Cultural Diversity and Health Disparities

What has caused an increase in diversity in many countries?

Wars, discrimination, political strife, worldwide socioeconomic conditions, creation of European Union

Instead of melting pot, is it a what?

Salad bowl (people can stand out and be seen as individuals)

Health ideology and health-care providers have learned that it is just as important to understand the patient's \_________ as it is to understand the physiological responses in illness, disease, and injury.

Culture

Treatment plan is less likely to be followed if what?

The recommendations don't match the patient's own health beliefs, dietary practices, and views toward wellness

A number of worldwide initiatives have addressed cultural competence as a means for improving what?

Health and health care, decreasing disparities, and increasing patient satisfaction

What are some societies that used to be rather homogeneous?

Portugal, Norway, Sweden, Korea, parts of the the United States and Britian

People have the right to expect the health care system to respect their what?

Personal beliefs, values, and health-care practices

All health-care providers need what?

Culturally specific information

The manner in which cultural information is used may differ based on what?

The discipline, individual experiences, specific circumstances of patient/provider/organization

If providers and the system are competent, most patients will access the health-care system when problems are first recognized, thereby reducing what?

Length of stay, complications, and overall costs

A lack of knowledge of patients' language abilities and cultural beliefs and values can result in serious threats to what?

Life and quality of care for all individuals

Organizations and individuals who understand their patients' \____________ are in a better position to be co-participants with their patients in providing culturally acceptable care

Cultural values, beliefs, and practices

Having what ensures that the health-care provider can conduct a more targeted assessment?

Ethnocultural-specific knowledge, understanding, and assessment skills to work with culturally diverse patients

Providers who know culturally specific data are less likely to do what?

Demonstrate negative attitudes, behaviors, ethnocentrism, stereotyping, and racism

The legal obligation for cultural competence is on who?

The health-care provider and the delivery system in which care is provided

Health-care providers need both general and specific cultural knowledge when doing what?

Conducting assessments, planning care, and teaching patients about their treatments and prescriptions

What is the worldwide life expectancy at birth?

66.12 years

What is the most popular first language?

Mandarin (12.65% of world population)

What percent of the world population is literate?

82

2/3 of the world's illiterate adults are found where?

8 countries, Bangladesh, China, Egypt, Ethiopia, India, Indonesia, Nigeria, and Pakistan (NIIP BEEC)

Of all illiterate adults, how many are women?

2/3

Extremely low literacy rates are concentrated where?

The Arab state, South and West Asia, Sub-Saharan Africa (about 1/3 of men and 1/2 of women are illiterate)

International migration is \___________, while internal migration is \_____________, especially in \______ countries

Decreasing, increasing, Asian

Migrants who pay taxes are not likely to what?

Put a greater burden on health and welfare services than the host population

Why are undocumented migrants run the highest health risks?

They are less likely to seek health care

Since undocumented immigrants are less likely to seek healthcare, it fuels what?

Sentiments of xenophobia and discrimination against all migrants

Hispanic is more used where?

East coast of US

Latino is more used where?

West coast of US

What percent of Americans are white?

65.1%

What percent of Americans are Hispanic/Latino?

15.8%

What percent of Americans are black?

12.9%

What percent of Americans are Asian?

4.6%

What percent of Americans are American Indian or Alaskan Native?

1.0%

What percent of Americans are Native Hawaiian or other Pacific Islander?

0.2%

According to the US census, White refers to people from where?

Europe, Middle East, Ireland, Germany, Italy, Lebanon, Turkey, Arab, and Poland

According to the US census, Black/African American refers to people from where?

Black racial groups of Africa and includes Nigerians and Haitians or any person who self-designates this category regardless of origin

According to the US census, American Indian/Alaskan Native refers to people from where?

Any of the original peoples of North, South, or Central America and who maintain tribal affiliation or community attachment

According to the US census, Asian refers to people from where?

The Far East, Southeast Asia, or India

According to the US census, Native Hawaiian/Pacific Islander refers to people from where?

Any of the original peoples of Hawaii, Guam, Samoa, Tahiti, the Mariana Islands, and Chuuk

Which race populations are rising in numbers and percentage of overall population?

Hispanic/Latino and Asian

Which race populations are growing in overall numbers but decreasing in percent population?

Black/African American, Native Hawaiian and Pacific Islanders, and American Indian and Alaskan Natives

Most Hispanic/Latinos are what?

Mexican

What is the largest group of Hispanic/Latino from Central America?

Salvadorans

3/4 of Hispanics live where?

West or South (50% in California and Texas)

What makes Hispanics in the US ideal candidates for recruitment into health professions?

Young age and minority representation

Before 1940, where did most immigrants come from?

Europe (Germany, the United Kingdom, Ireland, the former Union of Soviet Socialist Republics, Latvia, Austria, and Hungary)

Where are most immigrants from now?

Mexico, Philippines, China, India, Brazil

Immigrants bring what?

Culture

Individuals who speak only their native language are more likely to what?

Adhere to traditional practices, live in ethnic enclaves (less likely to assimilate into their new society)

A disparity exists if what?

A health outcome is seen in a greater or lesser extent among different populations

What factors contribute to an individual's ability to achieve good health?

Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location

Health disparities adversely affect people who have systematically experience greater obstacles to health based on their what?

Racial or ethnic group, religion, socioeconomic status, gender, age, mental health, disability, sexual orientation or gender identity, geographic location, or other characteristics historically linked to discrimination or exclusion

Powerful and complex relationships exist among what?

Health, biology, genetics, individual behavior, health services, socioeconomic status, environment, discrimination, racism, literacy levels, and legislative policies

What are determinants of health?

Factors that influence an individual's or population's health

Define culture

The totality of socially transmitted behavioral patterns, arts, beliefs, values, customs, lifeways, etc that guide worldview and decision making

What is a tertiary level of culture?

Visible to outsiders (things that can be seen, worn, observed)

What is the secondary level of culture?

Rules of behaviors only members know

What is the primary level of culture?

Rules that are known by all, observed by all, implicity and taken for granted

Is culture mostly conscious or unconscious?

Unconscious (has powerful influences on health and illness)

When are cultural beliefs/values/practices learned?

Birth, first at home, then church/other groups of people, then educational settings

Are race and culture synonymous?

No

What is attitude?

A state of mind or feeling about some aspect of a culture

What is a belief?

Something that is accepted as true, especially as a tenet or a body of tenets accepted by people in an ethnocultural group (ex. if you go out with wet hair, you'll get a cold)

What is ideology?

Thoughts and beliefs that reflect the social needs of a group

What is cultural awareness?

An appreciation of the external signs of diversity, such as the arts, music, dress, foods, and physical characteristics

What is cultural sensitivity?

Checking personal attitudes and not saying things that might be offensive to someone from a different cultural or ethnic background

What is cultural competence?

Having the knowledge, abilities, and skills to deliver care matching the patient's cultural beliefs and practices

Increasing one's consciousness of cultural diversity improves the possibilities for what?

Culturally competent care

What is unconscious incompetence?

Not being aware that one is lacking knowledge about another culture

What is conscious incompetence?

Being aware that one is lacking knowledge about another culture

What is conscious competence?

learning about the patient's culture, verifying generalizations about the patient's culture, and providing cultural-specific interventions

What is unconscious competence?

Automatically providing culturally congruent care to patients of diverse cultures

What is ethnocentrism?

The universal tendency of human beings to think that their way of thinking, acting, and believing are the only right, proper, and natural ways

What can be a major barrier to culturally competent care?

Ethnocentrism

What percent of humans share the same genes?

99.9%

Define race

Genetic origin and includes physical characteristics that are similar among members of the group, such as skin color, blood type, and hair and eye color

Do people in the same racial group always share the same culture?

No

Define worldview

The way individuals or groups of people look at the universe to form basic assumptions and values about their lives and the world around them

Define steryotyping

An oversimplified conception, opinion, or belief about some aspect of an individual or group

Generalizing is a \_________point, while stereotyping is an \____________endpoint

Starting, ending

Define subculture

A group of people with a culture that differentiates them from the larger culture they are a part of (ex. gays, goths, etc.)

Nursing favors which term, transcultural or cross-cultural?

Transcultural

What is cultural humility and where is it most used?

Focuses on the process of intercultural exchange, paying explicit attention to clarifying the professional's values and beliefs through self reflection and incorporating the cultural characteristics of the professional and the patient into a mutually beneficial and balanced relationship, common in physicians

What is cultural safety and where is it most used?

Expresses the diversity that exists within cultural groups and includes the social determinants of health, religion, and gender, popular in Australia, New Zealand, Canada

What is cultural leverage and where is it most used?

A process whereby the principles of cultural competence are deliberately invoked to develop interventions

What is acculturation?

Occurs when a person gives up the traits of his or her culture of origin as a result of contact with another culture, involuntary process

When does bicultural acculturation?

When a person can function in the dominant culture and their native culture

What is assimilation?

The gradual adoption and incorporation of characteristics of the prevailing culture

What is enculturation?

A natural conditioning process of learning accepted cultural norms, values, and roles in society and achieving competence via socialization

What is individuality?

The sense that each person has a separate and equal place in the community and where individuals who are considered "eccentrics or local characters" are tolerated

What are some highly individualistic cultures?

Canadian, German, Swedish (encourage personal expression, more informal)

What are some highly collectivist cultures?

Chinese, Korean, Japanese (more likely to hide mental/physical problems)

Are more cultures collectivist or individualist?

Collectivist

Describe a low context culture

Great emphasis on verbal mode, many words used to express a thought (individualistic)

Describe a high context culture

Implicit information, fewer words used to express a thought (collectivistic)

The greater perceived cultural stigma, the more likely \_______

Delaying treatment

When a patient is from a collectivist culture, what should one to in order to avoid the confusion around the word no?

A demonstration or some other response to show understanding of a concept/treatment

What are variant characteristics of culture?

Major influences that shape people's worldviews and the degree to which they identify with their cultural group of origin

What is an example of nationality being a variant characteristic of culture?

Jewish people changing their last name to change avoid discrimination

What is an example of race being a variant characteristic of culture?

Cosmetic surgery to change appearance