Community Nutrition: Culture & Diversity

Culture & Diversity

Learning Outcomes

  • Define culture.
  • Identify how to develop and evaluate nutrition education materials for multicultural groups.
  • Discuss factors affecting health and illness.

Key Terminologies

  • Diversity: The presence of differences within a given setting, encompassing various dimensions such as race, ethnicity, gender, age, sexual orientation, disability, religion, and socio-economic status.
  • Equity: Fair treatment, access, opportunity, and advancement for all people, while striving to identify and eliminate barriers that have prevented the full participation of some groups.
  • Cultural Competence: The ability to understand, communicate with, and effectively interact with people across cultures. This involves awareness of one’s own cultural worldview, knowledge of different cultural practices and worldviews, and cross-cultural skills.
  • Cultural Sensitivity: Being aware of cultural differences and similarities without assigning them a value – positive or negative, better or worse.
  • Global Perspective: An approach that considers the diverse experiences and viewpoints from different parts of the world, recognizing the interconnectedness and interdependence of all people globally. Understanding that diversity is a global phenomenon influenced by historical, social, political, and economic factors.

Culture, Race & Ethnicity

  • Culture: Shared beliefs, values, customs, behaviors, and traditions of a group of people. It is learned and passed down through generations. Example: Celebrating Hari Raya in Malaysia.
  • Race: Socially constructed classification of people based on physical characteristics, especially skin color, facial features, and hair texture. It does not determine culture or behavior. Example: Asian.
  • Ethnicity: Group of people who identify with each other based on shared ancestry, language, history, or cultural practices. Example: Malay, Chinese, and Indian are ethnic groups in Malaysia.

Key Aspects of Culture

  • Beliefs and Values: The deeply held principles and standards that guide behavior and decisions. These include moral values, religious beliefs, and social norms.
  • Practices and Rituals: The practices and rituals that are regularly observed within a culture. These can include celebrations, ceremonies, and everyday routines.
  • Communication: The system of symbols, including spoken and written language, that people use to communicate with each other. This also encompasses non-verbal communication such as gestures and body language.
  • Social Norms and Roles: The expectations and rules that govern how individuals behave and interact with each other within a society. Social roles can be based on factors such as gender, age, and social status.
  • Religion and Spirituality: The beliefs and practices related to the sacred and the divine, which often influence other aspects of culture such as art, laws, and social structure.
  • Food and Cuisine: The culinary practices and preferences that are characteristic of a culture. This includes the ingredients, preparation methods, and eating habits.

Developing Cultural Competence in Community Nutrition

  • Understanding the importance of social and cultural influences on individuals’ health belief and behavior.
  • Considering how these factors interact at multiple levels of the health care system.
  • Devising interventions that take these issues into account to assure quality of care.
  • Example: Use professional interpreters who are fluent in the language and familiar with the culture of participants. It is not advisable to use nonprofessional interpreters, such as participant’s child, friend, relatives, etc., due to confidentiality, and participants may be uncomfortable discussing personal issues.

Cultural Competence Continuum Model

The Cultural Competence Continuum Model has the following stages:

  • Cultural Destructiveness: Attitudes, practices, and policies are destructive to other cultures. It includes actions that dehumanize or exploit individuals from minority groups.
  • Cultural Incapacity: Paternalistic attitude toward the "unfortunates." No capacity to help. There is a lack of capacity to help minority clients or communities. This can include discriminatory hiring practices, subtle racism, and lower expectations for certain cultural groups.
  • Cultural Blindness: Belief that culture makes no difference. Everyone is treated the same. This stage is marked by an inability to recognize the differences between cultures. The belief is that all people are the same and that universal approaches are sufficient, which often leads to ignoring the cultural strengths of minority groups and perpetuating biases.
  • Cultural Pre-Competence: Weaknesses in serving culturally diverse populations are realized, and there are some attempts to make accommodations. Involves awareness of some cultural differences and the presence of efforts to improve cultural competence.
  • Cultural Competence: Differences are accepted and respected, self-evaluations are continuous, cultural skills are acquired, and a variety of adaptations are made to better serve culturally diverse populations. Situations can be evaluated from multiple frames of reference. Individuals or organizations actively seek to understand cultural differences and incorporate this understanding into their practices. There is a commitment to valuing diversity, ongoing self-assessment, and expansion of cultural knowledge and resources.
  • Cultural Proficiency: Engages in activities that add to the knowledge base, conducts research, develops new approaches, publishes, encourages organizational cultural competence, and works in society to improve cultural relations. This is the highest stage of the continuum, where individuals or organizations hold culture in high esteem and work to add to the knowledge base of culturally competent practice. This stage involves advocacy for cultural competence across systems and proactive efforts to improve cultural relations and policies.

Acquiring Cultural Competence

The steps to acquiring cultural competence are:

  • Cultural Awareness
  • Cultural Knowledge
  • Cultural Skill
  • Cultural Encounter
  • Cultural Desire

Cultural Awareness

  • Involves the self-examination and in-depth exploration of one’s own cultural and professional background.
    • Self-Reflection: Engaging in self-assessment to understand personal beliefs, values, and biases.
    • Understanding Privilege: Acknowledging how one’s own cultural background and position of power can affect interactions with others.
    • Mitigating Bias: Learning to recognize and control biases to ensure they do not negatively impact patient care.

Cultural Knowledge

  • Process of seeking and obtaining educational foundation about diverse cultural and ethnic groups. It involves understanding the worldviews of different cultures, including their health-related beliefs and practices.
    • Learning About Cultures: Gaining knowledge about the cultural practices, values, and health beliefs of various groups.
    • Health Disparities: Understanding the social determinants of health and how they affect different populations.
    • Resources and Tools: Utilizing educational resources, literature, and tools to deepen cultural knowledge.

Cultural Skill

  • Refers to the ability to collect culturally relevant data and perform culturally sensitive assessments and treatments.
    • Culturally Appropriate Assessments: Using techniques that respect cultural variations.
    • Communication Skills: Navigating language and non-verbal communication barriers.
    • Clinical Competence: Performing culturally respectful physical exams and diagnostics.

Cultural Encounters

  • Direct engagements with patients from diverse backgrounds. These interactions are crucial for developing cultural competence.
    • Patient Interactions: Engaging in face-to-face cultural encounters with diverse patients to learn from them directly.
    • Learning Through Experience: Gaining real-world experience by working with diverse populations.
    • Reducing Stereotyping: Using encounters to challenge and refine stereotypes and generalizations about cultural groups.

Cultural Desire

  • The motivation to engage in the process of becoming culturally aware, knowledgeable, skillful, and seeking cultural encounters. It is the cornerstone of cultural competence.
    • Personal Motivation: The genuine passion and commitment to becoming culturally competent.
    • Lifelong Learning: Embracing cultural competence as an ongoing process rather than a finite goal.
    • Advocacy: Advocating for cultural competence within one’s organization and community.

Importance of Cultural Knowledge in Community Nutrition

  • Important for nutritional assessment.
  • Information needed to provide adequate nutritional guidance and recommendation, included:
    • Type of food available
    • Commonly used food, who select them, how and where they are obtained
    • Accepted and/or preferred food
    • Food preparation method and how they are divided among family/community
    • Safety of the food supply and related health problem
    • Food eaten, how much, when, with whom, and where
    • Energy & nutrient quality of major food chosen
    • Food storage, facilities and method, food safety, and garbage disposal

Examples of Common Cultural Foods of Various Ethnic Groups

  • European Americans:
    • Commonly Consumed Foods: Beef, chicken, pork, pasta, rice, bread, dairy foods, potatoes, bananas, apples, citrus juices, lettuce
    • Dietary Concerns/Issues: High intake of fat, salt, sugar, and fast foods
  • Southern African Americans:
    • Commonly Consumed Foods: Pork, organ meats, corn bread, rice, black-eyed peas, okra, greens, lard, hot sauce
    • Dietary Concerns/Issues: Lactose intolerance is common; fried foods; low intake of fresh fruit and whole grains; pica common in rural South; breastfeeding rates are low
  • Asian/Pacific Island Americans:
    • Commonly Consumed Foods: Pork, chicken, eggs, rice, wheat, bok choy, Chinese eggplant, mushrooms, water chestnuts, ginger root, soymilk, soy sauce
    • Dietary Concerns/Issues: High salt intake; lactose intolerance is common; milk use is rare
  • Mexican Americans:
    • Commonly Consumed Foods: Chicken, eggs, beans, flour or corn tortillas, rice, tomatoes, squash, lard, chili peppers, onions, tropical fruits, pine nuts
    • Dietary Concerns/Issues: High intake of carbonated beverages; limited dental care among migrant workers
  • American Indians:
    • Commonly Consumed Foods: Game, fish, berries, roots, wild greens, commodity foods, fried bread
    • Dietary Concerns/Issues: Broad differences exist among the subgroups; lack of refrigeration; high intake of refined sugar, cholesterol, fat, and energy; lactose intolerance and obesity are common
  • Puerto Rican:
    • Commonly Consumed Foods: Beans, various meats, rice, cornmeal, yams, sweet potatoes, onions, green peppers, tomatoes, lard, pineapple, bananas, sugar
    • Dietary Concerns/Issues: Overweight and obesity are common; breastfeeding is not common; low intake of green, leafy vegetables; dairy intake is low
  • Middle Eastern Americans:
    • Commonly Consumed Foods: Fermented dairy products, feta cheese, lamb, legumes, pita bread, rice, olive oil, figs, dates, pomegranates, lemons, eggplants, phyllo pastries, honey
    • Dietary Concerns/Issues: High incidence of lactose intolerance

Traditional Health Beliefs Related to Food of Various Ethnic Groups

  • Chinese: The body is kept in harmony through a balance of yin and yang. Yin foods include those that are raw or cooked at low temperatures and are white or light in color. Yang foods usually are high-calorie foods, are cooked at high temperatures, and have red-orange-yellow colors. Some foods, such as rice, are considered neutral. Ginseng is used as a general health-promoting tonic and is thought to help cure a variety of ailments. Sometimes the