Cultural Sensitivity Ethnic or cultural characteristics, experiences, norms, values, behavior patterns, beliefs of a target population Relevant historical, environmental, & social factors Design, delivery, & evaluation of targeted health interventions Extent to which ethnic or cultural characteristics, experiences, norms, values, behavior patterns, and beliefs of a target population, & relevant historical, environmental, and social factors are incorporated in the design, delivery, & evaluation of targeted health interventions Resnicow et al., 2002

Cultural Competence Capacity of individuals to exercise interpersonal cultural sensitivity Resnicow et al., 2002

Cultural Humility Lifelong commitment to self evaluation & self critique to redress power imbalances Minkler, 2005, p. 10

Surface Structure Observable social & behavioral characteristics of a target population Resnicow et al., 2002

Deep Structure How cultural, social, psychological, environmental, & historical factors influence health behaviors differently across racial & ethnic populations Resnicow et al., 2002

Examples in the African American Community Surface structure: Dialect Female head of household Church Deep structure: Slavery Tuskegee (Syphilis) Experiment HIV/AIDS and the US government Tuskegee Experiment 1932-1972, US Public Health Service Deep structure: unique history that shapes consciousness of the community

Why Cultural Sensitivity? Ethical/moral argument Economic argument Pragmatic argument (health communication perspective) Ethical/moral – affirmative action Economic – justifies prevention more than trmt Pragmatic – increase attention, personal relevance, salience, market segmentation

Why Target & Tailor Interventions? Disease prevalence Risk factor prevalence Socio-economic distribution Physiological differences Environmental differences Behavioral differences Socio-cultural differences

Inequality Exists

Definitions of “Health Disparities” Whitehead/WHO (1992) Differences in health that are “not only unnecessary and avoidable but, in addition, are considered unfair and unjust.” NIH (2005) “…differences in the incidence, prevalence, mortality and burden of disease and other adverse conditions that exist among specific populations groups in the US.” NCI (2005) “…occur when members of certain population groups do not enjoy the same health status as other groups. Disparities are often identified along racial and ethnic lines-show, [but] also extend beyond race and ethnicity.”

Health Disparities/Inequalities Population-specific differences in the presence of disease, health outcomes, or access to health care Gaps in the quality of health & health care across populations

Ethnic Variation in Heart Disease Mortality Age-adjusted per 100,000 2004 National Center for Health Statistics, 2004

Ethnic Variation in Cancer Mortality Age-adjusted per 100,000 SEER Cancer Statistics Review, 1975-2002

Prevalence of Overweight Prevalence of Overweight* in Texas Children by Race/Ethnicity, School Physical Activity & Nutrition (SPAN) Study % of population HP 2010 Goal *Overweight is > 95th Percentile for BMI by Age/Sex Hoelscher et al., 2004

What Can We Do?

Community-Based Participatory Research (CBPR) “… a partnership approach to research that equitably involves, for example, community members, organizational representatives, and researchers in all aspects of the research process” Israel et al., 2003

Translation All vested parties work jointly to achieve a common goal by contributing different Instruments Talents Knowledge Expertise

Key Principles Builds on strengths & resources within the community Addresses health from an ecological perspective Collaborative partnerships in all phases of research Israel et al., 1998

Key Principles Integrates knowledge & action for mutual benefit of all partners Promotes co-learning & empowering process that attends to social inequalities Findings & knowledge disseminated to all partners Cyclical & iterative process Israel et al., 1998