If a health outcome is seen to a greater or lesser extent between populations, there is disparity. 7Hyon B. Shin and Rosalind Bruno, "Language Use and English-Speaking Ability: 2000," Census 2000 Brief, U.S. Census Bureau, October 2003, accessed at: www.census.gov/prod/2003pubs/c2kbr-29.pdf. The Lynch Foundation champions high-impact organizations with visionary leaders seeking to assist communities in need, with a diverse portfolio of grantmaking. Generally speaking, Latino cultures include a more family-centered decision making model than the more individualistic or autonomy-based model embraced by modern mainstream biomedical culture in the United States. For instance, 2002 estimates of life expectancy for Latinos was 77.2/83.7 years (male/female) compared to 68.4/75.1 for African-Americans and 74.7/80.1 for non-Hispanic whites.3 Latinos are less likely than non-Hispanic whites and African-Americans to suffer from heart disease (which is nevertheless the leading cause of death in all three groups). While we recommend going directly to a mental health professional , a primary care doctor can be a great place to start for an initial assessment or to get a referral for a recommended mental health professional. "We're becoming an increasingly culturally complex country," she says, adding that training in cultural competence should include race and ethnicity, sexual orientation, age, gender, disability status, and other demographic characteristics. Each person is unique and simultaneously formed by a variety of cultures and subcultures, not to mention personal choices and socioeconomic circumstances. We are committed to changing the perception of mental illness in the African-American community by encouraging those who suffer with this debilitating illness to get the help they need. Towards A Culturally Competent System of Care, Volume I. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center. Moreover, the family itself can play an enormously important role in supporting and empowering the patient within the medical setting. According to a study done at UCLA, 15.7 percent of non-elderly Latinos in either fair or poor health, who are covered under MediCal or Healthy Families (both California low-income health insurance programs), report having no usual source of care but rather obtain their clinical health care on an ad-hoc basis, if at all.11, Some Latinos find their health care in non-clinical places, relying on folk medicine and traditional healers. Additionally, within this family-centric decision making structure, there may be particular gender-based roles. In fact, compared to both white Americans and African-Americans, Latinos generally report feeling less listened to and understood by their doctors, as well as less able themselves to understand their doctors; and they are twice as likely to leave a doctor's office with unasked questions. Underwriting for these materials was provided by a generous anonymous donor. Latinos comprise the largest minority group in 20 of the 50 states. Very often they have faced extremely hazardous conditions crossing the border-enduring hunger, dehydration, violence from vigilantes, rape, abuse, severe weather conditions and harsh treatment by border agents. In terms of health, on some measures Latinos are better off than other ethnic groups. The Immigration Reform and Control Act of 1986 granted amnesty to immigrants who came to the U.S. before 1982; but the northward trend from Mexico and other parts of Latin America has continued since then, and many who have crossed the U.S.-Mexican border now live in the United States illegally. 14 Kleinman et. Vari Hall, Santa Clara University500 El Camino RealSanta Clara, CA 95053408-554-5319, The Ethics of Going Back to School in a Pandemic, Systemic Racism, Police Brutality, and the Killing of George Floyd, COVID-19: Ethics, Health and Moving Forward, The Ethical Implications of Mass Shootings, Political Speech in the Age of Social Media, Point/Counterpoint: Democratic Legitimacy, Brett Kavanaugh and the Ethics of the Supreme Court Confirmation Process, https://depts.washington.edu/pfes/PDFs/LatinoCultureClue.pdf, Culturally Competent Care for Latino Patients. The term "Latino" has become more commonly used in recent years to describe those whose primary ethnic heritage stems from Latin America. :�p��j�6��k4L�Ժ�e��4�"Ω����-hg�"`$�l��)�}@r���`�ÞIv7���,�:� m�t�@��dK�����D��V�ؖ��b�l6�. (Kaiser Foundation Health Plan, 2001): 4. 4Center for Disease Control and Prevention, "Leading Causes of Death," accessed at www.cdc.gov/men/lcod/index.htm; and Richard Allen Williams, "Cultural Diversity, Health Care Disparities, and Cultural Competency in American Medicine," Journal of the American Academy of Orthopedic Surgeons, Vol. This is especially (though far from uniquely) true in the agricultural sector of the U.S. economy. Still, being aware of these larger values may help health care providers to understand a particular patient's behaviors and actions in the context of larger cultural inclinations. Importantly, many Latinos themselves prefer the latter term, since it avoids reference to the more recent European colonial powers (from "Hispania," or the Iberian Peninsula) that laid claim to Latin America in the fifteenth and sixteenth centuries. �y�'``������*n��UZ��? While not considering Hispanics as a distinct race, the U.S. Census (utilizing federally delineated categories) defines someone "Hispanic" or "Latino" as "a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. For instance, a doctor could perceive as evasive a patient who declines to make direct eye contact, when in fact,that patient may be demonstrating respect for the doctor's position and authority. Apart from these language and socioeconomic disparities and variation in the way health care is envisioned and sought out, differences in the way values are ordered and articulated can also strain the clinical health care encounter for Latino patients. 16"Communicating with Your Latino Patient," University of Washington Medical Center, 2007; accessed at https://depts.washington.edu/pfes/PDFs/LatinoCultureClue.pdf. h��ҭ 10Mead et. 15Glenn Flores, "Culture and the Patient-Physician Relationship: Achieving Cultural Competency in Health Care," Journal of Pediatrics 136 (January 2000): 14-23; see also Maria R. Warda, "Mexican Americans' Perceptions of Culturally Competent Care," Western Journal of Nursing Research 22/2 (2000): 203-224. al., "Important Health Care Issues for California Latinos: Health Insurance and Health Status," UCLA Center for Health Policy Research, January 2003. As with any circumscribed ethnic group, there is, of course, enormous cultural heterogeneity among Latino patients-to the point where it seems almost ludicrous to try to identify broad cultural tendencies across such diversity. Hence, the individual's good cannot be neatly separated from his or her community. Health Care Provider Shortages. Similarly, a patient's silence when presented with a difficult treatment plan, rather than conveying agreement, may in fact indicate that patient's desire to maintain a polite relationship with the health care provider and avoid difficult or conflictual situations. The mission of the NCCC is to increase the capacity of health care and mental health care programs to design, implement, and evaluate culturally and linguistically competent service delivery systems to address growing diversity, persistent disparities, and to promote health and mental health equity. al., "Racial and Ethnic Disparities in U.S. Health Care: A Chartbook" (The Commonwealth Fund, March 2008), Charts 6-25 and 6-26; and Joseph R. Betancourt, Alexander R. Green, and J. Emilio Carrillo, "The Challenges of Cross-Cultural Healthcare-Diversity, Ethics, and the Medical Encounter," Bioethics Forum 16 (3). The final commentary, drawing on the others, seeks to join the issues from an explicitly bioethical perspective. Some states have extremely large Latino populations; for instance, as of 2006, 36 percent of Californians (13.2 million people) identified themselves as Hispanic or Latino, as did 36 percent of Texans (8.6 million people). Due to pathologization and mistreatment by mental health professionals, transgender people are often reluctant to engage with mental health providers. "1 The term does not refer only to Spanish speakers, however; many people usually thought of as "Hispanic"-the people of Brazil, for instance, or those from indigenous Mexican communities-often do not speak Spanish at all, or at least not as their primary language. There are likely many possible reasons for this, including poverty and lack of health insurance, and thus at best irregular access to health care; cultural factors that might cause patients to delay seeing a doctor, for example, the expectation that one should tolerate pain without complaint; and a belief that certain conditions (such as pregnancy) are natural and do not require medical attention. endstream endobj startxref ", In 2007, the total U.S. Hispanic or Latino population surpassed 45 million, or 15 percent of the total U.S. population. al., "Racial and Ethnic Disparities," Chart 5-2. Some common strategies for improving the patient-provider interaction and institutionalizing changes in the health care system include:(20) Education & Programs Use the evaluation tools and education developed by the American Evaluation Association to become a better evaluator. Visit these websites frequently for new information as it becomes available. The cases and reflections illustrate the kinds of challenges patients and health care professionals face when they come from different cultures and speak different languages. In one survey of Mexican American nurses, family support was identified as one of the most important areas to which health care providers should attend while caring for Latino patients. al., "Culture, Illness, and Care," 252. ]!���"]}ef���` �&} A qualitative exploration of the experiences of school nurses during COVID-19 pandemic as the frontline primary health care professionals. 1 (Sept. 2007). In spite of the large and rapidly increasing size of the U.S. Latino population, there has been no corresponding influx of Latinos working in the U.S. health care system. The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy. 9Carmen DeNavas-Walt, Bernadette D. Proctor, and Jessica Smith, "Income, Poverty, and Health Insurance Coverage in the United States: 2006," Current Population Reports, U.S. Census Bureau, August 2007; and Mead et. The value of familismo perhaps deserves to be emphasized for the important role it plays for many Latino patients. 15 supp. h�b```b`�������� Ȁ ��l@q���fFJ\���� Island cop earns Reconciliation Award for culturally safe and competent policing. al., "Racial and Ethnic Disparities," Chart 4-1. Today, one in three farm workers are newcomers to the United States, with most of these coming from Mexico. A��3�?�. We support initiatives across education, cultural and historic preservation, health care and wellness, and the religious and educational efforts of the Roman Catholic Church. Still, at the risk of oversimplifying, several trends emerge: -simpatia-politeness and the avoidance of hostile confrontation -personalismo-the value of warm personal interaction -respeto-the importance of showing respect to authority figures, usually including health care providers -familismo-collective loyalty to extended family and commitment to family obligation; -fatalismo-the belief that individuals cannot do much to alter fate15. These materials focus on the challenges that can confront Hispanics in American health care settings. 782 0 obj <>/Filter/FlateDecode/ID[<7B4BAB95E0104F56AC98707F9272B07E>]/Index[756 1176]/Info 755 0 R/Length 178/Prev 698883/Root 757 0 R/Size 1932/Type/XRef/W[1 3 1]>>stream %PDF-1.7 %���� The largest and fastest growing minority population in the United States today is commonly referred to as "Hispanic" or "Latino." Yet the call for cultural competence can-at its best-urge practitioners to adopt instead a stance of cultural "humility": one which encourages an open mind, and a recognition that each one of us sees the world through our own very distinctive cultural lenses. Karen Peterson-Iyer is a program specialist in health care ethics at the Markkula Center for Applied Ethics. Case 1: Delinquency or a Mental Health Problem: The Case of Pablo Sanchez, Case 3: From Chronic to Critical: End-of-Life Decisions. This reliance does not necessarily replace modern biomedicine; rather, herbal remedies and other non-allopathic treatments often are utilized in conjunction with Western medical care. Denboba, D., U.S. Department of Health and Human Services, Health Services and Resources Administration (1993). Major health philanthropies, including the Robert Wood Johnson Foundation (McGee-Avila, 2018) and the W. K. Kellogg Foundation, and large medical institutions, led by Kaiser Permanente, also took up the call, with Kaiser’s Institute for Culturally Competent Care (Chong, 2002) quickly heralded as a … Practical Strategies for Culturally Competent Evaluation. The Bracero program, a guest worker program started in 1942, was designed to bring experienced agricultural laborers to the U.S. from Mexico and led to a huge influx of Mexican immigrants. Caring Across Communities: Addressing Mental Health Needs of Diverse Children and Youth (Robert Wood Johnson Foundation). The provision of culturally tailored health care can improve patient outcomes.In 2005, California passed Assembly Bill 1195 that requires patient-related continuing medical education courses in California medical school to incorporate cultural and linguistic competence training in order to qualify for certification credits. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all 17Delese Wear, "Insurgent Multiculturalism: Rethinking How and Why We Teach Culture in Medical Education," Academic Medicine 78/6 (June 2003): 549-554. An examination of factors that affect immigrants' vulnerability to inadequate health care, such as socioeconomic background, immigration status, and federal, state and local policies on access to publicly funded care. 11Jennifer Aguayo et. Davis Company, 1998): 397-421. The U.S. Latino population is also quite young relative to the general U.S. population; in 2007, the median age for the former was 27.6, compared to 36.6 for the latter.2. Mental health in the context of primary care Mental health is vital to positive physical outcomes and, as for all patients, should be addressed for transgender patients in primary care. That won't do, says Helms, who wants cultural competence integrated into every aspect of graduate training. Key learning aims (1) To examine concepts such as race, ethnicity and culture and to provide a shared understanding of these terms for CBT therapists. When health care providers are located within majority African-American and Hispanic neighborhoods, they tend to offer lower-quality care. They offer specialized programs including their Gender Health Program which provides comprehensive medical care and support to … These broad generalizations are just that: broad generalizations. They also must beware of the tendency toward "othering"; that is, the penchant to understand non-dominant groups as inferior, exotic, or deviant.17 Some efforts at cultural competence may incline toward these unhelpful postures. Culturally competent workers aim to be non-judgemental and flexible in their work with CLD young people and their families. [1,2] Primary care settings may offer a 26, 2021 4:30 p.m. News Indeed, such a patient's silence might best be interpreted as an indirect and nonverbal form of disagreement. Although most Latinos living in the U.S. do speak at least some English, 60 percent of Latino adults speak primarily Spanish at home.6 According to the U.S. Census, more than half of U.S. Latino residents age 5 and older speak English "very well," but a nevertheless significant number of Latino adults speak English "not well" or "not at all. A culturally sensitive doctor would be aware of this interpretation and would ask for more information instead of assuming the problem is purely physical. The material in this section is part of a larger project by the Markkula Center for Applied Ethics on culturally competent care; that is, health care that is sensitive to the differing values and needs of cultural subgroups within our pluralistic society. 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