Discussion Health Promotion: Prevention of Disease W2

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Chapter 2

Emerging Populations and Health

� “Health disparities” is an umbrella term that includes disparities in health and in health care. Greater obstacles to health care Ø Obstacles commonly based on racial or ethnic group,

religion, socioeconomic status, gender, age, mental health, disability, sexual orientation or gender ID, geographic location

� “Health equity” is the accomplishment of the highest level of health for all people Ø Goal: elimination of health care disparities

Health Disparities and Health Equality

Emerging Populations

� Ethnic minorities Ø Asian Americans/Pacific Islanders Ø Blacks/African Americans Ø Latinos/Hispanic Americans Ø Native Americans Ø Arab Americans

� Homeless persons � Immigrants includes unauthorized immigrants

Ethnic Diversity Concepts

� Race—historically associated with power and privilege disparities, social injustice, and prejudice

� Ethnicity—commonalities of culture (language, history, customs, geographical origin, religion, or ancestry)

� Minority group—commonly disadvantage in relation to power, control, and wealth

Health Care Disparities

� Poverty, homelessness, and health care disparities disproportionately impact racial and ethnic minorities

Homeless man working as a day laborer with no health care benefits

Culture and Values Value Orientation

� Culture Ø Integrated patterns of human behavior (language,

thoughts, communications, actions, customs, values, institutions)

� Values Ø Belief about the worth of something Ø Standards which influence behavior and thinking

� Value orientation Ø Values learned and share through socialization Ø Reflect “personality type” of particular society

Culture

One cultural norm of the Moiri in New Zealand is to say good-bye by rubbing noses

� Culture may have impact on people’s Ø Health Ø Healing Ø Wellness belief systems Ø Perceived causes of illness and disease Ø Behaviors of seeking health care Ø Attitudes toward health care providers

� Cultural competency is one of the major elements in eliminating health disparities

Cultural Competency

Culturally Competent Care

� Knowledge of culture � Education and training in culturally competent care � Critical reflection � Cross-cultural communication � Culturally competent practice � Cultural competence in health care systems and

organizations � Patient advocacy and empowerment � Multicultural workforce � Cross-cultural leadership � Evidence-based practice and research

Folk Healing and Nursing Care Systems

� Folk healing practices Ø Reflect beliefs, values, treatment of cultural group Ø Unlicensed: lay midwives, herbalists, spiritualists

� Nurses must avoid ethnocentrism Ø Viewing other ways as inferior or unnatural Ø Obstacle in therapeutic provider-patient relationships

� Holistic approach Ø Incorporates family and support system in care Ø Considers patient viewpoint

Arab Americans

� Background Ø Three major waves of immigration from late 1800s to 1960s Ø Three largest groups: Lebanese, Syrians, Egyptians Ø Religions: Christianity, Judaism, Islam

� Health concerns and care issues Ø Adult-onset diabetes mellitus Ø Coronary artery disease Ø Role of acculturation Ø Mental health Ø Teenage smoking

Arab Americans (Cont.)

� Barriers to care Ø Islamophobia post 9-11 Ø Religious belief and practices Ø Cultural norms/modesty Ø Gender issues regarding providers Ø Communication difficulty Ø Folk remedies Ø Lack of culturally competent providers

� Selected health-related cultural aspects Ø Role of religion Ø Importance of family; male-dominated family structure Ø Present-oriented

Asian Americans/Pacific Islanders

� Background Ø Many diverse countries/cultures—100 languages Ø Largest groups: Chinese, Koreans, Filipinos Ø Often referred to as “model minority” Ø Value education

� Health concerns and care issues Ø Hesitancy to seek early diagnosis/screening Ø Higher rate of tuberculosis Ø Mental health problems due to adjustment issues Ø Lower rate of obesity, hypertension

Asian Americans/ Pacific Islanders (Cont.)

� Barriers to care Ø Language barriers Ø Hesitant to voice disagreement—noncompliance Ø Stigma to seeking mental heath services Ø Hesitant to seek GYN care—considered “private” matters Ø Mistrust and other stigmas with seeking care

� Selected health-related cultural aspects Ø Value of collectivism vs individualism Ø Family most important social institution; respect for elders Ø Cultural value of passivity to avoid conflict Ø Taoism: foundation of Chinese medicine “achieving harmony” Ø Use of folk medicine/alternative treatment modalities common

Latino and Hispanic Americans

� Background Ø Largest ethnic group; second fast growing minority Ø Mexican, Puerto Ricans, Cubans most common Ø High rates of poverty; highest rate uninsured

� Health vulnerabilities—higher incidence Ø Stomach cancer Ø Diabetes mellitus Ø Cardiovascular disease Ø HIV

Latino and Hispanic Americans (Cont.)

� Barriers to care Ø Lack of access to preventive care Ø Lack of interpreter services in health care Ø Lack of culturally appropriate health care services Ø Reliance on folk systems of healing

� Selected health-related cultural aspects Ø Family supersedes individual needs Ø Religion plays a key role Ø Hot and cold concept of disease Ø Illness due to supernatural and psychological force Ø Folk remedies in combo with professional care

Blacks/African Americans

� Background Ø Second largest minority behind Hispanic/Latino Ø Most descendants of enslaved persons from Africa Ø Inequities persists; substantial progress

� High rates for certain diseases Ø Cancer deaths Ø HIV Ø Hypertension Ø Obesity Ø Homicide

Blacks/African Americans (Cont.)

� Barriers to care Ø Poverty Ø Lack of health insurance Ø Inadequate or unsafe environments

� Selected health-related cultural aspects Ø Centered on family and religion Ø Family needs to be involved in care Ø Churches important in promoting health Ø Use traditional healing approaches

Native Americans/Alaskan Natives

� Background Ø Native to North/South America prior to arrival of

Europeans Ø Experience minority group status; lower education

and income levels compared to other groups � Health concerns and care issues

Ø Linked to social and economic conditions Ø Smoking, substance abuse Ø Deaths: unintentional injuries, liver disease, cancer

homicide, suicide, pneumonia, diabetes, CVA

Native Americans/Alaskan Natives (Cont.)

� Barriers to care Ø Difficult access to care Ø Underserved population

� Selected health-related cultural aspects Ø Present-oriented; take 1 day at a time Ø Value cooperation over competition Ø Share resources Ø Value families—form kinship systems Ø Believe health exists when person is in harmony with nature Ø Traditional health practices important (shaman)

Homeless Persons

� Characteristics Ø Lack of fixed, regular, adequate residence due to poverty Ø Considered temporary situation vs permanent condition Ø For veterans: mental illness, substance abuse, poverty

� Causes of homelessness Ø Changing housing markets—shortage of affordable rentals Ø Poor health both effect and cause homelessness Ø Widespread and unprecedented foreclosures Ø Poverty, unemployment, decline in public assistance Ø Substance abuse, domestic violence, mental illness

Homeless Persons (Cont.)

� Health concerns and care issues Ø Basic survival issues Ø Pneumonia, TB, HIV disease are widespread Ø Dental and vision problems Ø Mental health issues significant contributing factor Ø Substance abuse: both cause and consequence

� Barriers to care Ø Lack of access; lack of ID Ø Affordability issues, lack of health insurance Ø Lack of transportation Ø Lack of knowledge re where to obtain care

Strategies to Address Homelessness

� Community involvement in homelessness � Programs to provide food, clothing, shelter � Include rural homelessness in programs � Health care professionals have important

advocacy role � Educate community members re how to help

homeless persons � Strengthen professional curriculums and

research to address homelessness

Federal Response to Disparities

� NIH is devoting significant resources to reducing health disparities

� Congress created National Center on Minority Health and Health Disparities in 2010

� Healthy People 2020 lists as one of primary goals to reduce/eliminate health disparities

� Patient Protection and Affordable Care Act 2010 increases funding for indigent care

� Office of Minority Health reauthorized

Nursing’s Response to Emerging Populations and Health

� American Nurses Association (ANA) Ø Commitment to provide service regardless of

background or situation Ø Nurses are responsible to provide for culturally

competent care � ANA sponsored Ethnic-Minority Fellowship

Program to support minority health � Culturally relevant publications and journals

offered as resources to health care professionals

Publications Devoted to Culturally Competent Care

� Journal of Cultural Diversity � Journal of Multicultural Nursing and Health � Minority Nurse Newsletter � Cultural Care Diversity and Universality

Theory—Madeline Leininger (2001) � Current nursing texts from major publishers now

include chapters on culturally relevant care