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Cultural Cultural DiversityDiversity

Olga Usynska

Cultural diversity is the differences among people that result from ethic, racial and cultural variables

Definition of termsDefinition of terms

Definition of termsDefinition of termsWhat is Culture? - shared lifestyle, values, beliefs, ideals and

behavior of a particular group.

Picture it as a luggage that each of us carries around for our lifetime. It is sum of beliefs, practices, habits, likes, dislikes, norms, customs, rituals and so forth that we learned from our families during the years of socialization. In turn, we transmit cultural luggage to our children.

Dominant culture and minoritiesDominant culture and minoritiesDominant cultureDominant culture is the group, whose values prevail within a societyMinority groupMinority group is composed of an ethnic, racial, or religious group that constitutes less than a numerical majority of the population

The strength and greatness of America lies in the diversity of its people…

“The United States, already one of the most diverse societies in the world, is becoming increasingly multicultural and multilingual”

Lester, 1998

Growing Diversity in AmericaGrowing Diversity in AmericaDuring the Past 20

yearsWhite population increased 10%African American population increased 30%Native American population increased 58 %Hispanic population increased 125%

Projected DemographicsProjected DemographicsIn 2020 the population of African-Americans is predicted to double and that of Asian-Americans and Hispanic/Latinos to tripleBy the year 2050, white Americans’ share of the total population will decline from 75% to under 50%

Multiculturalism in United StatesMulticulturalism in United States

The dominant culture is composed of white middle-class Protestants of European ancestry

The minorities are Native Americans, African Americans, Asian Americans and Hispanic Americans

In California Population of 38 Million

1/3 of the population is of Hispanic origin Over 10% Asian Over 4% more than one race Nearly 17% identify as “Other race”

But… •“In many localities so-called minorities are now, in fact, the majority”

(ANA, 1998)

In California

1 in 4 are foreign born, 37% of these entered the US after 1990 Nearly 40% of the population over the age of 5 speaks a language other than English at home.

Food Preferences

Nutritional Related Health Problem

• Pork • Greens • Rice • Fried foods

• Calories• Cholesterol• Carbohydrates• Sodium

• Obesity• Cardiovascular illnesses(hypertension, coronary heartdisease)

African AmericansAfrican Americans

Food preferences and related Food preferences and related effects on healtheffects on health

Food preferences and related effects Food preferences and related effects on healthon health

Food Preferences


• Raw fish• Rice• Soy sauce

• Calories • Cholesterol • Carbohydrates • Sodium

• Coronary heart disease • Liver disease • Stomach cancer • Ulcers

AsianAsian AmericansAmericans


HispanicHispanic AmericansAmericansFood

Preferences


• Beans• Fried foods• Chili• Carbonated beverages•Spicy food

• Calories • Cholesterol • Carbohydrates • Sodium

• Obesity • Coronary heart disease • Diabetes


Food Preferences


• Blue cornmeal • Fish • Game • Fruits and berries

• Calories • Carbohydrates

• Malnutrition • Diabetes

NativeNative AmericansAmericans

Effects of biologic variations on Effects of biologic variations on selected drugsselected drugs

Isoniazid (drug used to treat tuberculosis) is rapidly metabolized, thus becoming inactive quickly; occurs in approximately 60% of population. An enzyme deficiency interferes with metabolism of primaquine (used to treat malaria); occurs in approximately 35% of population. Antihypertensive drugs (e.g., propranolol) need to be administered in higher doses to produce same effects as in European Americans

African Americans


Isoniazid (drug used to treat tuberculosis) is rapidly metabolized, thus becoming inactive quickly; occurs in approximately 85%-90% of population. Rapid metabolism of alcohol results in excessive facial flushing and other vasomotor symptoms.

Asian Americans

Chinese men need only about half as much propranolol (antihypertensive drug) as European American men. Asian people need smaller doses of alprazolam (antianxiety drug) to achieve same blood levels as their European American counterparts; the drug is also metabolized more slowly (remains in the bloodstream longer) in Asian men.


Asian Americans


European Americans

Due to liver enzyme differences, caffeine is metabolized and excreted faster than by people of other cultural groups.


Native AmericansIsoniazid (drug used to treat tuberculosis) is rapidly metabolized, thus becoming inactive quickly; occurs in approximately 60%-90% of population.

Rapid metabolism of alcohol results in excessive facial flushing and other vasomotor symptoms.

Ethnic Health Disparities

African AmericansHighest death rate from colon and rectal cancer of any ethnic group in the U.S.African Am women, diagnosed with breast cancer, have a 71% survival rate vs. an 86% rate for white women.

Ethnic Health DisparitiesNative Americans

2-3 times more likely to have diabetes mellitus that the general populationHigher than average mortality rates associated with heart disease, TB, suicide, pneumonia, influenza, homicide, and alcoholism

Differing Health Belief SystemDiffering Health Belief SystemMagicoreligious HBS: people believe that supernatural forces influence health and illness

Holistic Belief System: the forces of nature must be kept in natural balance and harmony

Scientific or Biomedical HBS: health and illness are controlled by a series of physical and biomedical process that can be analyzed and manipulated by humans. Disease and illness are caused by microorganism or malfunction of body

Factors that influence Health Beliefs and Factors that influence Health Beliefs and Behaviors of Culturally Diverse Ind/GrpBehaviors of Culturally Diverse Ind/GrpTraditional health and illness practices:

Natural folk medicineMagico-religious medicineUse of foodReligious practiciesUse of HealersSocial organizations – refers to family unit; environment in which people grow up and live.

- Description of family in this cultural group- Gender and age roles that affect choice of whom to

communicate

Folk medicine: healers and practicesFolk medicine: healers and practices

Elderly women healers "Community Mother" or "Granny" "Root doctor" Voodoo healer ("Mambo" or "oungan") Spiritualist

Herbs, rootsPoultices Oils Religious healing through rituals, (e.g., laying on of hands) Talismans are worn around the wrist or neck, or carried in a pouch to ward off disease

African Americans

• Herbalist • Physician

Use of hot and cold foodsHerbs (e.g., ginseng root, which is used as a restorative potion)SoupsCupping, pinching, and rubbing MeditationAcupunctureAcupressureApplication of tiger balm (a salve) to relieve muscular pain

Asian AmericansFolk medicine: healers and practicesFolk medicine: healers and practices


Exercise Medication (prescribed and over-the-counter) Modified diets Amulets Religious healing rituals

European AmericansNurse

Physician


Curandero – combinaiton of prayers, herbs, and other rituals to treat traditional illnesses, especially in children Espiritualista (spiritualist) - foretelling of future and interpretation of dreams, combination of prayers, herbs, potions, amulets for curing illnesses, including witchcraft)Yerbero (herbalist) – consultation for herbal treatment of traditional ilnessesSobadora (bonesetters) – massage and manipulation of bones and joints used to treat a variety of ailments, including musculoskeletal conditionParteras (lay midwifes) – assisting for women in childbirth and newborn care

Hispanic Americans

Cultural Diversity and Health Care

We All Have It!Obvious Manifestations:

ReligionEthnicity National Origin (language)Gender

Cultural Diversity and Health Care

Less Obvious Manifestations:AgeEducationEducational StatusMobility (including handicaps)

EthnicitySense of identification of a collective cultural groupCharacteristic of an ethnic group:

- Common language- Same food preferences- Shared traditions- Religion- Shared values, symbols, literature,

folklore, music

AFRICAN-AMERICANSAFRICAN-AMERICANS Communication

Languages include English and Black EnglishHead nodding does not necessarily meanagreementDirect eye contact is often viewed as being rudeNonverbal communication is very importantIt is considered to be intrusive to ask personalquestions of someone on initial contact ormeeting

Time orientation and spaceOriented more to the present than the futureClose personal space is importantTouching another's hair is sometimes viewed as offensive

AFRICAN-AMERICANSAFRICAN-AMERICANS

Social rolesLarge extended-family networks are importantMany single-parent, female-headed householdsReligion is usually Protestant (Baptist)Strong church affiliation with community isimportantSocial organizations are strong within com munities


Health and illnessHarmony with natureNo separation of body, mind, and spiritIllness is a disharmonious state that may be caused by demons or spiritsIllness can be prevented by nutritious meals, rest and cleanliness


Health risksSickle cell anemiaHypertensionCoronary heart diseaseCancer (especially stomach and esophageal)Lactose intoleranceCoccidioidomycosis


ImplementationAvoid stereotypingDo not label Black English as an unacceptableform of languageClarify meaning of client's verbal and nonverbalbehaviorBe flexible and avoid rigidity in scheduling careEncourage involvement with familyA folk healer or herbalist may be consulted beforean individual seeks medical treatment


ASIAN-AMERICANSASIAN-AMERICANS Communication

Languages include Chinese, Japanese, Korean, Vietnamese, EnglishSilence is valuedEye contact is considered rudeCriticism or disagreement is not expressedverballyHead nodding does not necessarily meanagreementThe word "no" is interpreted as disrespect for others

Time orientation and space Oriented more to presentSocial distance is importantUsually do not touch others during conversationTouching is unacceptable with members of oppo site sexThe head is considered to be sacred; thereforetouching someone on the head is disrespectful

ASIAN-AMERICANSASIAN-AMERICANS

Social rolesDevoted to traditionLarge extended-family networks, loyalty to immediate and extended family and honor are valuedFamily unit is very structured and hierarchicalMen have the power and authority, and womenare expected to be obedientReligions include Taoism (Buddhism), Islam,ChristianitySocial organizations are strong within the community


Health and illnessHealth is a state of physical and spiritual harmony with nature and a balance between positive and negative energy forces (yin and yang)

A healthy body is viewed as a gift from ancestors

Illness is viewed as an imbalance between yin and yang

Yin foods are cold, and yang foods are hot; cold foods are eaten when one has a hot illness, and hot foods are eaten when one has a cold illness

Illness is contributed to prolonged sitting or lying, or to overexertion


Health risksHypertensionCancer (stomach and liver)Lactose intoleranceThalassemiaCoccidioidomycosis


ImplementationAvoid physical closeness and excessive touching;only touch a client's head when necessary, informing the client before doing soLimit eye contactAvoid gesturing with handsClarify responses to questionsBe flexible and avoid rigidity in scheduling careEncourage involvement with familyA healer may be consulted before an individual seeks out traditional treatment


EUROPEAN (WHITE)-ORIGIN EUROPEAN (WHITE)-ORIGIN AMERICANSAMERICANS Communication

Languages include national languages, EnglishSilence can be used to show respect or disrespect for another, depending on situationEye contact is viewed as indicating trustworthiness

Time orientation and spaceFuture orientedAloof and tend to avoid close physical contactHandshakes are used for formal greetings

EUROPEAN (WHITE)-ORIGIN EUROPEAN (WHITE)-ORIGIN AMERICANSAMERICANS

Social rolesThe nuclear family is the basic unit; the extended family is also importantThe man is the dominant figureReligion includes Judeo-ChristianCommunity social organizations are important


Health and illnessHealth is usually viewed as an absence of disease or illnessHave a tendency to be stoical when expressing physical concernsPrimarily rely on modern Western health care delivery system


Health risksBreast cancerHeart diseaseDiabetes mellitusThalassemia


ImplementationMonitor and assess client's body languageRespect client's personal space


HISPANIC-AMERICANSHISPANIC-AMERICANS Communication

Languages include Spanish and Portuguese, with various dialectsTend to be verbally expressive, yet confidentiality is importantEye behavior is significant; for example, the "evil eye" can be given to a child if a person looks at and admires a child without touching the childAvoiding eye contact indicates respect and attentivenessDirect confrontation is disrespectful, and the expression of negative feelings is impoliteDramatic body language, such as gestures or facial expressions, is used to express emotion or pain

Time orientation and spaceOriented more to presentComfortable with close proximity to othersVery tactile and use embraces and handshakesValue the physical presence of othersPoliteness and modesty are essential

HISPANIC-AMERICANSHISPANIC-AMERICANS

Social rolesThe nuclear family is the basic unit; also, there arelarge extended-family networksThe extended family is highly regardedNeeds of the family take precedence over individual family members' needsMen are the decision makers and breadwinners,and women are the caretakers and homemakersReligion includes CatholicismStrong church affiliationSocial organizations strong within the community


Health and illnessHealth may be a reward from God or a result ofgood luckHealth results from a state of balance be tween "hot and cold" forces and "wet and dry"forcesIllness occurs as a result of God's punishmentfor sinsFolk medicine traditions


Health risksLactose intoleranceDiabetes mellitusParasitesCoccidioidomycosis


ImplementationCommunicate with male head of familyProtect privacyOffer to call priest or other clergy because ofthe significance of religious practices related toillnessesAlways touch a child when examining him or herBe flexible and avoid rigidity in scheduling care


NATIVE AMERICANSNATIVE AMERICANS Communication

Languages include English, Navajo, and othertribal languagesSilence indicates respect for the speakerSpeak in a low tone of voice and expect others to be attentiveEye contact is avoided because it is a sign ofdisrespectBody language is important

Time orientation and spaceOriented more to presentPersonal space is very importantWill lightly touch another person's hand duringgreetingsMassage is used for the newborn infant to promote bonding between infant and motherTouching a dead body is prohibited in some tribes

NATIVE AMERICANSNATIVE AMERICANS

Social rolesVery family orientedBasic family unit is the extended family, which often includes people from several householdsIn some tribes, grandparents are viewed as family leadersElders are honoredChildren are taught to respect traditionsThe father does all the work outside the home, and the mother assumes responsibility for domestic dutiesSacred myths and legends provide spiritual guidanceReligion and healing practices are integrated


Health and illnessHealth is a state of harmony between the person,the family, and the environmentIllness is caused by supernatural forces anddisequilibrium between person and environmentTraditional health and illness beliefs may continue to be observed; natural and magicoreligious folk medicine tradition


Health risksAlcohol abuseAccidentsHeart diseaseDiabetes mellitusTuberculosisArthritisLactose intolerance Gallbladder disease


ImplementationClarify communicationUnderstand that the client may be attentive even when eye contact is absentBe attentive to own use of body languageObtain input from members of extended familyEncourage client to personalize space in which health care is delivered; for example, encourage client to bring personal items or objects to the hospitalIn the home, assess for the availability of running water, and modify infection control and hygiene practices as necessary


It is because we are different that each of us is special!