Health Behaviors in Diverse Populations - Slides | HNFE 4644, Study notes of Public Health

Download Health Behaviors in Diverse Populations - Slides | HNFE 4644 and more Study notes Public Health in PDF only on Docsity! Health Behaviors in Diverse Populations Lecture 14 Overview • Definitions of diversity, culture, culturally competent care and related concepts • Frameworks related to health and culture. • Barriers to studying culture and using it in clinical settings. • Approaches and methods to study culture. • Diversity in health promotion and health care. Why Study Diversity in Health? Or Culturally Competent HealthCare? • Culture as a determinant of health • Disparities • Using culture to understand health – Cross cultural comparisons • Improving health care – Making health promotion more effective. – Need for clinical sensitivity and understanding. Defining Disparities, Race, Ethnicity, Culture, & Acculturation Lack of clarity and consensus around constructs commonly used for grouping individuals (race, ethnicity, and culture) IOM Chapter : Dimensions in Diversity Race • No biological basis for race • Remains a social construct (especially in U.S.) • Experience of race and racism has health consequences • Grouping by race may be positive or negative • Race is not necessarily a determinant of disparities in health risks or outcomes What is Ethnicity? Ethnicity • Relates to the sense of identity an individual has based on common ancestry and national, religious, tribal, linguistic or cultural origins • Implies a set of shared values, lifestyles, beliefs and norms among those claiming affiliation • Provides a sense of social belonging and loyalty Ethnicity • Also used to stereotype diversity among groups • Used to label those outside your group • Ethnicity ≠ Race – Race is a biological term use to classify physical characteristics • May be to broad a category to be meaningful (e.g. Asian American) CDC statement on race • Emphasis on race and ethnicity in public health surveillance diverts attention from underlying risk factors • Despite the potential limitations of the categories of race and ethnicity, such information can assist in public health efforts to recognize disparities between groups for a variety of health outcomes • In all reports and other uses of surveillance data, the reason for analyzing race and/or ethnicity should be given, approaches to measurement of race and ethnicity should be specific and findings should be interpreted. What is Culture? Assimilation • The social, economic, and political integration of a cultural group into a mainstream society to which it may have emigrated or otherwise been drawn. – Requires a minimal level of acculturation Acculturation • Acculturation is a term used to describe the degree to which an individual from one culture has given up the traits of that culture to adopt the dominant culture – Four levels (Lock; in Huff & Kline) • Bicultural • Traditional • Marginal • Acculturated Assessment of Acculturation • Assessed often in research, not HPDP or clinical settings. • Example scale – How many generations in U.S.? – Preferred language? – Preferences for whom the individual most often socializes? Ethnocentrism, Ethnosensitivity, Cultural Competence Ethnocentrism • Assumption an individual makes that his or her way of believing and behaving is the most preferable and correct one (Ferguson, 1991; in Huff & Kline) • May lead to dysfunctional treatment between provider and client • Examples? Ethnosensitivity • Concerned with becoming more sensitive and respecting of cross-cultural differences • Need to develop awareness of one’s own communication style as important to becoming sensitive to someone else’s cultural differences • Easier said than done (especially at organizational level) Biocultural Approach • Concentrates on the processes by which the human body adapts to changing environmental conditions – Dynamic, interactive, multilevel processes • Examines how the body is shaped by environmental stressors and the way bodily processes influence people’s behavior. Interpretive Approach • Focuses on the experience of illness in a given social and cultural context. • Meaning influences the course of disease by shaping subjective experience as well as individual and social behavior in response to disease. Critical Approach • Focuses on the social origins of disease and the ways imbalances in power relations influence health and sickness. • Cultures must be seen in have to be seen in political, cultural and economic contexts. • Addresses the social production of disease and the social context of biomedicine and biomedical practice. The Three Frameworks • Differ in their emphasis on cultural phenomena in relation to health and disease • Similarities – Culture is a pervading reality, not just a variable to be controlled. • Conceptions of reality are filtered through a world-view. – Culture is dynamic. Potential Mechanisms for Cultural Effects on Health Mechanisms of Culture • Real differences in health behaviors – Notion of preventive practices is not widespread. – Ideas of what will produce health vary. – Differences in information available. – Differences in what is valued & prioritized. • Role of world-view. Barriers to Cultural Diversity Issues of culture and diversity • Race persists as a social construct without biological basis • Race/ethnicity are only good predictors for health outcomes when ‘grossly’ measure • Diversity ≠ Disparity • Tendency to reify culture as a static experience for members of an ‘ethnic group’ • Differences in health risks and/or outcome may reflect environmental factors • Victim blaming: assuming a group of people have more power to change their behavior than they really do Health Promotion & Culture • Medicine is not all that scientific • Many different ways to perceive, understand, and approach health & disease • Varies across cultural and ethnic groups • Cultural ignorance by health professionals may be a major barrier. – Cultural diversity of healthcare industry or workplace can also present challenges. Barriers to Multicultural HPDP • Demographic factors • Attitudes about health care (especially Western) • Health beliefs and practices • Healthcare systems • Others?? Considerations for Health Counselor • Groups/ages in which cultural gaps may exists – Aging issues – Migrant /Immigrant populations • Language barriers—identify qualified interpreters • Traumatic Events; PTSD • Western medicine versus traditional medicine Considerations for Health Counselor – Gender • Females may not seek care • Females may not hold decision making authority about treatment or care – Religious beliefs • Approaches and attitudes to health, death, seeking of treatments and acceptable treatments • Religious exemptions from vaccination, chemotherapy blood transfusions