HHS 435 Cont Issues, Trends, Health Law Ethics in H & HS WK5-1

Chapter 26 TRENDS AND CHALLENGES OF CULTURAL DIVERSITY

R. DONNA PETRIE

We are born in families, whether small or large, with one or more parenting figures. These families are embedded in a web of other families, all of which are part of a particular society or culture. In the United States families share a common culture because they all live in one country, but they also share a family culture that may or may not be like the culture of the nation. It is virtually impossible to overemphasize the influence an individual’s family culture has on the day-to-day activities of any given person’s life. In this country it is also nearly impossible to overestimate the points of difference within cultures and between cultures. Diversity itself has historically represented a core component of the democratic fabric of that which defines American life. This position and role is as viable today in 2003 as it was during the past two centuries.

The purpose of this chapter is to broadly introduce the challenges of multicultural human service work. These challenges are threefold. First, human service professionals need to have an understanding of specific value areas wherein misunderstanding between cultures is likely to occur; second, workers need to understand different cultural models of healing and caring; and finally, human service professionals, whether they think of themselves as bicultural or as “American,” need to understand how they are seen as “agents” of mainstream American culture.

FUTURE POPULATION TRENDS

A decade ago the New York Times reported that the United States Census Bureau has had to recalculate population growth (Pear, 1992). The population of the United States, it appears, will continue to grow through 2050 rather than decline after the year 2038. To summarize, for the years 1990 to 2025 there will be more babies born, particularly to new immigrants, and the proportion of men to women is likely to even out, as the life expectancy of men appears to be rising faster than that of women.

Despite this overall increase in the number of people in the United States, whites will account for a declining share in the population. The numbers of black Americans, Asian Americans, and Hispanic Americans will grow appreciably. Using the 1990 census, the Bureau predicts a 412.5 percent population growth for Asian and Pacific Islanders; a 237.5 percent growth in numbers for Hispanic Americans; a 109.1 percent increase in the number of Native American Indians, Eskimos, and Aleuts; and a 93.8 percent increase for black Americans. These figures contrast significantly with the 29.4 percent projected growth of white Americans from 1992 to 2050.

The Census Bureau makes the future trends somewhat more complex by noting that immigration by itself will account for the expected growth in the Asian American population and not the number of births. Birth rates are increasing among the black and Hispanic populations. The birth rate of whites, however, is not expected to increase. In the United States the youngest population group is Hispanic Americans. In fact, whereas the median age of all Americans is thirty-three, more than one-third of the Hispanic population in the United States is under the age of eighteen.

In addition to shifts in the growth of ethnic populations, other demographic variables are also changing. For example, in the age category of 55 years or older, 13 percent are over 65, with the quickest rate of change observed in the nonwhite population, especially Latinos and Asian Americans (Gelfand and Yee, 1991). With this sociocultural picture and the continuation of “urban sprawl,” jobs traditionally available to typical city dwellers will be less available. Consequently, human service workers on the two coasts (namely New York, northern New Jersey, Long Island, Los Angeles, Anaheim, and Riverside, California) will likely experience more interpersonal racial and ethnic conflict because of the greater numbers of immigrants and the greater density mixes of black, white, yellow, and brown cultures. Other urban areas such as Miami and Fort Lauderdale, Florida; Houston, Galveston, and Brazoria, Texas; and San Francisco, Oakland, and San Jose, California, may also experience the effects of polarizing differences between Hispanics and Asians and between Asians and blacks (U.S. Department of Commerce, 1991). Color consciousness and ethnic intolerance, although longstanding and typically a white-black issue in this country, is no less a problem between and within other racial and ethnic groupings.

Social characteristics of various cultural groups in this country add to the complexity of the challenge of working with culturally diverse client populations. Whereas the percentage of persons twenty-five years of age and over who have not completed an elementary school education (zero to eight years) is lowest for Asian Americans (6.4 percent with five years or less completed) and highest for Hispanic Americans (34 percent), the percentage of whites is 11 percent and of blacks 17 percent. Level of education, unemployment, and poverty have a high degree of correspondence for all cultural groups in America, except for whites. The unemployment rate for whites is the lowest of all groups, as are their numbers in families living below the poverty line, and this despite the fact that 11 percent of the white population has only an elementary school education (U.S. Department of Commerce, 1991).

These population trends can help us create an accurate picture of current and future clients seeking human services. People of color will continue to dominate the social welfare client rolls and will continue to have multiple problems. The clients will be very young or very old, their formal education will be limited, and they will have trouble finding work. If they are immigrants or children of immigrants, they will likely have problems navigating family and personal cultural issues as well.

Although individuals from this client population profile are well known to any entry-level human service professional, the human service model of helping does not automatically attribute deficiency or mental illness to these individuals (Schmolling, Youkeles, and Burger, 1992; Papa-john and Spiegel, 1975). On the contrary, many such clients, although wanting economic security, may not subscribe at all to the American values of materialism and of being “bigger and better” or more successful than one’s forebears. Indeed, on many levels, not only their needs and wants may be different from mainstream cultural stereotypes presented in the media, but individual clients may be very different from the culture or family in which they were raised (Pedersen, 1976).

BASIC AREAS OF DIFFERENCE IN CULTURAL VALUES

We can safely assume that all people in the United States, regardless of cultural affiliation, want to have an optimal life (Speight, Myers, Cox, and Highlen, 1991). Given that definitions of an optimal life differ and that individuals living in an increasingly multicultural and multilingual society will often have to interact or negotiate with members of another culture, on what subjects are they likely to have interpersonal misunderstandings?

Apart from differences in individual communication style and language usage (Sarbaugh, 1988; Baruth and Manning, 1991), cultural anthropologists have categorized differences between ethnic groups in the following ways: (1) their understanding of authority, (2) their definitions of success, and (3) their beliefs about how people should conduct themselves and their relationships (Carter, 1991; Baruth and Manning, 1991). Understanding the values of each client group on the previously stated dimensions can help to clarify how an individual may be in conflict with his or her own culture or with the larger multiethnic culture. In the next several paragraphs we will look at a number of ethnic groups’ general responses to these questions.

What motivates human beings? Are they basically good or well meaning, or are they born with evil intentions? The answer to this question is a basic building block of an individual’s belief structure. Research has shown that blacks and Puerto Ricans often contrast sharply with Eurocentric Americans in their view of human nature (Carter, 1991). Although several studies of white, middle-class Americans provide mixed views of human nature, none offer evidence that Euro-Americans think human beings are born malevolent in character; blacks and Puerto Ricans are more fatalistic, believing some people do evil things because they are evil.

Similarly, Euro-Americans tend to differ from blacks, Chinese, Africans, Italians, Cubans, and Native American Indians in their belief that individuals exert control over life events and that each person should use willpower for one’s own gain (Carter, 1991; Helms, 1992; Pinderhughes, 1989). While many blacks, Cubans, and Native Americans believe people live in nature and are partners with all of nature, other blacks, Italians, and Chinese believe that people have little control over natural forces or what happens to people and also what they can do about what has happened. Clearly, trying to help an individual who believes that personal effort is futile because “that’s the way things are” and that one must comply with fate is likely to “feel” frustrating and futile to Euro-American and Japanese American intake workers who have put themselves through college. Euro-American culture believes in action, in achievement, and in self-expression (Carter, 1991; Helms, 1992). Action is centered in the individual, who not only has the right but is expected to be autonomous from the group—to, in effect, place his or her goals ahead of those of the group (Carter, 1991). This “rugged individualism” is so widespread in the United States, it has become almost synonymous with American culture. But not all cultures in America hold individualistic values. Puerto Ricans, Italians, and Greeks, to name a few, do not (Carter, 1991), and, interestingly, some studies of Euro-American college students indicate a movement away from mastery over nature and action value orientations (Carter, 1991).

What is success, and what should be emphasized in social relations between people? Typically Euro-Americans believe success occurs somewhere in the future, that success is usually gained through individual effort, and that success will be observable in material gain or achievements (Carter, 1991; Helms, 1992). Few other cultures put as much emphasis on the value of delayed gratification or material well-being as white, middle-class Americans do. For other cultures, either traditional customs or the activities and events of the present are of central importance (Carter, 1991). So, again, human service college graduates who seek to help individuals from a different culture must be open to other definitions of success and achievement (Pinderhughes, 1989).

To summarize this section, human service workers who have graduated from college have learned how to function successfully within the mainstream value culture of this country. Specifically, they have been encultured by others who believe in rugged individualism, delayed gratification, material success, personal effort and responsibility, and the basic goodness of human nature. Because human service workers have negotiated the educational system, they can assist in educating clients about American culture and work habits so that clients may also become multicultural. The helper’s self-knowledge can also prevent possible misunderstandings in interpersonal communication.

Still and all, there is no way to simplify cross-cultural diversity. Pinderhughes (1989) lists at least fourteen different sources of cultural differences between people. When within-group differences are added, as in immigrant second-and third-generation groups, gaining a comprehensive knowledge of any single culture becomes impossible. The best students can do to meet the challenges inherent in cross-cultural helping is to know their own culture, to stay open and accepting of other cultures, and to keep an eye on what “works” in the dominant or mainstream culture. C. Gilbert Wrenn (1987), a longtime researcher in cross-culture counseling and therapy, suggests that students (1) read positive long-range-thinking scholars who talk about the spiritual as well as the beautiful, (2) unlearn something every day to make way for change, (3) trust that there is a light at the end of the tunnel, and (4) risk acceptance and validation of another’s experience. The latter point is important to the next section, which explores kinds of caring.

KINDS OF CARING

Textbooks in human services usually emphasize one-on-one talking or group talking as the most frequently used helping interventions. Sometimes the skills of brokering, advocacy, outreach, and community organizing are also added (Schmolling, Youkeles, and Burger, 1992; Okun, 1992; Shulman, 1982). There are other ways of intervening with clients. Madeleine M. Leininger (1987) persuasively argues for transcultural caring as an innovative and essential approach to helping people “live and survive in diverse and changing contexts” (p. 107). She believes that helpers must learn what “cultural-care” behaviors are likely to be accepted by helpees before “real care” or service can be given. Other researchers have highlighted culturally specific interventions, too. What follows are summary findings from Leininger (1987), McGowan (1988), Vontress (1991), Prince (1980), and Tseng and McDermott (1981) about kinds of caring in different cultures (see Table 26.1). The summaries are not meant to be exhaustive but rather to provide evidence of the diversity of helping methods.

Leininger (1987), from a study of thirty-five cultures, determined forty-two different ideas about caring for others. Those on the list that are usually taught in human service classes include trust, understanding, empathy, listening, and respect. But there were others current education does not suggest as appropriate to American culture: touching, loving, succoring, protecting, and sharing (Leininger, 1987). Whether there are universal elements basic to all cultures has not been determined because the process of helping is complex, and there is often a very hazy boundary between psychological and physical problems (Prince, 1980). Methods are made more complicated, too, by the fact that some cultures believe psychological suffering is a fact of living to be accepted rather than an idiosyncratic personality outlook that can be changed (Prince, 1980).

Aside from these qualities and purposes of helping, each culture has a characteristic stance on who can effectively do the helping. In many cultures only an expert can be a “healer.” This point of view is true of mainstream American culture—our experts are those who have managed to successfully complete a number of years of post-secondary education. In Africa, as Vontress (1991) writes, the healing specialists include the herbalist, the fetish man, the medium (usually a woman who is able to transmit messages from the dead to the living), the sorcerer (usually one who can do evil), and the healers (perhaps an equivalent to our generalists). Although different from our experts, they are experts nonetheless.