The+Spirit+Catches+You+and+You+Fall+Down


 * 28 August 2006**
 * The Spirit Catches You and You Fall Down**
 * Dr. Constance Shriner, Ph.D., and Dr. Imran Ali, M.D.**

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=**Rationale**=


 * Profile of U.S. population is changing
 * More non-caucasian populations in recent years
 * Data exists showing health disparities within and between population groups
 * Introduction of federal mandates (CLAS standards)

=**Diversity**=
 * By 2050, half of the U.S. Population would be people of color
 * Diversity goes beyond ethnic diversity and includes diversity as individuals
 * Culture
 * Religion
 * Mental or physical abilities
 * Age
 * Gender
 * Sexual orientation

=**Health Disparities**=
 * Based on barriers to access and utilization of services
 * Health outcomes including disability, disease, and death
 * Poorer overall health
 * Barriers to optimal health include social, economic, and cultural factors
 * Population specific differences result in gaps in the quality of health and health care across racial and ethnic groups
 * e.g. infant mortality in American Indians and Alaskan natives, cervical cancer in Vietnamese women, diabetes in Pima Indians of Arizona

=**Federal Mandates**=
 * 2001 National Standards for Cultural and Linguistically Appropriate Services in Health Care (CLAS standards)
 * Issued by the U.S. Department of Health and Human Services, Office of Minority Health
 * 14 Standards composed of mandates, guidelines and recommendations, emphasizing:
 * Cultural competent care
 * Language access services
 * Organizational support for cultural competence

=**Definitions**=
 * Race
 * Socio-political construct
 * Defines categories of people based on inherent physical characteristics
 * Categories not reflected on genetic level
 * Minimum Race/Ethnicity categories include: Native Americans/Alaskan, African American, Asian, Hawaiian/Pacific Islander, Caucasian, and Hispanic/Latino
 * Ethnicity
 * Self-defined and relates to one’s identity with a group
 * Group can share common ancestry, religion, history, or culture
 * Can identify with multiple ethnicities
 * Culture
 * Learned construct
 * System of beliefs, values, customs, artifacts, and behaviors that are learned and shared by members of a group
 * Transmitted from generation to generation
 * Individuals often embrace more than one culture at a time
 * Generalizations
 * Starting point to identify common trends
 * More information need and sought to determine if the trend is appropriate for a specific individual
 * Stereotypes
 * Ending points
 * No attempt is made to learn if the statement is appropriate for an individual
 * Cultural Competency
 * Defined as a set of congruent behaviors, attitudes, and policies that come together in a system and enable functioning in cross-cultural situations

=**Cultural Competency**=
 * Becoming comfortable with differences
 * Acquiring the ability to control and change false beliefs and assumptions
 * Respecting and appreciating the values and beliefs of those that are different
 * Thinking flexibly
 * Behaving flexibly

**Requirements**

 * Skills
 * Specific to each group or culture
 * Credible communicator
 * Elicit patient’s view of illness
 * Recognize culture related problems
 * Cultural interpretation of behavior
 * Language proficiency or effective translator use
 * Application of epidemiological principles to common illness
 * Knowledge
 * Aware of differences
 * Appreciate diversity
 * Concepts of race, culture, ethnicity, and power
 * Communication
 * Culture specific illnesses and behavior
 * Attitudes
 * Recognize and accept differences
 * Cultural and individual assessment
 * Patient’s belief integration in health plan
 * Social and political context investigated and not dismissed
 * Life Context
 * Family structure
 * Religion, death, and traditions
 * Prevailing psychosocial and political context of the group’s existence

=**LEARN Model**=
 * **L**isten with sympathy and understanding
 * **E**xplain your perception of the problem and treatment strategy
 * **A**cknowledge and explain differences
 * **R**ecommend treating remember patient’s cultural parameters
 * **N**egotiate an agreement

=**Conclusions**=
 * Concept of culturally competent care and its impact on delivery of health care
 * The role of various stake holders
 * Assess the problem and develop solutions
 * Be better physicians and deliver better health care