Multicultural Health Second Edition
Lois A. Ritter, EdD, MS, MA, MS-HCA, PMP
Consultant, Health and Education
Donald H. Graham, JD, MA Attorney and Consultant, Human Services
World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 firstname.lastname@example.org www.jblearning.com
Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com.
Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to email@example.com.
Copyright © 2017 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.
The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett Learning, LLC. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not be used for advertising or product endorsement purposes. All trademarks displayed are the trademarks of the parties noted herein. Multicultural Health, Second Edition is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product.
There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only.
Production Credits Chief Executive Officer: Ty Field Chief Product Officer: Eduardo Moura VP, Executive Publisher: David D. Cella Publisher: Cathy L. Esperti Editorial Assistant: Sara J. Peterson Associate Director of Production: Julie C. Bolduc Production Manager: Tina Chen Marketing Director: Andrea DeFronzo Rights & Media Specialist: Jamey O’Quinn Media Development Editor: Troy Liston Cover Design: Theresa Manley Text Design: Scott Moden VP, Manufacturing and Inventory Control: Therese Connell Composition: Cenveo® Publisher Services Project Management: Cenveo Publisher Services Cover Image: Backgrounds: © Click Bestsellers/Shutterstock, © Ms.Moloko/Shutterstock; Portraits, clockwise from top left: © Andresr/Shutterstock; © Nolte Lourens/Shutterstock; © wong sze yuen/Shutterstock; © Monkey Business Images/Shutterstock; © project1photography/Shutterstock; © project1photography/ Shutterstock; © Fotoluminate LLC/Shutterstock; © Stuart Jenner/Shutterstock Printing and Binding: RR Donnelley Cover Printing: RR Donnelley
Library of Congress Cataloging-in-Publication Data Names: Ritter, Lois A., author. | Graham, Donald H., author. Title: Multicultural health / Lois A. Ritter, Donald H. Graham. Description: Second edition. | Burlington, MA : Jones & Bartlett Learning,  |
Includes bibliographical references and index. Identifiers: LCCN 2015048787 | ISBN 9781284021028 (pbk. : alk. paper) Subjects: | MESH: Cultural Competency | Culturally Competent Care | Cross-
Cultural Comparison | Ethnic Groups | United States Classification: LCC RA418.5.T73 | NLM W 21 | DDC 362.1089—dc23 LC record available at http://lccn.loc.gov/2015048787
Printed in the United States of America 20 19 18 17 16 10 9 8 7 6 5 4 3 2
About the Authors
UNIT I The Foundations
Chapter 1 Introduction to Multicultural Health Key Concepts and Terms Diversity Within the United States Cultural Adaptation Health Disparities Causes of Health Disparities Legal Protections for Ethnic Minorities Personal Health Decisions Ethical Considerations Summary Review Activity Case Study References
Chapter 2 Theories and Models Related to Multicultural Health Theories of Health and Illness Pathways to Care Cultural Competence
Promoting Cultural Competence Summary Review Activity Case Study References
Chapter 3 Worldview and Health Decisions Worldview Worldview and Medical Decisions Worldview and Response to Illness Summary Review Activity Case Study References
Chapter 4 Complementary and Alternative Medicine History of Complementary and Alternative Medicine Complementary and Alternative Health Care Modalities Laws Affecting Cultural Practices and Health Summary Review Activity Case Study References
Chapter 5 Religion, Rituals, and Health Religion in the United States Religion and Health Behaviors Religion and Health Outcomes Religion and Well-Being Rituals Summary Review
Activity Case Study References
Chapter 6 Communication and Health Promotion in Diverse Societies Health Communication Delivering Your Health Message Printed Materials Public Health Programs Evaluating Your Multicultural Health Program Summary Review Activity Case Study References
UNIT II Specific Cultural Groups
Chapter 7 Hispanic and Latino American Populations Introduction Terminology History of Hispanics in the United States Hispanics in the United States General Philosophy About Disease Prevention and Health Maintenance Healing Traditions, Healers, and Healing Aids Behavioral Risk Factors and Common Health Problems Considerations for Health Promotion and Program Planning Tips for Working With the Hispanic Population Summary Review Activity Case Study
Chapter 8 American Indian and Alaskan Native Populations Introduction Terminology History of American Indians and Alaska Natives in the United States American Indian and Alaskan Native Populations in the United States American Indian and Alaskan Native General Philosophy About Disease Prevention and Health Maintenance Healing Traditions, Healers, and Healing Aids Behavior Risk Factors and Prevalent Health Problems Considerations for Health Promotion and Program Planning Tips for Working With American Indian and Alaskan Native Populations Summary Review Activity Case Study References
Chapter 9 African American Populations Introduction Terminology History of African Americans in the United States African Americans in the United States General Philosophy About Disease Prevention and Health Maintenance Healing Traditions Behavior Risk Factors and Prevalent Health Problems Considerations for Health Promotion and Program Planning
Tips for Working With the African American Population Summary Review Activity Case Study References
Chapter 10 Asian American Populations Introduction Terminology History of Asian Americans in the United States Asian Americans in the United States General Philosophy About Disease Prevention and Health Maintenance Healing Traditions, Healers, and Healing Aids Behavioral Risk Factors and Common Health Problems Considerations for Health Promotion and Program Planning Tips for Working With the Asian American Population Summary Review Activities Case Study References
Chapter 11 European and Mediterranean American Populations Introduction Terminology History of European and Mediterranean Americans in the United States European and Mediterranean Americans in the United States General Philosophy About Disease Prevention and Health Maintenance
History, Healing Practices, and Risk Factors for Three Subcultures Behavior Risk Factors and Prevalent Health Problems for European and Mediterranean Americans Tips for Working With European and Mediterranean American Populations Summary Review Activity Case Studies References
Chapter 12 Nonethnic Cultures Introduction Introduction to the “Culture of People Suffering Discrimination” History of Gay Americans in the United States Introduction to People With Disabilities Introduction to the Culture of Commerce Consumers Farmworkers Introduction to People Who Are Recent Immigrants or Refugees Summary Review Activities Case Study References
UNIT III Looking Ahead
Chapter 13 Closing the Gap: Strategies for Eliminating Health Disparities Strategies for Reducing or Eliminating Health Disparities
Summary Review Activities Case Study References
To Gary and Samantha, for creating countless hours of laughter—lr
Your mind is like a parachute . . . it functions only when open. ~ Author unknown
Health care professionals work in a diverse society that presents both opportunities and challenges, so being culturally competent is essential to their role. Although knowing about every culture is not possible, having an understanding of various cultures can improve effectiveness. Multicultural Health provides an introduction and overview to some of the major cultural variations related to health.
Throughout this text, those engaged in health care can acquire knowledge necessary to improve their effectiveness when working with diverse groups, regardless of the predominant culture of the community in which they live or work. The content of this book is useful when working in the field on both individual and community levels. It serves as a guide to the concepts and theories related to cultural issues in health and as a primer on health issues and practices specific to certain cultures and ethnic groups.
New to This Edition NEW! A Student Activity is added to each chapter to challenge student comprehension.
NEW! Two new Feature Boxes appear in each chapter—What Do You Think? and Did You Know?—to engage readers and enhance critical thinking.
NEW! Chapter 3, Worldview and Health Decisions, provides information about the ways that worldview and communication affect health, the provision of health services, health care decisions, and communication.
Expanded! Reiki has been added to Chapter 4, Complementary and
Alternative Medicine. Chiropractic care, homeopathy, hypnosis, and hydro-therapy, although important treatment modalities, were removed to keep the chapter focused on culturally based CAM modalities.
Expanded! In Chapter 5, Religion, Rituals, and Health, a section was added about the clinical implications of the relationships among religion, spirituality, and health.
Expanded! In Chapter 6, Communication and Health Promotion in Diverse Societies, tips for communicating with people with limited English proficiency have been added.
Expanded! Chapters 7 through 12 have new sections on worldview, pregnancy, mental health, and death and dying as they relate to the cultural group discussed in each chapter.
Expanded! Chapter 12, Nonethnic Cultures, has been expanded to include people with disabilities, immigrants and refugees, and the culture of commerce.
Expanded! In Chapter 13, Closing the Gap: Strategies for Eliminating Health Disparities, information about the Health and Humans Services Action Plan to reduce racial and ethnic health disparities and the National Stakeholder Strategy for Achieving Health Equality have been added.
Revised! Laws and ethics material is now integrated throughout where appropriate.
Revised! The model programs have been removed from Chapters 7 through 12 and an activity has been added for learners to conduct research and identify a model program themselves.
About This Book Multicultural Health is divided into three units.
UNIT I, The Foundations, includes Chapters 1 through 6 and focuses on the context of culture, cultural beliefs regarding health and illness, health disparities, models for cross-cultural health and communication, and approaches to culturally appropriate health promotion programs and evaluation.
Chapter 1, Introduction to Multicultural Health, discusses the reasons
for becoming knowledgeable about the cultural impact of health practices. It defines terminology and key concepts that set the foundation for the remainder of the text. The chapter addresses diversity in the United States and the racial makeup of the country, health disparities and their causes, and issues related to medical care in the context of culture.
Chapter 2, Theories and Models Related to Multicultural Health, addresses theories regarding the occurrence of illness and its treatment. Terms and theoretical models related to cultural competence are provided. Individual and organizational cultural competence assessments are included.
Chapter 3, Worldview and Health Decisions, explores the concept of worldview on illness and treatment and cultural influences that affect health. Differences in worldview and how that affects perceptions about health, health behaviors, and interactions with health care providers are described. Verbal and nonverbal communication considerations are explained. The chapter closes with discussions about how worldview and communication influence specific areas of health, such as the use of birth control.
Chapter 4, Complementary and Alternative Medicine, provides an introduction to complementary and alternative medicine and health practices. It explores the major non-Western medicine modalities of care, including Ayurvedic medicine, traditional Chinese medicine, herbal medicine, and holistic and naturopathic medicine. The history, theories, and beliefs regarding the source of illness and treatment modalities are described.
Chapter 5, Religion, Rituals, and Health, explores the role of religion and spiritual beliefs in health and health behavior. The similarities and differences between religion and rituals are described. The chapter integrates examples of religious beliefs in the United States and their impact on health decisions and behaviors.
Chapter 6, Communication and Health Promotion in Diverse Societies, includes information about culturally sensitive communication strategies used in public health. Considerations to making health care campaigns using various communication channels, such as social media, appropriate for diverse audiences are explained. A section on health literacy is included.
UNIT II, Specific Cultural Groups, includes Chapters 7 through 12 and addresses the history of specific cultural groups in the United States, beliefs regarding the causes of health and illness, healing traditions and practices, common health problems, and health promotion and program planning for the various cultural groups. These points are applied to specific cultural groups as follows:
Chapter 7, Hispanic and Latino American Populations
Chapter 8, American Indian and Alaskan Native Populations
Chapter 9, African American Populations
Chapter 10, Asian American Populations
Chapter 11, European and Mediterranean American Populations
Chapter 12, Nonethnic Cultures
UNIT III, Looking Ahead, outlines priority areas in health disparities and strategies to eliminate health disparities.
Chapter 13, Closing the Gap: Strategies for Eliminating Health Disparities, explores the implications of the growth of diversity in the United States in relation to future disease prevention and treatment. It further addresses diversity in the health care workforce and its impact on care, as well as the need for ongoing education in cultural competence for health care practitioners.
Features and Benefits Each chapter includes a “Did You Know?” and “What Do You Think?” section to stimulate critical thinking and classroom discussions. Also included are chapter review questions, related activities, and a case study. Key concepts are listed and their definitions are provided in the glossary.
We hope the information contained in Multicultural Health will introduce you to the rich and fascinating cultural landscape in the United States and the diverse health practices and beliefs of various cultural groups. This book is not intended to be an end point; rather, it is a starting point in the journey to becoming culturally competent in health care.
For the Instructor
Instructor resources, including Power-Point presentations, Instructor’s Manual, and test bank questions, are available. Contact your sales representative or visit go.jblearning.com/Ritter2e for access.
We would like to express gratitude to the many dedicated people whose contributions made this book possible. We extend a special thanks to those who provided us with permission to reprint their work. We also are grateful to the Jones & Bartlett Learning team who assisted with the editing, design, and marketing of the book. We would like to particularly acknowledge Sara J. Peterson and Cathy Esperti at Jones & Bartlett Learning for their efforts. Cherilyn Aranzamendez and Jessica Ross, we appreciate your efforts to locate research on the topic of multicultural health. We are also indebted to the reviewers for their thoughtful and valuable suggestions:
First Edition Patricia Coleman Burns, PhD, University of Michigan Maureen J. Dunn, RN, Pennsylvania State University, Shenango Campus Mary Hysell Lynd, PhD, Wright State University Sharon B. McLaughlin, MS, ATC, CSCS, Mesa Community College Melba I. Ovalle, MD, Nova Southeastern University
Second Edition William C. Andress, DrPH, MCHES, La Sierra University Debra L. Fetherman, PhD, CHES, ACSMHFS, University of Scranton Carmel D. Joseph, MPH, Nova Southeastern University Kirsten Lupinski, PhD, Albany State University Hendrika Maltby, PhD, RN, University of Vermont Cindy K. Manjounes, MSHA, EdD, Linden-wood University–Belleville Mary P. Martinasek, PhD, University of Tampa
To our family, friends, and colleagues, we want to express our gratitude because you provided continued encouragement, support, and recognition throughout the process.
About the Authors
Lois A. Ritter earned a doctorate in education and master’s degrees in health science, health care administration, and cultural and social anthropology. She has taught at the university level for approximately 20 years and has led national and regional research studies on a broad range of health topics.
Donald H. Graham is an attorney and holds a master’s degree in urban affairs. He has developed and managed client-centered and culturally appropriate health and human service programs for more than 30 years.
CHAPTER 1 Introduction to Multicultural Health
CHAPTER 2 Theories and Models Related to Multicultural Health
CHAPTER 3 Worldview and Health Decisions
CHAPTER 4 Complementary and Alternative Medicine
CHAPTER 5 Religion, Rituals, and Health
CHAPTER 6 Communication and Health Promotion in Diverse Societies
Courtesy of David Bartholomew
Introduction to Multicultural Health
We have become not a melting pot but a beautiful mosaic. —Jimmy Carter
One day our descendants will think it incredible that we paid so much attention to things like the amount of melanin in our skin or the shape of our eyes or our gender instead of the unique identities of each of us as complex human beings.
Multicultural health Cultural competence Culture Dominant culture Race Racism Discrimination Ethnicity Cultural ethnocentricity Cultural relativism Cultural adaptation Acculturation M