Public Health HW2
ned.kh
ph_484_chapter_4-_2015.pptxChapter 4
Culture Competency and CEOD Process: Immigrant Populations, Health Care, Public Health, and Community
Defining and Exploring Culture
A group or community with whom one shares common experiences that shape the way they understand the world
Can include groups:
Born into
Gender
Race
National origin
Class
Religion
Moved into
Moving into a new community
Change in economic status
Change in health status
Four Concepts Associate With Culture:
Cultural knowledge / the knowledge of cultural characteristics, history, values, beliefs and behaviors of another ethnic or cultural group
Cultural awareness / being open to the idea of changing cultural attitudes
Cultural sensitivity / knowing that differences exist between cultures, but not assigning values to the differences
Cultural competence / having the capacity to bring into its systems different behaviors, attitudes and policies and work effectively in cross-cultural settings to produce better outcomes
Learning Culture
Be more aware of your own culture
What is your culture?
Do you have more than one culture?
What is your cultural background?
Learn about other’s culture
Make s conscious decision to establish friendships with people from other cultures
Put yourself in situations where you will meet people of other cultures
Examine your biases about people from other cultures
Ask questions about the cultures, customs and views
Read about other people’s cultures and histories
Listen and show caring
Observe differences in communication styles and values; don’t assume that the majority’s way is the right way
Risk making mistakes
Learn to be an ally
Understanding Culture for Community Engagement, Organization and Development (CEOD)
U.S. communities are becoming more diverse
Racial profiling & stereotyping will be key discussion points when engaging and developing communities in public health practice and may be harmful because they can impede communication, engagement and development
Racial profiling / a law enforcement practice of scrutinizing certain individuals based on characteristics thought to indicate a likelihood of criminal behavior
Stereotyping / a fixed, over generalized belief about a particular group or class of people (Cardwell, 1996)
CEOD and Cultures of the Future
Questions to help engage, organize and develop a healthy community of the future:
If you could have your ideal community right now what would it look like?
If you can’t have your ideal community right now, what will be the next steps in building the kind of cultural community you desire?
Who lives in the community right now?
What kinds of diversity already exist?
How will diversity be approached in your community?
What kinds of relationships are established between cultural groups?
Are the different cultural groups well organized?
What kind of struggles between cultural groups exists?
What kind of struggles within cultural groups exists?
Are these struggles openly recognized and talked about?
Are there efforts to build alliances and coalitions between groups?
What issues do different cultural groups have in common?
Culture Building and Context
Contextualization / communicating or providing a service in such a way that it addresses the needs of the people it seeks to serve
Principles that will create a favorable environment for building diverse communities:
Every person needs to feel included and important
Guilt/blaming does not work in fostering diversity
Treating everyone the same may be unintentionally oppressive (learn about cultural difference and treat appropriately)
Keep a spirit of hope on all issues\
Team building
Welcome differences among groups
“How” content is delivered is often more important than “What” the content is
Engage families, organizations, institutions and neighborhoods
The Demographic Challenge: Birth Dearth or Population Bomb
| 2000 Census | 2010 Census | Change (%) | |
| U.S. Population | 281.4 million | 308.7 million | +27.3 million (9%) |
| Non-Hispanic White Hispanic Black Asian | 194.6 (69%) 35.3 (12.5%) 34.7 (12.3%) 10.2 (3.6%) | 196.8 (64%) 50.5 (16.3%) 38.9 (12.6%) 14.7 (4.8%) | +2.3 (1.2%) +15.2(43%) +4.3 (12.3%) +4.4 (43%) |
Immigration Policy and Practice in the US: A Historical Perspective
The McCarran Walter Act of 1952
The Hart-Cellar Act of 1965
The Illegal Immigration Reform and Immigrant Responsibility Act of 1996
The 1996 Welfare Reform Act
The 2009 CHIP Reauthorization Act
Results of September 11, 2001 for immigration
The Response of Native Born to Immigrant
Nativism / intense opposition to an internal minority on the grounds of its foreign connections
Racism / a belief that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race
Ethnocentrism / characterized by or based on the attitude that one's own group is superior
Assimilate / to absorb into the culture or mores of a population or group
Health Status of Immigrant Populations
Immigrants tend to have more positive health behaviors and fewer negative health behaviors when compared to the U.S. born population.
Over successive generations, immigrants tend to becomes more “American” in habits, which can result in “unhealthy assimilation”
Language barriers play a large role in adverse health outcomes for many immigrants
Poverty and lack of education also plays a negative role in health status
The Irony of Health Care for Immigrants: The Inequity Surprise
Uninsured: Immigrants = 12.3 million 26.6% of total uninsured
Immigrants spend one half to two thirds the medical expenditures of native-born Americans, even when fully insured
Contrary to stereotype, immigrants as a group are sparing users of health services
California, Texas, Florida and New York account for 58.8% of uninsured immigrants in U.S.
The uninsured (immigrants and native born) are responsible for only 2% of the cost of health care in U.S.
Health disparities must be addressed to improve the health status of the nation
Those Because insurance companies negotiate rates with providers and hospitals, patents with insurance are charged significantly less than those without coverage (Those least able to pay are charged the most)
The 2010 Health Reform Law / Affordable Care Act is expected to expand coverage for poor uninsured, mainly through the expansion of Medicare and CHIP, but will not address undocumented immigrants
Generational Differences & Generational Change
Over successive generations, European Immigrants become more closely approximated to the host population progressively erasing deficits in education attainment, economic achievement and health status along seven dimensions:
Cultural
Structural
Marital
Identity
Prejudice
Discrimination
Civic assimilation
Asian and White European fare better than other immigrants of color
Cuban Americans are the most successful Hispanic group
Effecting Change and Establishing Dialogue: Organization as Education
Cross cultural care for immigrant patients
Humility
Empathy
Curiosity
Respect
Sensitivity
Awareness of outside influences
