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Social and Cultural
Influences on Health
Laurine T. Charles, M.H.S.
D. Beth Kennedy, M.S.
S.C. Area Health Education Consortium
19 Hagood Avenue Suite 802
P.O. Box 250814
Charleston, SC 29425-0814
[email protected]
[email protected] AHEC
SOUTH
CAROLINA
Developed as part of an
Enhanced AHEC Community
Partnership for Health
Professions Workforce and
Educational Reform project
funded by the Health
Resource and Service
Administration (HRSA)
SOUTH
CAROLINA
AHEC
OBJECTIVES


Define diversity and its impact on health
and health care
Demonstrate an understanding of
cultural competency
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CAROLINA
AHEC
Global Demographics
If only 100 people lived in the world, there would be:
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57 Asians.
21 Europeans.
14 people living in North & South America.
8 Africans.
52 women.
48 men.
70 persons of color.
30 Christians.
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CAROLINA
AHEC
Global Demographics
Of these same 100 people:
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6 would own 59% of the entire world’s wealth.
All 6 would be citizens of the United States.
70 would be unable to read
50 would suffer from malnutrition
80 would live in sub-standard housing
1 would be near death, 1 would be near birth
1 would have a college education
1 would own a computer
SOUTH
CAROLINA
AHEC
Definitions

Race
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Ethnicity
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Genetic determinants
Physical
characteristics
Common heritage
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Customs
Characteristics
Language
Common history
National origin
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CAROLINA
AHEC
Culture

Shared system of values, beliefs, history,
and patterns of behavior
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Learned and practiced
Generate meaning
Influence behavior and decision-making
Elements
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CAROLINA
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DISCUSSION
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Discuss the ways in which health care
providers share a common culture.
Discuss the ways in which members of
your health discipline share a culture.
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CAROLINA
AHEC
Cultural Variation
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Ethnicity
Age
Socioeconomic
status
Religion
Education
Language
Gender
Ability
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Sexual orientation
Length of time in
South Carolina
Urban vs.. rural
residence
Amount and type of
contact with elders
Degree of
acculturation
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CAROLINA
AHEC
Multiculturalism

The practice of acknowledging, valuing
and respecting all cultures, religions,
ethnicities, attitudes, and opinions within
an environment
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CAROLINA
AHEC
Diversity and Its
Stumbling Blocks
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Language and
Literacy
Class-related
values
Culture-related
values
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Communication
Stereotypes
Racism
Ethnocentricity
Collusion
SOUTH
CAROLINA
AHEC
Language
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Essential for making sense of the world
Basic reading and writing skills
Stress or emotional trauma
Limited English Proficiency

Barriers to care
SOUTH
CAROLINA
AHEC
Literacy
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40 to 44 million Americans are
functionally illiterate
50 million have only marginal literacy
skills
72 million cannot read technical reports
or news magazines
One-half of the adult population has
basic deficiencies
SOUTH
CAROLINA
AHEC
Belief Systems
and Language Semantics
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Hypertension vs.
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“High blood”
“High pertension” or “tension”
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CAROLINA
AHEC
Class- and CultureRelated Values
Class Related Values Culture Related Values
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Socioeconomic status
Marginalization
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Macroculture
Microculture
Culturally based beliefs
Cross-cultural differences
SOUTH
CAROLINA
AHEC
Cross-Cultural Differences
“The Spirit Catches You and
You Fall Down:
A Hmong Child,
Her American Doctors,
and the Collision of Two Cultures”
Anne Fadiman
SOUTH
CAROLINA
AHEC
SOUTH
CAROLINA
AHEC
Communication
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Personal experience, family attitude,
group beliefs
Explanatory models
Folk illnesses
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Empacho
SOUTH
CAROLINA
AHEC
SOUTH
CAROLINA
AHEC
Communication
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Multiple sources of care
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Complementary care
Spiritual practices
Health-related beliefs and practices
SOUTH
CAROLINA
AHEC
Stereotypes & Racism
Stereotypes
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Stigmatize
Homogenize
Marginalize
Racism
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Discrimination
based on an
ideology of racial
superiority
SOUTH
CAROLINA
AHEC
Ethnocentricity and Collusion
Ethnocentricity
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Judging
Superiority
Contempt
Centrality
Collusion
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Destructive
cooperation
Perpetuates bias and
exclusion
SOUTH
CAROLINA
AHEC
Diversity Building Blocks
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Cross-Cultural Understanding
Linguistic Pluralism
Attention to Ethnically/Culturally
Appropriate Learning & Problem Solving
Styles
Cultural Competence
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CAROLINA
AHEC
Cross-Cultural Understanding
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Transcultural
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Illness, health care
Healing
Cultures in community
Patient- and community-centered care
SOUTH
CAROLINA
AHEC
Linguistic Pluralism
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1990 Census
14% speak a language other than
English at home
45% of those had trouble speaking
English
1 in 10 people in U.S. are foreign born
Multiple language proficiency
SOUTH
CAROLINA
AHEC
Ethnically/Culturally Appropriate
Learning & Problem Solving Styles
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Understanding of common cultural
values of populations represented in the
community
Detecting when values across cultures
are in conflict
Negotiating successful resolutions
SOUTH
CAROLINA
AHEC
Cultural Competence
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Definition
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Awareness
Sensitivity
Understanding
Commitment
Ethical values
Autonomy vs. social justice
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CAROLINA
AHEC
DISCUSSION
Why is cultural competence necessary?
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CAROLINA
AHEC
Demographic Changes
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By 2000, 30 % of the U.S. population will
be foreign-born or children of foreign-born
By 2100, 50% of all Americans will be
Black, Hispanic, or Asian in origin
By 2030, about 20 % of population will be
over 65 years of age; now it is about 13 %
The 85+ population is expected to double
its current size by 2025
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CAROLINA
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Elements of a Cultural
Competence Model
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Valuing Diversity
Cultural Self-assessment
Dynamics of Difference
Institutionalization of Cultural
Knowledge
Adaptation of Services
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CAROLINA
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Valuing Diversity
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Explanatory system for world view
Sense of challenge by diversity
Lack of threat from differences
Comfortable with the fact that people
think and behave differently based on
their culture
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CAROLINA
AHEC
Cultural Self-Assessment
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Knowledge of one’s own background
and culture
Acknowledgement of biases
Managing differences
SOUTH
CAROLINA
AHEC
Elements of Cultural
Competence
Dynamics of
Difference
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Interaction between
different cultures
Based on
assumptions,
behaviors and
expectations
Institutionalization of
Cultural Knowledge
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Knowing clients
Disseminating
information
Activity modification
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CAROLINA
AHEC
Adaptation of Services
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Cross-cultural relationship of patient
and provider
Culturally sensitive health care system
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Accessible
Respectful
Knowledgeable
Sensitive
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CAROLINA
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Cultural Competency
Continuum
Negative
Cultural
Destructiveness
Positive
Cultural
Awareness
Cultural
Indifference
Cultural
Proficiency
Cultural
Competence
SOUTH
CAROLINA
AHEC
Essentials of Cultural
Competence
Culturally competent care is care that:
 Is sensitive to differences
 Understands how responses formed
 Elicits pertinent information
 Recognizes important differences
 Negotiates acceptable plan
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CAROLINA
AHEC
Resolving Cross-Cultural
Discrepant Models of Sickness
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Know commonly held folk beliefs and
behaviors
Assess the likelihood of acting on
beliefs
Negotiate between the two belief
systems
SOUTH
CAROLINA
AHEC
Summary
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The world is becoming increasingly diverse.
Social and cultural beliefs, values, attitudes
and behavior figure significantly in the
health of communities and their individual
members.
Cultural competence is essential to the
health of individuals and communities.
SOUTH
CAROLINA
AHEC
Discussion Time

Discuss the challenges of implementing
the proposed standards for Culturally &
Linguistically Appropriate Health Care
Services, particularly as it relates to
managed care and controlling costs.
SOUTH
CAROLINA
AHEC