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Chapter 2 Chapter 2 Emerging Populations and Health Emerging Populations and Health Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Chapter 2Chapter 2

Emerging Populations and HealthEmerging Populations and Health

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Health Disparities Health Disparities and Health Equalityand Health Equality

““Health disparitiesHealth disparities” ” is an umbrella term that is an umbrella term that includes disparities in health and in includes disparities in health and in healthcare.healthcare.

““Health equityHealth equity” ” is the accomplishment of the is the accomplishment of the highest level of health for all people.highest level of health for all people.

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Emerging PopulationsEmerging Populations

Ethnic minoritiesEthnic minorities Asian Americans/Pacific IslandersAsian Americans/Pacific Islanders Blacks/African AmericansBlacks/African Americans Latinos/Hispanic AmericansLatinos/Hispanic Americans Native AmericansNative Americans Arab AmericansArab Americans

Homeless personsHomeless persons Persons with HIV/AIDSPersons with HIV/AIDS

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MigrationMigration

Voluntary migration Voluntary migration Immigrants vs. refugeesImmigrants vs. refugees

• Immigrants come for positive experience; refugees leave Immigrants come for positive experience; refugees leave negative homeland threat of injury/loss of lifenegative homeland threat of injury/loss of life

Permanent vs. sojournerPermanent vs. sojourner• Sojourners stay for a specific time then return to home Sojourners stay for a specific time then return to home

countrycountry

Involuntary migrationInvoluntary migration Fleeing or being forced out of homelandFleeing or being forced out of homeland

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Ethnic DiversityEthnic Diversity

Race Race Previously a categorization of people based on Previously a categorization of people based on

physical properties and biological heredityphysical properties and biological heredity Arbitrary taxonomy—more variation within “race” than Arbitrary taxonomy—more variation within “race” than

between racesbetween races Social construct—not useful to identify populations Social construct—not useful to identify populations

for health/research purposesfor health/research purposes EthnicityEthnicity

Sense of collective identity; distinctivenessSense of collective identity; distinctiveness Sharing of customs, food, dress, languageSharing of customs, food, dress, language

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Ethnic Diversity (Cont.)Ethnic Diversity (Cont.)

Ethnic group Ethnic group Group set apart on basis of cultural/national origin Group set apart on basis of cultural/national origin

characteristicscharacteristics Values/perceptions about health/illnessValues/perceptions about health/illness

• Socialization process within ethnic groupSocialization process within ethnic group

Minority groupMinority group People who receive disproportionately less wealth, People who receive disproportionately less wealth,

power, social statuspower, social status

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Culture, Values, Culture, Values, and Value Orientationand Value Orientation

CultureCulture Shared patterns of values/behaviors—shaped by Shared patterns of values/behaviors—shaped by

cultural groupcultural group Cultural valuesCultural values

Unique cultural beliefs of what is valued that guide Unique cultural beliefs of what is valued that guide decisions and behavior (such as health values)decisions and behavior (such as health values)

Value orientationValue orientation Values learned by socialization by group and that Values learned by socialization by group and that

reflect overall beliefs of that groupreflect overall beliefs of that group

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Cultural CompetencyCultural Competency Culture may have impact on people’sCulture may have impact on people’s

HealthHealth HealingHealing Wellness belief systemsWellness belief systems Perceived causes of illness and diseasePerceived causes of illness and disease Behaviors of seeking health careBehaviors of seeking health care Attitudes towards health care providers. Attitudes towards health care providers.

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

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Barriers to Health Care Barriers to Health Care for Diverse Populationsfor Diverse Populations

Transcultural nursing (Leininger (2002))—Transcultural nursing (Leininger (2002))—transform health care for diverse populationstransform health care for diverse populations

Health care barriers for diverse populationsHealth care barriers for diverse populations Lack of insuranceLack of insurance Availability of health care facilities/resourcesAvailability of health care facilities/resources Inadequate transportationInadequate transportation Complexity of health care systemComplexity of health care system Fragmentation of careFragmentation of care Attitudes of health care providers and incongruent Attitudes of health care providers and incongruent

beliefs between patients/providersbeliefs between patients/providers

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Folk Healing Folk Healing and Professional Careand Professional Care

Self-care: 70% to 90% population; mild illnessesSelf-care: 70% to 90% population; mild illnesses Professional health care systemProfessional health care system

Specialized training; remuneration for servicesSpecialized training; remuneration for services Folk healing practicesFolk healing practices

Reflect beliefs, values, treatment of cultural groupReflect beliefs, values, treatment of cultural group EthnocentrismEthnocentrism

Practice of viewing other ways as inferior or unnaturalPractice of viewing other ways as inferior or unnatural Obstacle in therapeutic provider-patient relationshipsObstacle in therapeutic provider-patient relationships

HolismHolism Incorporates family and support system in careIncorporates family and support system in care Considers patient viewpointConsiders patient viewpoint

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Arab AmericansArab Americans BackgroundBackground

Three major waves of immigration from late 1800s to Three major waves of immigration from late 1800s to 1960s1960s

Three largest groups: Lebanese, Syrians, EgyptiansThree largest groups: Lebanese, Syrians, Egyptians Religions: Christianity, Judaism, IslamReligions: Christianity, Judaism, Islam

Health concerns and care issuesHealth concerns and care issues Adult-Onset Diabetes MellitusAdult-Onset Diabetes Mellitus Coronary artery diseaseCoronary artery disease Role of acculturationRole of acculturation Mental healthMental health Teenage smokingTeenage smoking

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Arab Americans (Cont.)Arab Americans (Cont.)

Barriers to careBarriers to care Religious belief and practicesReligious belief and practices Cultural norms/modestyCultural norms/modesty Gender issues regarding providersGender issues regarding providers Communication difficultyCommunication difficulty Folk remediesFolk remedies Lack of culturally competent providersLack of culturally competent providers

Selected health-related cultural aspectsSelected health-related cultural aspects Role of religionRole of religion Importance of family; male-dominated family structureImportance of family; male-dominated family structure Present-orientedPresent-oriented

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Asian Americans/Asian Americans/Pacific IslandersPacific Islanders

Background Background Two waves of migrationTwo waves of migration Largest groups: Chinese, Koreans, FilipinosLargest groups: Chinese, Koreans, Filipinos Diverse origins, cultures, lifestylesDiverse origins, cultures, lifestyles Value education Value education

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

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Asian Americans/Asian Americans/Pacific Islanders (Cont.)Pacific Islanders (Cont.)

Barriers to careBarriers to care PovertyPoverty Stress in intergenerational relationshipsStress in intergenerational relationships Cultural norms that prevent health care seekingCultural norms that prevent health care seeking Loss of social networksLoss of social networks Poor access to servicesPoor access to services

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

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Latino and/or Hispanic AmericansLatino and/or Hispanic Americans BackgroundBackground

Largest ethnic group; relatively young populationLargest ethnic group; relatively young population Mexican, Puerto Ricans, Cubans most commonMexican, Puerto Ricans, Cubans most common Large diversity within Latino populationLarge diversity within Latino population

Health concerns and care issuesHealth concerns and care issues Higher incidence of Higher incidence of

• Stomach cancerStomach cancer

• Diabetes mellitusDiabetes mellitus

• Cardiovascular diseaseCardiovascular disease

• HIVHIV

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Latino and/or Hispanic Latino and/or Hispanic Americans (Cont.)Americans (Cont.)

Barriers to careBarriers to care Highest uninsured rate of any U.S. racial/ethnic groupHighest uninsured rate of any U.S. racial/ethnic group Use/receive less preventative health careUse/receive less preventative health care Lack of interpreter services in health careLack of interpreter services in health care Lack culturally appropriate health care servicesLack culturally appropriate health care services Reliance on folk systems of healingReliance on folk systems of healing

Selected health-related cultural aspectsSelected health-related cultural aspects Family supersedes individual needsFamily supersedes individual needs Spiritual strength importantSpiritual strength important Hot and cold concept of diseaseHot and cold concept of disease Disease attributed to supernatural or psychological causesDisease attributed to supernatural or psychological causes Folk remedies used in combination with Western medicineFolk remedies used in combination with Western medicine

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Blacks/African AmericansBlacks/African Americans

BackgroundBackground Involuntary migration historyInvoluntary migration history American slave system facilitated racism/alienationAmerican slave system facilitated racism/alienation Recent substantial progress; inequities remainRecent substantial progress; inequities remain

Health concerns and care issuesHealth concerns and care issues Higher cancer deathsHigher cancer deaths HIVHIV HypertensionHypertension ObesityObesity Mental health concernsMental health concerns

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Blacks/African Americans Blacks/African Americans (Cont.)(Cont.)

Barriers to careBarriers to care PovertyPoverty Lack of health insuranceLack of health insurance Inadequate or unsafe environmentsInadequate or unsafe environments

Selected health-related cultural aspectsSelected health-related cultural aspects Centered on family and religionCentered on family and religion Family needs to be involved in careFamily needs to be involved in care Churches important in promoting healthChurches important in promoting health Use traditional healing approachesUse traditional healing approaches

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Native Americans/Alaskan NativesNative Americans/Alaskan Natives

BackgroundBackground Native to North/South America for thousands of Native to North/South America for thousands of

yearsyears Experience minority group status; lower education Experience minority group status; lower education

and income levels compared to other groupsand income levels compared to other groups Health concerns and care issuesHealth concerns and care issues

Linked to social and economic conditionsLinked to social and economic conditions Smoking, substance abuseSmoking, substance abuse Deaths: unintentional injuries, cirrhosis, homicide, Deaths: unintentional injuries, cirrhosis, homicide,

suicide, pneumonia, diabetessuicide, pneumonia, diabetes

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Native Americans/Alaskan Natives Native Americans/Alaskan Natives (Cont.)(Cont.)

Barriers to careBarriers to care Difficult access to careDifficult access to care Underserved populationUnderserved population

Selected health-related cultural aspectsSelected health-related cultural aspects Present-oriented; take one day at a timePresent-oriented; take one day at a time Value cooperation over competitionValue cooperation over competition Share resourcesShare resources Value families—form kinship systemsValue families—form kinship systems Believe health exists when person is in harmony with Believe health exists when person is in harmony with

naturenature Traditional health practices important (shaman)Traditional health practices important (shaman)

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Homeless PersonsHomeless Persons CharacteristicsCharacteristics

Transience of instability of place Transience of instability of place Instability or absence of connections to familyInstability or absence of connections to family Instability or absence of housingInstability or absence of housing More homeless families, adolescents, and veteransMore homeless families, adolescents, and veterans

Causes of homelessnessCauses of homelessness Changing housing marketsChanging housing markets Lack of employment opportunities for undereducatedLack of employment opportunities for undereducated Inadequate support for persons with mental illnessInadequate support for persons with mental illness PovertyPoverty Substance abuseSubstance abuse Contraction of “safety net”—cuts in program fundingContraction of “safety net”—cuts in program funding

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Homeless Persons (Cont.)Homeless Persons (Cont.)

Health concerns and care issuesHealth concerns and care issues Basic survival issuesBasic survival issues Respiratory and infectious diseasesRespiratory and infectious diseases Dental and vision problemsDental and vision problems Mental health concerns (substance/drug abuse)Mental health concerns (substance/drug abuse)

Barriers to careBarriers to care AccessAccess AffordabilityAffordability Lack of transportationLack of transportation PovertyPoverty

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Strategies to Address Strategies to Address HomelessnessHomelessness

Multifaceted approachesMultifaceted approaches Residential programsResidential programs Supportive services for chronically illSupportive services for chronically ill Role of community health nursesRole of community health nurses TrainingTraining Developing sense of community within homeless Developing sense of community within homeless

populationpopulation Development of public/private partnershipsDevelopment of public/private partnerships

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Persons with HIV/AIDSPersons with HIV/AIDS

OverviewOverview Over 1 million persons in United States affectedOver 1 million persons in United States affected Affects all ethnic groups, sexual orientationsAffects all ethnic groups, sexual orientations Adults over 50 years old fastest growing cohortAdults over 50 years old fastest growing cohort

HIV strategiesHIV strategies Prevention—Most Important!Prevention—Most Important! Rapid diagnosisRapid diagnosis Symptom managementSymptom management

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Persons with HIV/AIDS (Cont.)Persons with HIV/AIDS (Cont.)

African Americans most severely affected African Americans most severely affected populationpopulation

Barriers to treatmentBarriers to treatment Communication gap between health care professionals Communication gap between health care professionals

and at-risk populationsand at-risk populations Socioeconomic factors such as povertySocioeconomic factors such as poverty Cultural values, stigmaCultural values, stigma Personal values and attitudes, behaviorsPersonal values and attitudes, behaviors Political influencesPolitical influences

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HIV and the Role of CultureHIV and the Role of Culture Fatalistic orientation—perception that the person has Fatalistic orientation—perception that the person has

no control over his or her lifeno control over his or her life African Americans and Asian Americans have this perceptionAfrican Americans and Asian Americans have this perception Leads to lower participation in screening programsLeads to lower participation in screening programs

FamilyFamily Deterrent in seeking early diagnosis; fear, shame, or Deterrent in seeking early diagnosis; fear, shame, or

stigmatizationstigmatization Commitment to family strong motivator for helping afflicted Commitment to family strong motivator for helping afflicted

family membersfamily members Prevention strategiesPrevention strategies

Must consider cultural influences and beliefsMust consider cultural influences and beliefs

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Responses to Health Challenges Responses to Health Challenges of Emerging Populationsof Emerging Populations

The nation’s responseThe nation’s response Healthy People 2020: Healthy People 2020: Nationwide health promotion/disease Nationwide health promotion/disease

prevention agendaprevention agenda Office of Minority Health: Office of Minority Health: Eliminate health disparitiesEliminate health disparities Additional minority health initiativesAdditional minority health initiatives

Nursing’s responseNursing’s response Major nursing organizations: Commitment to development of Major nursing organizations: Commitment to development of

culturally competent careculturally competent care Professional journals with transcultural and cultural diversity Professional journals with transcultural and cultural diversity

focusfocus Educational materials for nursing Educational materials for nursing Ongoing nursing education/staff developmentOngoing nursing education/staff development

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