This presentation presents information about the national CLAS Standards, defines culture, and explores the intersections of culture and health. Medical mistrust and its impact on health seeking behaviors is also examined.
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Introduction to Culture and Health - May 26 2016
1. INTRODUCTION
TO CULTURE &
HEALTH
Cultural Health SeriesMay 26, 2016
Jean-Michel Brevelle
Sexual Minorities Program Manager
Infectious Disease Prevention and Health Services
Bureau
2. Learning Objectives
As a result of this workshop, participants will be
able to:
Describe the National Standards for Culturally
and Linguistically Appropriate Services in
Health and Health Care (CLAS Standards);
Identify factors that influence health-seeking
behaviors of culturally distinct groups;
Apply principles of cultural respect in
interactions with clients.
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Infectious Disease Prevention and Health Services
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3. A Brief Overview of CLAS
Culturally and Linguistically Appropriate
Services
First published in 2000 by the Office of
Minority Health (DHHS)
Framework for healthcare organizations to
best serve increasingly diverse communities
Included in Healthy People planning
Updated and enhanced 2010 – 2013
Inclusive of LGBT communities as of 2013
Used by different accreditation boards (JCAHO,
AAAHC, etc.) 3May 26, 2016
Infectious Disease Prevention and Health Services
Bureau
4. Who Uses Enhanced CLAS
Standards?
Accreditation and Credentialing Agencies
Community-Based Organizations
Educators
Governance and Leadership
Health Care and Service Providers
Health and Health Care Staff and
Administrators
Patients/Consumers
Public Health Workforce
Purchasers (of health plans) 4May 26, 2016
Infectious Disease Prevention and Health Services
Bureau
5. Enhanced CLAS Standards
15 Standards
Provide individuals and organizations with a
blueprint for successfully implementing and
maintaining culturally and linguistically
appropriate services.
All 15 Standards are necessary to advance health
equity, improve quality, and help eliminate health
care disparities.
Directed toward a broader audience than the
original Standards in order to address more fully
every point of contact throughout the health care
and health services continuum. 5May 26, 2016
Infectious Disease Prevention and Health Services
Bureau
6. Enhanced CLAS Standards
Principal Standard and Three
Themes
1. Provide effective, equitable, understandable,
respectful, and quality care and services that are
responsive to diverse cultural health beliefs and
practices, preferred languages, health literacy, and
other communication needs.
Principal Standard
Governance, Leadership, and Workforce
Communication and Language Assistance
Engagement, Continuous Improvement, and
Accountability
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7. Enhanced CLAS Standards
Health
Beliefs/Practices
What causes sickness
What it means to be
“healthy”
Who can treat someone
who is sick
Languages
Language other than English
Hearing/Speech Impairments
Regional or Group dialects
and/or vocabulary
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Health Literacy
How the body works
Science vs culture
Using medical services
Taking medication
Other
Communication
Low literacy
Disclosing/keeping secrets
Withholding unpleasant
information
Communicating with family
8. Cultural Health Practices
The Enhanced National CLAS Standards
frame cultural health as a set of standards-
based practices intended to advance health
equity, improve quality, and help eliminate
health care disparities.
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NHAS Vision
The United States will become a place where new
HIV infections are rare, and when they do occur,
every person, regardless of age, gender,
race/ethnicity, sexual orientation, gender identity, or
socio-economic circumstance, will have unfettered
access to high quality, life-extending care, free from
stigma and discrimination.
9. Health Equity
Health equity is the attainment of the highest level of
health for all people. Currently, individuals across the
United States from various cultural backgrounds are
unable to attain their highest level of health for several
reasons, including the social determinants of health, or
those conditions in which individuals are born, grow, live,
work, and age, such as socioeconomic status, education
level, and the availability of health services. Though health
inequities are directly related to the existence of historical
and current discrimination and social injustice, one of the
most changeable factors is the lack of culturally and
linguistically appropriate services.National Standards for CLAS in Health and Health Care:
A Blueprint for Advancing and Sustaining CLAS Policy and Practice, pg. 14.
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Infectious Disease Prevention and Health Services
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10. What is Culture?
What comes to mind when you
think of the word culture?
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11. Defining Culture
The integrated pattern of thoughts,
communications, actions, customs, beliefs,
values, and institutions associated, wholly
or partially, with racial, ethnic, or linguistic
groups, as well as with religious, spiritual,
biological, geographical, or sociological
characteristics. Culture is dynamic in
nature, and individuals may identify with
multiple cultures over the course of their
lifetime.
Definition from the National Standards for CLAS in Health and Health Care: A Blueprint for Advancing and
Sustaining CLAS Policy and Practice. U.S. Department of Health and Human Services, Office of Minority Health,
2013.
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Infectious Disease Prevention and Health Services
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12. Elements of Culture
Age
Cognitive ability/limitations
Country of origin
Degree of acculturation
Educational level attained
Environment and
surroundings
Family and household
composition
Gender identity
Generation
Health practices
Linguistic characteristics
Military affiliation
Occupational groups
Perceptions of family and
community
Perceptions of health and
wellbeing
Perceptions/beliefs about
diet and nutrition
Physical ability/limitations
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13. Elements of Culture, cont’d
Political beliefs
Racial and ethnic groups
Religious and spiritual
characteristics
Residence (urban, rural,
suburban)
Sex
Sexual orientation
Socioeconomic status Individuals do not experience their lives or their
health through a single lens of identity (e.g.,
solely race, gender, or religion); rather, many
elements inform their perceptions, beliefs,
customs, and reactions.
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14. Exploring Culture
Since culture refers to groups that share
characteristics or world views, people often
automatically think of culture in terms of ethnic
or racial groups.
Cultures can be based on shared
characteristics or experiences other than race
and ethnicity.
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15. Exploring Culture
Lesbian Culture
Rave Culture
Gay Culture
Christian
Culture
Drug Culture
Goth Culture
Senior Culture
Cultures not Based on Race or Ethnicity
Bisexual
Culture
Migrant Culture
Suburban
Culture
Women’s
Culture
Hip Hop Culture
Geek Culture
Gamer Culture
Muslim Culture
Rural Culture
Skater Culture
Transgender
Culture
Academic
Culture
Gang Culture
More?
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16. Exploring Culture
Which cultures exist within your organization?
Which cultures exist among the clients you
serve?
Which cultures exist within the community
where you work?
How would you describe the cross-cultural
interactions that take place where you work?
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17. Exploring Culture
Members of a cultural group may share a
number of common norms and values.
Can anyone offer an example?
Cultural Norms and Values
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18. Exploring Culture
Time, timeliness, and time consciousness
Focus on relationships, family, and friends
Valuing individual vs. group
Valuing conflict vs. harmony
Sense of self, space, and physical contact
with others
Communication and language
Cultural Norms and Values
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19. Exploring Culture
Work habits and practices
Health beliefs and practices
Beliefs and attitudes about authority, control,
and fate
Adherence to prescribed gender roles
Mental processes and learning styles
Anything else?
Cultural Norms and Values
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20. Cultural History
The Elements of Culture exist within a
continuum of time and place. For example:
environment, generation, and occupational
groups (among others) are sensitive to time and
place.
History is another factor that shapes cultures.
A culture’s history is the collective memories and
experiences over time of its individual members.
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21. Cultural Mistrust of Medical &
Governmental Systems
Basis for
mistrust
is real
Tuskegee
Syphilis
Study
Birth
Control
Pills Study
Forced
Sterilization
Forced
Sexual
Orientation
Change
Efforts
Radiation
Experiment
s on Poor
and
Incarcerate
d
Experiment
s on Poor
Children &
Children of
Color
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Infectious Disease Prevention and Health Services
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22. Activity Time!22
Exploring Cultural Mistrust
of Healthcare and
Government
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23. Legacies of Mistrust
Read the information sheet that you have been
given.
Discuss as a group the following:
What did you know about this topic before reading?
What are your initial responses to this information?
How do you relate to this information? Does it match your
own experiences or expectations, or does it challenge
them?
How might this history impact your clients’ expectations
around healthcare?
Small Group Work
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24. Legacies of Mistrust
What did you learn?
What did you feel?
What other questions did this raise for you?
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25. Racism and Public Health
…more than 200 years’ worth of anecdotal
and documentary evidence on racism in
medicine and mental health cuts across
age, gender and different racial/ethnic
groups, leading to a high degree of
vigilance, mistrust and disdain towards the
medical establishment in general and
mental health in particular.
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Excerpted from Beyond Misdiagnosis, Misunderstanding and Mistrust: Relevance of the Historical
Perspective in the Medical and Mental Health Treatment of People of Color. Suite, D et al;
Journal of the National Medical Association, Vol. 99, No. 8, August 2007.
26. Cultural Safety
Your cultural safety and that of your agency
have already been evaluated by your clients
Peer-recommended
History-sensitive approach to service design and delivery
Waiting room cues — papers & magazines, LGBT “Safe
Space” stickers, posters, videos
Inclusive language in intake assessments (e.g., partner,
spouse) and in your own speech
Open-ended (e.g., “Tell me what brings you in today”) and
direct (e.g., “How are you protecting yourself from HIV”?)
questions
Non-reactivity in your responses
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27. Cultural Respect
For the provider of health information or health
care, [cultural] elements influence beliefs and
belief systems surrounding health, healing,
wellness, illness, disease, and delivery of health
services. The concept of cultural respect has a
positive effect on patient care delivery by
enabling providers to deliver services that are
respectful of and responsive to the health
beliefs, practices and cultural and linguistic
needs of diverse patients.
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National Institutes of Health
Clear Communication. Office of Communications and Public Liaison
28. It’s That Time…
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