2. 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

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

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

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

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

7. 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 , US Public Health Service
Deep structure: unique history that shapes consciousness of the community

8. 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

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

10. Inequality Exists

11. 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.”

12. 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

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

14. Ethnic Variation in Cancer Mortality
Age-adjusted per 100,000
SEER Cancer Statistics Review,

15. 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

16. What Can We Do?

17. 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

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

19. 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

20. 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