Chapter 10: Human Diversity

Human Diversity Overview and Core Concepts

• Human Diversity (Cultural Diversity): Addresses the variety of human societies and cultures, examining their similarities and differences. Literally defined, it refers to the differences inherent among people that make each person unique and valuable in their own right.

• Cultures: All of the socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human work and thoughts by particular classes, communities, or populations. Cultures develop behaviors, norms, and values suited to specific environments, which over time take on the strength of tradition.

• Globalization: The process by which individuals cross borders into other countries to work, attend school, receive medical care, visit, and live, making nations, societies, and businesses increasingly multicultural.

• Cultural Competency: Defined as possessing a set of attitudes, congruent behaviors, and policies that come together in an agency, in a system, or among professionals that enable effective interactions in a cross-cultural or multicultural environment.

• Statue of Liberty Inscription: Excerpted from The New Colossus, a poem by Emma Lazarus located at the base of the Statue of Liberty:

  • "Give me your tired, your poor,     Your huddled masses yearning to breathe free,     The wretched refuse of your teeming shore.     Send these, the homeless, tempest-tost to me,     I lift my lamp beside the golden door."

Primary Characteristics and Dimensions of Human Diversity

• Human Diversity Characteristics: Intrinsic and extrinsic human characteristics that affect individual perceptions of self and others, personal values, opportunities, and acceptance:

  • Age

  • Disability

  • Economic status

  • Education

  • Ethnicity

  • Family status

  • First language

  • Gender

  • Geographic location

  • Lifestyle

  • Organizational level

  • Physical characteristics

  • Political affiliation

  • Religious preference

  • Sexual orientation

  • Work style or ethic

• Core Diversity Traits Addressed: Age, ethnicity and national origin, race, gender and sexual orientation, mental and physical ability, and religion.

Age Demographics and Ageist Biases

• Cultural Perceptions of Aging:

  • Some Asian cultures demonstrate deference toward older adults, acknowledging that societal advances occurred due to contributions made by elderly citizens.

  • European and Western cultures generally do not share this perspective and sometimes regard older adults as burdens on society, as indicated by an upsurge in reported elder abuse cases.

• U.S. Census Demographic Generational Breakdown:

  • Greatest Generation (born between $1916$ and $1928$): $1.75\text{ million}$ ($1\text{\%}$ of population).

  • Silent Generation (born between $1929$ and $1946$): $23.63\text{ million}$ ($7\text{\%}$ of population).

  • Baby Boomers (born between $1946$ and $1964$): $68.70\text{ million}$ ($21\text{\%}$ of population).

  • Generation X (born between $1965$ and $1980$): $65.13\text{ million}$ ($20\text{\%}$ of population).

  • Millennials / Generation Y (born between $1981$ and $1999$): $82.22\text{ million}$ ($25\text{\%}$ of population).

  • Generation Z / New Silent Generation (born between $2000$ and $2020$): $86.40\text{ million}$ ($20\text{\%}$ of population).

• Generational Impact on Society:

  • Combined, the Greatest Generation, Silent Generation, and Baby Boomers comprise over $29\text{\%}$ of the total U.S. population.

  • $75\text{ million}$ babies were born during the Baby Boomer era ($1946$ to $1964$). In $2006$, the first Baby Boomers turned $60\text{ years}$ old.

  • Millennials ($25\text{\%}$) represent the largest single generation, overtaking Baby Boomers due to mortality rates and immigration patterns.

  • The "graying of America" alters banking, healthcare, labor, politics, retirement systems, social services, and the stock market.

  • In $2000$, Americans over age $85$ outnumbered those at the beginning of the 20th century by $26\times$.

  • At the start of $2010$, over $53,000$ Americans were over age $100$. Projections suggest over $1\text{ million}$ Baby Boomers will live to age $100$

• Societal Age Biases:

  • Valuing youth over age.

  • Viewing aging as undesirable or bad.

  • Placing little value on contributions of senior citizens.

  • Favoring reactive instead of proactive approaches to policy implementation.

  • Considering senior citizens to be mentally inferior.

• Legal Protection:

  • Age Discrimination in Employment Act (29 U.S.C. §§ 621–634): Prevents employers from discriminating based solely on age in hiring, promotion, job assignment, compensation, and termination.

Ethnicity, National Origin, and Race

• Key Terminology:

  • Ethnicity: Relates to a person's distinctive racial, national, religious, linguistic, or cultural heritage.

  • Race: A population that differs from others in the relative frequency of some gene or genes; distinguished by physical features (hair type, eye/skin color, stature, bodily proportions).

  • Ethnocentrism: Tendency of individuals to view the norms and values of their own culture as absolute and use them as a standard against which all other cultures are measured.

  • Racism: Belief in racial superiority, leading to discrimination and prejudice toward races considered inferior.

  • Bias: Prejudice; thinking negatively of others without significant justification, combining stereotyped beliefs and negative attitudes.

  • Discrimination: Actions involved in the unequal or prejudicial treatment of people because they belong to a certain category, group, race, ethnicity, disability, or sexual orientation.

• U.S. Census Data Report on Ethnic and Racial Makeup:

  • White Only: $2010\text{ Census} = 223.6\text{ million } (72.4\%)$ | $2020\text{ Census} = 204.3\text{ million } (61.6\%)$

  • Black / African American: $2010\text{ Census} = 38.9\text{ million } (12.6\%)$ | $2020\text{ Census} = 41.1\text{ million } (12.4\%)$

  • Asian: $2010\text{ Census} = 14.7\text{ million } (4.8\%)$ | $2020\text{ Census} = 19.9\text{ million } (6.0\%)$

  • American Indian / Native Alaskan: $2010\text{ Census} = 2.9\text{ million } (0.9\%)$ | $2020\text{ Census} = 3.7\text{ million } (1.1\%)$

  • Native Hawaiian / Other Pacific Islander Only: $2010\text{ Census} = 540,013\text{ } (0.2\%)$ | $2020\text{ Census} = 689,966\text{ } (0.2\%)$

  • Multiracial (White and another race): $2010\text{ Census} = 9.0\text{ million } (2.9\%)$ | $2020\text{ Census} = 33.8\text{ million } (10.2\%)$

  • Other Races: 2010\text{ Census} = 19.1\text{ million } (6.2\push) | $2020\text{ Census} = 27.9\text{ million } (5.2\%)$

  • Hispanic / Latino Growth: In $2019$, Statista recorded $60.5\text{ million}$ Hispanic/Latino individuals in the U.S., making them the largest minority group. Projections forecast that the current majority ethnic group will lose majority status in the 21st century.

• Assimilation vs. Biculturalism:

  • Assimilation: Process where diverse cultural groups give up original language/identity over time to merge into a larger majority culture. Diminishes contributions of minority cultures.

  • Biculturalism: Ability of individuals to competently negotiate two or more cultures (mainstream and their own culture).

• Core Cultural Values Matrix (Table 10.2):

  • U.S. Mainstream Culture: Activity and hard work, personal achievement and success, individualism, efficiency and practicality, affluence/consumerism/material comfort, competition, openness, directness, and being well informed.

  • African American: Extended family, cooperation, spirituality, interdependence.

  • Latino: Extended family, father as patriarch, respect, hierarchical relationships.

  • Mexican American: Extended family (close-knit), Curanderism (Mexican folk healing), frequent contact with native country (Mexico).

  • Native American: Respect, extended family, spiritualism, collectivism, unified whole universe.

Linguistic Differences and Healthcare Communication

• Linguistic Barriers and Informed Consent:

  • Informed consent cannot be achieved if a patient does not understand what is being communicated, placing healthcare providers at legal liability and creating a barrier to medical treatment decisions.

  • Quality of healthcare depends heavily on effective communication between providers and patients. Limited English proficiency subrogates patient rights and responsibilities.

• Institutional Strategies to Overcome Linguistic Barriers:

  • Hiring additional bilingual and bicultural staff.

  • Providing medical interpreters.

  • Providing translators.

  • Encouraging employees to become bilingual or multilingual.

  • Providing medical documents (e.g., consent forms) in different languages.

  • Using digital translation apps.

• Common Imaging Commands Across Languages (Table 10.3):

  • English: Hello, what is your name?

  • Spanish: ¿Hola, cuál es su nombre?

  • French: Bonjour, quel est votre nom?

  • German: Hallo, was ist ihr name?

  • Italian: Ciao, che cosa é il vostro nome?

  • Japanese: こんにちは,お名前は何ですか。

  • English: Take a deep breath.

  • Spanish: Tomar una respiración profunda.

  • French: Prenez un soufflé profound.

  • German: Nehmen Sie einen tiefen Atem.

  • Italian: Prenda un alito profondo.

  • Japanese: 深呼吸してください。

  • English: Hold your breath.

  • Spanish: Contenga La respiracion.

  • French: Tenee votre soufflé.

  • German: Halten Sie ihren Atem.

  • Italian: Tenga il rostro alito.

  • Japanese: 呼吸を止めて。

  • English: Breathe.

  • Spanish: Respirar.

  • French: Respirez.

  • German: Atmen Sie.

  • Italian: Respiri.

  • Japanese: 呼吸してください。

  • English: Show me where you hurt.

  • Spanish: Muestrame donde daeles

  • French: Montres moi oûvous blessez.

  • German: Zeigen Sie mir Sie verletzen.

  • Italian: Mostrimi dove danneggiate.

  • Japanese: 痛いところはどこですか。

  • English: Radiology

  • Spanish: Radiologia

  • French: Radiologie

  • German: Radiologie

  • Italian: Radiologia

  • Japanese: 放射線学

  • English: x-ray

  • Spanish: Radiografia or rayos X

  • French: Rayon-x

  • German: Röntgenstrahle

  • Italian: Raggi X

  • Japanese: x線

Legal Framework for Civil Rights

• Statutory Protections Against Discrimination:

  • Civil Rights Act of 1964 (Title VII): Prohibits discrimination based on race, color, religion, sex, or national origin.

  • Rehabilitation Act of 1973: Protects individuals with disabilities from discrimination in federally funded programs.

  • Americans with Disabilities Act (ADA) of 1990: Guarantees equal rights for people with disabilities and mandates reasonable accommodations and accessible facilities.

  • 19th-century Civil Rights Acts, amended in $1993$, ensure equal rights under law.

• Quote on Discrimination (Zora Neale Hurston):

  • "Sometimes I feel discriminated against, but it does not make me angry. It merely astonishes me. How can anyone deny themselves the pleasure of my company? It's beyond me."

Gender and Sexual Orientation

• Gender Concepts and Intersex Statistics:

  • Intersex: Approximately $1 \text{ in } 500$ infants are born intersex, possessing physical or genetic characteristics that do not adhere strictly to female or male categories.

  • Gender Roles: Biologic or chromosomal sexual identity of an individual.

  • Gender Identity: An inner sense of maleness, femaleness, a combination, or neither, influenced by culture.

  • Glass Ceiling: An artificial barrier precluding women from being promoted or elected to top executive, legal, medical, or political positions because of gender.

• Center for American Women in Politics (CAWP) Statistics (September 2021):

  • First Female Vice-President of the United States.

  • First Female Speaker of the House.

  • $9$ Female Governors.

  • $18$ Lieutenant Governors.

  • $26.77\%$ of Congress are women.

  • $27.40\%$ of Senators are women.

  • $31$ female mayors in the $100$ largest U.S. cities.

  • $38\%$ of state legislators are women.

• Gender Role Stereotyping: The expectation of how people should behave based solely on whether they are male or female, limiting individual alternatives.

• Sexual Orientation Categories and Legal History:

  • Heterosexual: Individuals mentally, physically, and/or sexually attracted to the opposite gender.

  • Homosexual (Gay/Lesbian): Individuals attracted to persons of the same gender.

  • Bisexual: Individuals attracted to members of both genders.

  • LGBTQ+: Acronym representing Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual/Ally, and others.

  • Supreme Court Marriage Equality Ruling (June 2015): Landmark $103\text{-page}$ decision (Obergefell v. Hodges) establishing that same-sex couples have a constitutional right to marry in all states under the Fourteenth Amendment's Due Process Clause.

  • Homophobia: Irrational fear of homosexuality accompanied by hostility toward individuals who are or are perceived to be homosexual, gay, lesbian, or bisexual.

• Dr. Alfred Kinsey Research and the Kinsey Scale (KSix):

  • Initiated a $20\text{-year}$ human sexuality study in $1938$, publishing midpoint findings in $1948$ that provided statistical validation of homosexuality.

  • Kinsey Rating Scale (KSix):

  • 0: Exclusively heterosexual experience(s)

  • 1: Predominantly heterosexual experience(s), only incidentally homosexual

  • 2: Predominantly heterosexual experience(s), but more than incidentally homosexual

  • 3: Equally heterosexual and homosexual experience(s)

  • 4: Predominantly homosexual experience(s), but more than incidentally heterosexual

  • 5: Predominantly homosexual experience(s), but only incidentally heterosexual

  • 6: Exclusively homosexual experience(s)

  • Kinsey Findings: American males generally fell in categories $1\text{ to } 2$, with the majority within $1\text{ to } 5$ exhibiting bisexual tendencies; $10\%$ of American males were exclusively homosexual.

• Clinical Care Protocols for Transgender and Intersex Patients:

  • Address patients using their preferred name. A birth name not aligned with identity is referred to as a dead name, and using it is experienced as violent.

  • Request only necessary medical info relevant to imaging (e.g., asking: "Genital anatomy and surgical history are important to how I position you for this x-ray. Is there anything I need to know to make sure we do this correctly to avoid a repeat exposure?").

Mental and Physical Ability

• Global Disability Statistics and Human Rights Shift:

  • Over $600\text{ million}$ individuals (approx. $10\%$ of world population) have a disability.

  • Historical treatment often involved shunning, ridicule, isolation, or treating individuals as objects requiring assistance rather than human rights subjects.

  • UN General Assembly proclaimed $1981$ as the International Year of the Disabled.

  • $1993$ UN Resolution: Standard Rules on the Equalization of Opportunities for People with Disabilities.

  • $1993$ Vienna Declaration for Human Rights: Reaffirmed that human rights are universal and unreservedly include persons with disabilities.

  • Language terminology shift: Replacing "disabled" (dis- meaning "to deprive of") with "differently abled".

• Four Core Values of Human Rights Law (Table 10.4):

  • Autonomy: Provides respect for the right of persons with a disability to have self-directed actions and behaviors; requires the individual to be at the center of all decisions.

  • Dignity: Provides mechanisms that recognize and support the inestimable value and inherent self-worth of every individual regardless of ability.

  • Equality: Relates to fair and equal treatment of everyone, regardless of perceived differences.

  • Solidarity: Requires society to support and maintain the freedoms of individuals through appropriate social mechanisms.

Religious Diversity

• Religious Considerations in Healthcare:

  • Hundreds of religions exist, with varying beliefs even within single denominations. North America is the most religiously diverse culture in world history.

  • Healthcare providers must respect religious beliefs, taboos, atheism, agnosticism, and non-religious spirituality without imposing personal views.

  • Statement from World Religions for Healthcare Professionals: "Regardless of the context from which you offer healthcare, providers must also be purposeful in this day and age to attend to matters of religion… North America is the most religiously diverse culture to ever appear and our healthcare providers must deal with this fact routinely."

Social Movements and Embracing Diversity

• The #MeToo Movement:

  • Emerged in late $2017$ to empower women, particularly young, vulnerable brown or black women, against sexual harassment and assault.

  • World Health Organization (WHO) estimate: Sexual harassment affects $1/3$ of all women worldwide.

  • $2017$ poll data: $54\%$ of American women reported receiving unwanted sexual advances, with $95\%$ stating such behavior goes unpunished.

• Quote on Diversity (Ronald Brown, Former Secretary of Commerce):

  • "Diversity transcends race and gender, affirmative action, and equal employment opportunity. It must encompass a fundamental appreciation of one another and a respect for both our similarities and our differences. It must include a heartfelt respect in attitude and in behavior toward those of different race, gender, age, sexual orientation, and those with disabilities. All the facets that make each individual the unique and precious resource that each of us is."

Developing Cultural Competency

• Five Essential Elements of Institutional Cultural Competency:

  1. Valuing diversity.

  2. Possessing the capacity for cultural self-assessment.

  3. Having a consciousness of the dynamics of cross-cultural interaction.

  4. Institutionalizing cultural knowledge.

  5. Developing adaptations of service delivery that reflect an understanding of a multicultural environment.

• Professional Organization Initiatives:

  • ARRT (American Registry of Radiologic Technologists): Standards of Ethics preclude discriminatory practice. Endows the Royce Osborne Minority Student Scholarship to provide financial support to minority imaging and therapy students.

  • ASRT (American Society of Radiologic Technologists): Formulates position statements supporting cultural competency and integrates ethical attributes into practice documents.

• Core Empathetic Healthcare Practices:

  • Three Critical Practices:

  1. Making quick, powerful connections with the patient (communication).

  2. Gathering culturally relevant information (assessment and communication).

  3. Working with patients to form strategies meeting individual, provider, and facility needs (negotiating).

  • Benefits of Empathy:

  • Promotes better healthcare outcomes overall.

  • Increases patient satisfaction.

  • Decreases healthcare costs.

  • Decreases provider liability.

• Six Areas of Human Diversity Affecting Care Delivery (Table 10.5):

  • Communication: Ability to convey and receive info. Knowing cultural norms lessens miscommunication.

  • Space: Distance and personal space boundaries, eye contact, and touch practices.

  • Time: Temporal orientation (past, present, or future).

  • Past-oriented cultures (e.g., England, China) value tradition and may hesitate to try new treatments.

  • Present-oriented cultures (e.g., Latin American, Native American, Middle Eastern) focus on the here-and-now and may neglect preventive care.

  • Environmental Control: Ability to control nature; differences in health/illness definitions and practices.

  • Biologic Variations: Ethnicity/race-related differences in body structure, skin color, hair texture, genetic disease susceptibility, nutritional preferences, and psychological traits.

  • Social Organizations: Cultural behavior patterns learned via enculturation (e.g., decision-making authority of elders or defined child roles).

Chapter Summary Quote

• "Always remember that you are unique, just like everybody else." — Anonymous