks to health

• due to: socio-economic factors, region, sex/ethnicity/disability, homelessness

what is the black report

Relationship between social class and health

what are the 4 explanations for the relationship between health and social class

• artefact explanation

• social/natural selection explanation

• materialist explanation

• cultural/behavioural explanation

explain the 4 explanations for the relationship between health and social class

• artefact explanation

• social/natural selection explanation

• materialist explanation

• cultural/behavioural explanation

1. Artefact explanation

How social class and health were measured 

2. Social/natural selection explanation

Health status may influence positioning in the class structure (healthier indv more likely to move ub social class)

3. Materialist explanation 

Poverty/low income/poor housing conditions shape health experiences 

4. Cultural/behavioural explanation 

Culture of lower social classes can be unhealthy (more likely to smoke/poorer diets/exercise less)

what is the inverse care law

• People who are more in need of care are less likely to receive it 

• GPs in more deprived areas are underfunded, understaffed and are of less quality compared to practices in wealthier areas 

what are the 5 explanations of health inequalities

1. Cultural/behavioural explanations (lifestyle approach to health)

2. Materialist explanations 

3. Marxist explanations 

4. Interactionist explanations 

5. Psycho-social explanations 

explain the explanation for health inequalities

1. Cultural/behavioural explanations (lifestyle approach to health)

• what is a critique of this (blame)

1. Cultural/behavioural explanations 

• Health differences are explained as the result of lifestyle and cultural choices made by indv 

• Working class aremore likely to make unhealthy choices (smoking/exercising less)

• Middle class generally more health conscious, better informed about eating healthy, avoid risky behaviours 

• CRITIQUE: this blames the person, not the uncontrolled circumstance 

explain the Materialist explanation

2. Materialist explanations

• Poor health is related to unequal economic and social organisation of society and the distribution of income and wealth 

• Poor housing condition, poor diet, employment, deprived regions 

explain the marxist explanation

3. Marxist explanations 

• Capitalist economy causes poverty, which causes ill health 

• Unequal distribution of health/wealth/resources required to maintain health 

• Wealth is concentrated 

explain the interactionist explanation

4. Interactionist explanations 

• Middle-upper class patients might receive more time/attention because of access to knowledge 

• Small everyday interactions can challenge/reinforce differences in power-social stratification 

explain the psycho-social explanation

5. Psycho-social explanations 

• Some societies experience high levels of health inequality while other rich societies dont 

• Perception and experience of economic and social inequality produces health inequalities in rich societies 

• What happens to the body in terms of illness is the product of the psychological reaction to inequality 

• The less income and wealth inequality that exists in a society,more likely social relations will be positive and will make a shared sense of community