1. HW 215: Models for Health and Wellness Unit 2: Multicultural Perspective to Understanding Health

2. Principles of Bioethics  Autonomy  Beneficence  Non-Maleficence  Justice

3. What is Meant by Multicultural(ism)?  Many cultures coexisting  Liberal perspective – acknowledges ethnic variety, encourages tolerance  Critical perspective – recognizes the role that social practices and institutions have on health

4. Health Disparities Goal 2: Eliminate Health Disparities The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population. http://www.healthypeople.gov/

5. Health Disparities - 2020 In Healthy People 2020, the goal has been expanded – to achieve healthy equity, eliminate disparities, and improve the health of all groups.. http://www.healthypeople.gov/

6. Health Disparities - 2020 To better understand the context of disparities, it is important to understand more about the U.S. population. In 2008, the U.S. population was estimated at 304 million. In 2008, approximately 33 percent, or more than 100 million persons, identified themselves as belonging to a racial or ethnic minority population.1 In 2008, 51 percent, or 154 million, were women. In 2008, approximately 12 percent, or 36 million people not living in nursing homes or other residential care facilities, had a disability. In 2008, an estimated 70.5 million persons lived in rural areas (23 percent of the population), while roughly 233.5 million lived in urban areas (77 percent). http://www.healthypeople.gov/

7. Health Disparities - 2020 For all Americans, other influences on health include the availability of and access to: A high-quality education Nutritious food Decent and safe housing Affordable, reliable public transportation Culturally sensitive health care providers Health insurance Clean water and nonpolluted air http://www.healthypeople.gov/

8. Racial and ethnic minorities. Low income groups Women. Children. Elderly. Residents of rural areas. Individuals with disabilities and special health care needs. Health Disparities

9. Blacks had a rate of new AIDS cases 10 times higher than Whites. Asian adults age 65 and over were 50% more likely than Whites to lack immunization against pneumonia. American Indians and Alaska Natives were twice as likely to lack prenatal care in the first trimester as Whites. Hispanics had a rate of new AIDS cases over 3.5 times higher than that of non-Hispanic Whites. Poor children were over 28% more likely than high income children to experience poor communication with their health care providers. Source: Agency for Healthcare Research and Quality. 2007 National Healthcare Disparities Report. Rockville, MD: U.S. Depart m e n t of Health and Human Services, Agency for Healthcare Research and Quality; February 2008. AHRQ Pub. No. 08-0041. Health Disparities (Examples)

10. 1. Cross-cultural misunderstandings between providers and patients can lead to mistrust and frustration, but are unlikely to have an impact on objectively measured clinical outcomes. a. True b. False Cultural Competence

11. 1. Cross-cultural misunderstandings between providers and patients can lead to mistrust and frustration, but are unlikely to have an impact on objectively measured clinical outcomes. (False: Low levels of cultural competence can impede the process of making an accurate diagnosis, cause the provider to order contraindicated medication, and reduce patient adherence to recommended treatment.) Cultural Competence

12. 2. When the patient and provider come from different cultural backgrounds, the medical history obtained may not be accurate. a. True b. False Cultural Competence

13. 2. When the patient and provider come from different cultural backgrounds, the medical history obtained may not be accurate. (True: Because of language and cultural barriers, the patient may not understand the questions or may be reluctant to report symptoms; in turn, the provider may misunderstand the patient’s description of symptoms.) Cultural Competence

14. 4. A really conscientious health provider can eliminate his or her own prejudices or negative assumptions about certain types of patients. A. True B. False Cultural Competence

15. 4. A really conscientious health provider can eliminate his or her own prejudices or negative assumptions about certain types of patients. (False: Most of us harbor some assumptions about patients, based on race, ethnicity, culture, age, social and language skills, educational and economic status, gender, sexual orientation, disability/ability, and a host of other characteristics. These assumptions are often unconscious and so deeply rooted that even when an individual patient behaves contrary to the assumptions, the provider views this as the exception to the rule. A conscientious provider will not allow prejudices to interfere with making an accurate diagnosis and designing an appropriate treatment plan.) Cultural Competence

16. What are some types of disparities in Panama that were mentioned in the assigned reading? Discussion

17.  What do you need to know about verbal communication practices of Panamanians in order not to violate social taboos?  What about not verbal communication?  Other considerations (time)? Discussion

18. Cultural Immersion  Do you think cultural immersion is a good technique for learning?  If you were immersed into Panamanian culture, what type of religious services would you want to attend?

19.  What role does religious affiliation play in the lives of Panamanians?  How does religion/spirituality affect health practices in Panama? Discussion

20. Some Additional Considerations.... Infectious Disease in Panama

21. Questions  Any questions about tonight’s Seminar?

22. Have a Great Week!

23. Referenes The Providers Guide to Quality and Culture. Retrieved on 6/20/11 from http://erc.msh.org/mainpage.cfm?file=1.0.htm &module=provider&language=English&ggro up=&mgroup= http://erc.msh.org/mainpage.cfm?file=1.0.htm &module=provider&language=English&ggro up=&mgroup=