Transcultural Diversity And Health Care

Transcultural Diversity And Health Care

Read chapter 1 of the class textbook and review the attached Power Point presentation.  Once done answer the following questions.

1.  In your own words and using the proper evidence-based references define transcultural diversity and Health care and discuss how both term interact and how they help in the delivery of health care to different heritages.

2.  Mention and discuss at least 4 variant characteristics of culture.

Assignment must be submitted in the discussion forum.  A minimum of 2 evidence-based references no older than 5 years are required.  You must post at least two replies to any of your peers sustained with the proper references.  A minimum of 500 words are required.

Transcultural Diversity and Health Care

Chapter 1

LARRY D. PURNELL

The Need for Culturally Competent Health Care Cultural competence in multicultural societies continues as a major initiative for business, health-care, and educational organizations in the United States and throughout most of the world. The mass media, health-care policy makers, the Office of Minority Health, and other Governmental organi- zations, professional organizations, the workplace, and health insurance payers are addressing the need for individ- uals to understand and become culturally competent as one strategy to improve quality and eliminate racial, ethnic, and gender disparities in health care. Educational institutions from elementary schools to colleges and universities also address cultural diversity and cultural competency as they relate to disparities and health promotion and wellness.

Many countries are now recognizing the need for addressing the diversity of their society, including the client base, the provider base, and the organization. Societies that used to be rather homogeneous, such as Portugal, Norway, Sweden, Korea, and selected areas in the United States and the United Kingdom, are now facing sig- nificant internal and external migration, resulting in eth- nocultural diversity that did not previously exist, at least not to the degree it does now. As commissioned by the U.K. Presidency of the European Union, several European countries—such as Denmark, Italy, Poland, the Czech Republic, Latvia, the United Kingdom, Sweden, Norway, Finland, Italy, Spain, Portugal, Hungary, Belgium, Greece, Germany, the Netherlands, and France—either have in place or are developing national programs to address the value of cultural competence in reducing health dispari- ties (Health Inequities: A Challenge for Europe, 2005).

Whether people are internal migrants, immigrants, or vacationers, they have the right to expect the health-care system to respect their personal beliefs, values, and health-care practices. Culturally competent health care from providers and the system, regardless of the setting in which care is delivered, is becoming a concern and expec- tation among consumers. Diversity also includes having a diverse workforce that more closely represents the popu- lation the organization serves.

Health-care personnel provide care to people of diverse cultures in long-term-care facilities, acute-care facilities, clinics, communities, and clients’ homes. All health-care providers—physicians, nurses, nutritionists, therapists, technicians, home health aides, and other caregivers— need similar culturally specific information. For example, all health-care providers engage in verbal and nonverbal communication; therefore, all health-care professionals and ancillary staff need to have similar information and skill development to communicate appropriately with diverse populations. The manner in which the informa- tion is used may differ significantly based on the disci- pline, individual experiences, and specific circumstances of the client and provider.

Culturally competent staff and organizations are essen- tial ingredients in increasing clients’ satisfaction with health care and reducing multifactor reasons for gender, racial, and ethnic disparities and complications in health care. If providers and the system are competent, most clients will access the health-care system when problems are first recognized, thereby reducing the length of stay, decreasing complications, and reducing overall costs.

A lack of knowledge of clients’ language abilities and cultural beliefs and values can result in serious threats to life and quality of care for all individuals. Organizations

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and individuals who understand their clients’ cultural values, beliefs, and practices are in a better position to be coparticipants with their clients in providing culturally acceptable care. Having ethnocultural specific knowledge, understanding, and assessment skills to work with cultur- ally diverse clients assures that the health-care provider knows what questions to ask. Providers who know ethno- culturally specific knowledge are less likely to demon- strate negative attitudes, behaviors, ethnocentrism, stereotyping, and racism. Accordingly, there will be improved opportunities for health promotion and well- ness; illness, disease, and injury prevention; and health maintenance and restoration. The onus for cultural com- petence is on the health-care provider and the delivery system in which care is provided. To this end, health-care providers need both general and specific cultural knowl- edge to help reduce gender and ethnic and racial dispari- ties in health care.

World Diversity and Migration The world’s population reached 6.5 billion people in the year 2005 and is expected to approach 7.6 billion by 2020 and 9.3 billion by 2050. The estimated population growth rate is 1.14 percent, with 20.05 births per 1000 popula- tion, 8.6 deaths per 1000 population, and an infant mor- tality rate of 48.87 per 1000 population. Worldwide, life expectancy at birth is currently 64.77 years, with males at 63.17 years and females at 66.47 years (CIA, 2007).

As a first language, Mandarin Chinese is the most popu- lar, spoken by 13.59 percent of the world’s population, fol- lowed by Spanish at 5.05 percent, English at 4.8 percent, Hindi at 2.82 percent, Portuguese at 2.77 percent, Bengali at 2.68 percent, Russian at 2.27 percent, Japanese at 1.99 percent, German at 1.49 percent, and Wu Chinese at 1.21 percent. Only 82 percent of the world population is liter- ate. When technology is examined, more people now have a cell phone than a landline: 1.72 billion versus 1.2 billion. Slightly over 1 billion people are Internet users (CIA, 2007).

We currently live in a global society, a trend that is expected to continue into the future. According to the United Nations High Commissioner for Refugees, there is a global population of 9.2 million refugees, the lowest num- ber in 25 years, and as many as 25 million internally dis- placed persons. Migrants represent 2.9 percent or approxi- mately 190 million people of the world population, up from 175 million in the year 2000. Moreover, international migration is decreasing while internal migration is increas- ing, especially in Asian countries. Only two countries in the world are seeing an increase in their migrant stock— North America and the former USSR (CIA, 2007).

The International Organization for Migration com- pleted the first-ever comprehensive study looking at the costs and benefits of international migration. According to the report, ample evidence exists that migration brings both costs and benefits for sending and receiving coun- tries, although these are not shared equally. Trends sug- gest a greater movement toward circular migration with substantial benefits to both home and host countries. The perception that migrants are more of a burden on, than a benefit to, the host country is not substantiated by

research. For example, in the Home Office Study (2002) in the United Kingdom, migrants contributed U.S. $4 billion more in taxes than they received in benefits. In the United States, the National Research Council (1998) esti- mated that national income had expanded by U.S. $8 bil- lion because of immigration. Thus, because migrants pay taxes, they are not likely to put a greater burden on health and welfare services than the host population. However, undocumented migrants run the highest health risks because they are less likely to seek health care. This not only poses risks for migrants but also fuels sentiments of xenophobia and discrimination against all migrants.

2 • CHAPTER 1

What evidence do you see in your community that migrants have added to the economic base of the community? Who would be doing their work if they were not available?

UNITED STATES POPULATION AND CENSUS DATA

As of 2006, the U.S. population was over 300 million, an increase of 16 million since the 2000 census. The most recent census data estimates that 74.7 percent are white, 14.5 percent are Hispanic/Latino (of any race), 12.1 per- cent are black or African American, 0.8 percent are American Indian or Alaskan Native, 4.3 percent are Asian, 0.1 percent are Native Hawaiian or other Pacific Islander, 6 percent are some other race, and only 1.9 percent are of two or more races. Please note: These figures total more than 100 percent because the federal government consid- ers race and Hispanic origin to be two separate and dis- tinct categories. The categories as used in Census 2000 are

1. White refers to people having origins in any of the original peoples of Europe, the Near East, and the Middle East, and North Africa. This cate- gory includes Irish, German, Italian, Lebanese, Turkish, Arab, and Polish.

2. Black or African American refers to people having origins in any of the black racial groups of Africa, and includes Nigerians and Haitians or any per- son who self-designates this category regardless of origin.

3. American Indian and Alaskan Native refer to people having origins in any of the original peoples of North, South, or Central America and who main- tain tribal affiliation or community attachment.

4. Asian refers to people having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent. This category includes the terms Asian Indian, Chinese, Filipino, Korean, Japanese, Vietnamese, Burmese, Hmong, Pakistani, and Thai.

5. Native Hawaiian and other Pacific Islander refer to people having origins in any of the original peo- ples of Hawaii, Guam, Samoa, Tahiti, the Mariana Islands, and Chuuk.

6. Some other race was included for people who are unable to identify with the other categories.

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7. In addition, the respondent could identify, as a write-in, with two races (U.S. Bureau of the Census, 2006).

The Hispanic/Latino and Asian populations continue to rise in numbers and in percentage of the overall popula- tion; although the black/African American, Native Hawaiian and Pacific Islanders, Native American and Alaskan Natives groups continue to increase in overall numbers, their percentage of the population has decreased. Of the Hispanic/Latino population, most are Mexicans, followed by Puerto Ricans, Cubans, Central Americans, South Americans, and lastly, Dominicans. Salvadorans are the largest group from Central America. Three-quarters of Hispanics live in the West or South, with 50 percent of the Hispanics living in just two states, California and Texas. The median age for the entire U.S. population is 35.3 years, and the median age for Hispanics is 25.9 years (U.S. Bureau of the Census, 2006). The young age of Hispanics in the United States makes them ideal candidates for recruitment into the health professions, an area with crisis-level shortages of person- nel, especially of minority representation.

Before 1940, most immigrants to the United States came from Europe, especially Germany, the United Kingdom, Ireland, the former Union of Soviet Socialist Republics, Latvia, Austria, and Hungary. Since 1940, immigration patterns to the United States have changed: Most are from Mexico, the Philippines, China, India, Brazil, Russia, Pakistan, Japan, Turkey, Egypt, and Thailand. People from each of these countries bring their own culture with them and increase the cultural mosaic of the United States. Many of these groups have strong ethnic identities and maintain their values, beliefs, prac- tices, and languages long after their arrival. Individuals who speak only their indigenous language are more likely to adhere to traditional practices and live in ethnic enclaves and are less likely to assimilate into their new society. The inability of immigrants to speak the language of their new country creates additional challenges for health-care providers working with these populations. Other countries in the world face similar immigration challenges and opportunities for diversity enrichment. However, space does not permit a comprehensive analysis of migration patterns.

the Secretary’s Task Force’s report on Black and Minority Health (Perspectives on Disease Prevention and Health Promotion, 1985). Two goals from Healthy People 2010 are to increase quality and years of healthy life and eliminate health disparities (Healthy People 2010, 2005). In 2005, the Agency for Healthcare Research and Quality (AHRQ) released the Third National Healthcare Disparities Report (Agency for Healthcare Research and Quality [AHRQ], 2005) that provides a comprehensive overview of health disparities in ethnic, racial, and socioeconomic groups in the United States. This report is a companion document to the National Healthcare Quality Report (NHQR) that is an overview of quality health care in the United States. These two documents highlight four themes: (1) Disparities still exist, (2) some disparities are diminishing, (3) opportunities for improvement still exist, and (4) information about disparities is improving. These docu- ments address the importance of clinicians, administra- tors, educators, and policymakers in cultural competence. Disparities are observed in almost all aspects of health- care, including

1. Effectiveness, patient safety, timeliness, and patient centeredness.

2. Facilitators and barriers to care and health-care utilization.

3. Preventive care, treatment of acute conditions, and management of chronic disease.

4. Clinical conditions such as cancer, diabetes, end- stage renal disease, heart disease, HIV disease, mental health and substance abuse, and respira- tory diseases.

5. Women, children, elderly, rural residency, and individuals with disabilities and other special health-care needs.

6. Minorities and the financially poor receive a lower quality of care (AHRQ, 2005).

When ethnocultural specific populations are exam- ined, although some disparities have shown improve- ment, many have not improved and some have wors- ened. With whites as the comparison group, the report shows:

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