COMS 213 Exam 4

Religion and Health Care pp

Cultural Influences on Approaches to Medicine

Indirect versus Direct Styles

Directapproach - Ask for information from the appropriate person Indirect approach - Not comfortable giving information

Honesty versus Harmony

Harmonyis more important in many countries in Asia U.S. Americans tend to focus on saving their own face—maintaining self-pride, reputation, and credibility

Communication Challenges inTourism Contexts

Language Challenges Social Norms and Expectations Culture Shock The Search for Authenticity

The Domestic and Global Economy

The Domestic and Global Economy

Business Etiquette pp

Varies from culture to culture Related to differences in values and communication styles Most cultural groups tend to be more formal in business contexts than Americans are

International Negotiation

Negotiating occurs when business groups have both common interests in working together and conflicting interests that may keep them apart Negotiation - Process of resolving conflicts to a mutually satisfactory end Basic dimensions of international negotiationsimpacted by cultural differences •Difference in basic concept of the negotiation process •Difference in task or relationship priority •Difference in basis of trust •Difference in preferred form of agreement

Communication Challenges inBusiness Contexts

Work-related values Language issues Communication styles Business etiquette Virtual communication International negotiations Intercultural relationship building Diversity, prejudice, and discrimination

Admissions, Affirmative Action, and Standardized Tests pp

Admissionsto universities are competitive Because of the economic importance of university degrees, admissions are important in empowering and disempowering cultural groups Emergence of the notion of reverse discrimination, or policies that disadvantage Whites and/or males, has become a rhetorical strategy to argue for more spaces for those dominant groups

Racial Intolerance

Area where social issues arise that can impact the educational experiences of international students Much of the scholarly literature focuses on adaptation issues, however, some encounters can be difficult because of intolerance of the host culture

Language Issues pp

Come into play in various ways in business contexts With the growing cultural diversity in the workplace comes linguistic diversity Another potential language issue involves communication between deaf and hearing people

Roles for Teachers and Students pp

Cultural differences can create confusion in the classroom for students and teachers •Learning Styles: Different ways that students learn in different cultures •Teaching Styles: Styles that instructors use to teach

Power in Communication aboutHealth Care

Imbalances of Power in Health Communication Health Care as a Business Intercultural Ethics and Heath Issues

Individualistic versus Collectivist

Individualistic •Workers are expected to perform certain functions with clearly defined responsibilities Collectivist •Cultures place more importance on the individual in relation to groups

The Importance of Communication in Health Care

· Intercultural communication is increasingly relevant in the health communication context for a number of reasons. o First, as the population becomes increasingly diverse, complexities arise in communicating about health issues. § Not only are health care professionals communicating with people from differing cultural backgrounds, but these same patients are communicating with nurses, doctors, and other health care professionals from differing cultural backgrounds. o Second, health care professionals and patients may not realize the importance of communication. § This oversight may seem incidental to medical training and treatment, but the reality is, much medical practice, particularly diagnosis, relies heavily on patient communication. § In many ways, this shortcoming in health care reflects a Western cultural phenomenon, "due partly to the belief that the biomedical model of health care—the predominant model in Western societies—is based on a range of predominantly physical procedures (physical examination, physical manipulation, injections, etc.) rather than communication between two parties." § However, good communication is crucial to quality health care. Health care providers ask questions to diagnose problems, to help patients understand the treatment, and so on. And patients come to health professionals to seek treatment and ask questions. § But even native English speakers complain about the use of medical jargon—potentially confusing or difficult-to-understand medical terminology—by physicians. § For those patients who are communicating in a second language, medical terminology—scientific language used by doctors to describe specific medical conditions—can be particularly confusing. § And when cultural misunderstandings arise, it can lead to inadequate treatment. This misunderstanding is sometimes called medical miscommunication. This type of miscommunication can result in medical mistakes, problems with patientuse of medication and other problems. o Third, and probably the most obvious barrier to health services, are language barriers. Some health care providers ask their bilingual employees to serve as interpreters to patients who do not speak English. o Fourth, health care providers and patients alike may operate out of an ethnocentric framework without realizing it, and assumptions about health care often have cultural roots. o Fifth, treating patients is not always a matter of communication between the physician and the patient. § While one-to-one communication generally works well in Western cultures, which are more oriented to individualism, other cultures may focus more on the family's role in health care. § Unfortunately, most health communication research has limited itself to the physician-patient relationship. · In the United States, disclosure of health information is guided by a federal law known as the Health Insurance Portability and Accountability Act (HIPAA). o HIPAA includes a strict privacy rule that restricts communicating health information to anyone other than the patient and those who may need to know, for example, other physicians, nurses, and health insurance companies for billing purposes. o Cultural bias in thinking about the role of the family in health care can lead to problems. o Health care professionals must be sensitive to cultural differences and must adapt their communication accordingly. o Finally, some work has begun to show the importance of community involvement in health care. o In their work on community-based health communication, communication scholars Leigh Arden Ford and Gust Yep found that a community oriented approach often works much better than a focus on individuals. § Partof this effectiveness emerges when community health workers "become catalysts for change. Through their public health and communication network role enactments, they promote community organizing efforts and enable individual empowerment. § Significantly, community health workers empower themselves as they become a means to empowerment for individuals, families, neighborhoods, and communities. o A focus on community as a foundation for health care is quite different from a more traditional focus on the individual, but it seems to work.

Intercultural Ethics and Health Issues

· With regard to communication ethics in health care, physicians can give information aboutthe patient's health within the following four general frameworks. o Strict paternalism: It reflects a physician's decision to provide misinformation to the patient when the physicianbelieves it is in the best interests of the patient. o Benevolent deception: It occurs when the physician chooses to communicate only a part of a patient'sdiagnosis. o Contractual honesty: It refers to the practiceof telling the patient only what she or he wants to hear or to know. o Unmitigated honesty: It refers to when a physician chooses to communicate the entire diagnosis to a patient. · The fear of malpractice suits guides many decisions related to ethics. o Sometimes health care organizations use ethics committees—often staffed by health care professionals, religious leaders, and social workers—to help make decisions about ethics. · In some cultures, the family is intimately involved in the health care and medical treatment of its members. In other cultures, medical information is confidential and is given only to the patient, unless he or she is incapacitated or incapable of understanding. · Knowing the appropriate way to communicate with patient and family is not easy. o In some religious systems, euthanasia, which involves ending the life of a terminally ill patient, is seen as suicide and therefore is unacceptable. In other religions, euthanasia is acceptable for terminally ill patients.

international students

· meaning that they come to the United States or go abroad to study.

Prejudicial Ideologies

· sets of ideas based on stereotypes—about various cultural groups affect both health care professionalsand patients. These attitudes can present significant barriers to intercultural communication. · Given the concern with the kinds of health care received by members of nonmainstream cultural groups, these comments take on even more significance than simply being prejudicial. o Suchattitudes may influence the quality of health care that patients receive.And healthcare professionals are hardly immune to prejudice. Attending nursing school or medical school does not purge feelings of homophobia, racism, sexism, and other kinds of prejudice. · Patients, too, often enter the health care system with prejudicial attitudes toward health care providers. o Because of this mistrust, many people prefer to obtain a significant amount of their medical information from their own communities.

Grading and Power pp

•The classroom is embeddedwith culturalexpectationsabout power relations •This difference can be greateror lesser in various cultures

Intercultural Relationship Building pp

Specific strategies vary from culture to culture Fundamental value of strong relationships is crucial to effective worldwide business encounters

Health Care as a Business pp

Because there is a power imbalance at work, patients need to recognize that HMOs and health insurance companies and other providers are businesses

Culture Shock pp

Beingin new cultural contexts can lead to culture shock and feelings of disorientation and distress

Domestic Growth pp

Business employees today are: •Older •More likely to be female •Include a growing number of disabled employees •More ethnically diverse than in the past The number of businesses owned by minorities has increased dramatically in the past 10 years About a third of venture-backed companies that went public between 2006 and 2012 had at least one immigrant founder

The Importance of Communication in Health Care pp

Communicatingabout health care is more complex as population becomes increasingly diverse Health care professionals and patients may not realize the importance of communication Language barriers Health care providers and patients alike may operate out of an ethnocentric framework without realizing it Treating patients is not always a matter of communication between the physician and the patient Community involvement in health care is important as it often works much better than a focus on individuals

Imbalances of Power in Health Communication pp

Communication between physician and patient is often marked by an imbalance in power with regard to medical knowledge and access to treatment Physicianscan: •Have the power to prescribe drugs •Elect to refer or not refer patients to specialists •Recommend certain treatments •Order medical tests Determinewhat kind of treatment the patientreceives

Global Growth pp

Economies of the world are now connected more than ever

Educational Goals pp

Education is important for advancement in society

Intercultural Communication in Educational Settings pp

Educationis deeply embedded in culture Expectations for the educational process are a part of our culture Roles we enact in the classroom are part of the cultural influences on education

Quality versus Efficiency

For most Americans, efficiency and getting the job done for the lowest cost is the ultimate goal The French think one should not worry if a product is competitive as long as it's well designed Germans believe it's important to do the best job on principle and that people will pay for the best quality

Culturally Specific Education pp

HBCUs: Historically Black colleges and universities Other types of Minority-Serving Institutions (MSIs) include: •Hispanic-Serving Institutions (HSIs) •Tribal Colleges or Universities •Native American-Serving Nontribal Institutions •Alaska Native and Native Hawaiian Serving Institutions •Asian American and Native American Pacific Islander-Serving Institutions

High or Low Context Communication

High Context - Communicators prefer to communicate more of the message nonverbally or contextually Low Context - Communicators prefer to make information very explicit—expressed in words

Intercultural Barriers to EffectiveHealth Care

HistoricalTreatment of Cultural Groups Prejudicial Ideologies

Historical Treatments of Cultural Groups pp

Historically, widespread ideologies about different cultural groups have fostered differential treatment, especially racial and ethnic minorities, by medical professionals

Power Issues in InterculturalBusiness Encounters

Intercultural communication occurs in many different types of business settings •Includes domestic contexts with multicultural workforces and international contexts Communication across power divides can be difficult when there is cultural difference in how power is viewed or how power distance is expressed Cultural groups that believe in high power distance feel that an organization functions best when differences in power are clearly marked Cultural groups that believe in low power distance feel that power differences, though very real, should be minimized and that an egalitarian view is best

Social Norms and Expectations

Many cultural norms have implications for intercultural communication between tourists and hosts Some of the most relevantnorms are about: •Public social behavior Shopping Comportment in public •Sometimes the norms are related to religious beliefs and traditions Shopping - Communication norms involved in shopping also vary from culture to culture •Touching merchandise •Conversations with clerks Bargaining

Studying Abroad pp

Many universities offer study-abroad programs to give their students the opportunity to experience another culture Not equally available to all students Not taken advantage of by all students

Work and Material Gain

Most Americans think that hard work is a virtue that will eventually pay off To the people of many other cultures, however, work is a necessary burden Cultural groups that see work as having a low priority believe that, because work is necessary and takes up most of the daylight hours, ways should be found to make it more agreeable by creating a convivial workplace

Language Challenges pp

One cannot learn all the languages of the world It can be frustrating not to be able to understand what is being said It is often part of culture shock Can even occur when visiting countries where people speak the same language you do

Intercultural Ethics and Health Issues

Physician-PatientRelationship Physicians can give information about the patient's health in four general frameworks •Strictpaternalism:A physician's decision to provide misinformationto the patient for the supposed benefit it might provide the patient •Benevolent deception: Withholding a part of the information from a patient, ostensibly for his or her own good •Contractual honesty:- Telling the patient only what he or she wants to know •Unmitigated honesty: A physician's communication of the entirety of a medical diagnosis to a patient The fear of malpractice suits guides many decisions related to ethics Ethics Committees:Staffed by health care professionals, religious leaders, and social workers and are used to help make decisions about ethics

Political and Environmental Impact on Tourism

Political instability can have devastating consequences and impact tourism dramatically Pandemics, a global disease outbreak, can also wreak havoc on tourism Natural disasters have an enormous effect on tourism

Additional Social Issues and Education

Recognize that the educational process reflects cultural power Recognize that the structure of education institutions, as opposed to people in them play a significant role in the way power functions We must work harder at developing dialogues of respect •Addressing cultural differences and the reasons for those differences can begin to change the educational process

Prejudicial Ideologies pp

Sets of ideas based on stereotypes about various cultural groups affect both health care professionals and patients •These attitudes present significant barriers to intercultural communication Attitudes may influence the quality of health care that a patient receives Attending nursing school or medical school does not purge feelings of homophobia, racism, sexism, and other kinds of prejudice Patients enter the health care system with prejudicial attitudes Regional differences can influence whether people trust medical professionals Mistrust leads many people to obtain medical information from their own communities

Social Issues and Education pp

Social issues are played out in the educational context and can influence the educational experiences of students Few social issues •Bullyingcan be exacerbated by cultural differences •Defined by the U.S. Department of Health and Human Services, "Bullying is unwanted, aggressive behavior among school aged children that involves a real or perceived power imbalance. The behavior is repeated, or has the potential to be repeated, over time." •Bullying can include verbal, nonverbal, and cyber communication Racial intolerance is another important area where social issues arise •Social issues can impact the educational experiences of international students •Much literature focuses on adaptation issues, but some encounters can be difficult because of intolerance of the host culture

Culture Learning and Tourism

Socially responsible tourism: Tourism that emphasizes positive economic, social, cultural, and environmental impacts in the tourism industry •Many tourists support this move In addition to simply enjoying travel, many tourists want to learn more about the host country, meet local people, and reduce the environmental and social impact of their visit

Cultural Influences on Approachesto Medicine

Spiritualityand/or religion can be helpful in the healing process of an illness •May be helpful in facing death Different cultures bring different perspectives on our health—how we stay healthy and how we fall ill Biomedical Science - Dominant model of medicine in the United States and many other Westernized nations

Travel and Tourism

The World Tourism Organization estimates that more than a billion people crossed international borders every year—almost 3 million a day In 2015,international tourism receipts reached a record of $1,232 billion Many people travel within their own country •U.S. Americans make 1.7 billion person-trips a year for leisure purposes Tourism contexts provide rich opportunities for intercultural encounters

Virtual Communication pp

The intercultural communication issues in online business interaction are: •Access issues •Language used in emails, videoconferencing, and Skype •Unique impact of values on virtual messages •Impact of communication style in virtual encounters •Always preferable to be a bit more formal and not too casual

The Search for Authenticity pp

The issue of authenticityis often a challenge in tourist-host encounters, particularly for those engaged in cultural or heritage tourism In tourism, the search for "real" cultural experiences is important •Tourists expect an unique experience that is very different from their everyday life Staged authenticity: Alteration of cultural traditions by locals to meet tourist expectations •The resulting representation of the local culture is not authentic The tourist's search for authenticity can create the very conditions that the tourist was trying to avoid, which is an inauthentic cultural experience

Intercultural CommunicationTraining in Business

They employ intercultural professionals, experts in an applied field of intercultural communication, called cross-cultural training or diversity training •Cross-cultural trainers tend to focus on cultural differences that impact business effectiveness •Diversity trainers tend to focus more on racial/ethnic/gender differences and on power issues in business context

Tourism, Intercultural Communication, and New Media

Tourists: •Can be much better prepared for intercultural encounters with the vast amount of cultural information on the Internet •Use social media while visiting other countries and cultures

Task versus Relationship Priority

U.S. - Task accomplishment China - Personal relationships Latin America - Personal relationships

Global Growth

· While the U.S. economy has recovered somewhat from the devastating recession, its trade deficit is now the highest since the financial crisis 10 years ago. · A lot of debate exists about the pros and cons of rampant globalization. Americans seem increasingly skeptical about the benefits of globalization, free trade, and the common practice of outsourcing. · The economies of the world are now connected more than ever. One only has to look at the U.S. economy, where the stock market rises and falls with breaking news of the latest economic crisis in Europe or the political instability in the Middle East. And in both domestic and international settings, intercultural encounters occur.

Virtual Communication

· As more and more business interaction occurs online, it is worth consideringintercultural communicationissues that may arise in virtual communication. · First, there are access issues. o The telecommunication infrastructure varies widely around the world, from very high Internetand mobile technology access in North America, Europe, and the highly industrializedAsian countries, to less coverage in South America and little coverage in most of Africa (except South Africa). o A second issue concerns the language used in e-mails or in videoconferencing/ Skype communication. In general, the guidelines given earlier also work virtually (e.g., using simplelanguage, avoiding jargon and jokes), whether written or video. Additionally, communicating by e-mail, rather than video may be preferred when there are language challenges, because it allows non-native speakers the time to craft their messages and eliminates misunderstandings due to accent or other paralinguistic cues. o A third issue is the unique impact of values on virtual messages. For example, in many countries where high-context communication is preferred and relationships are highly valued, businesspeople may actually prefer face-to-face meetings over virtual contact—especially for initial meetings. § In fact, China experts caution that technology should not be used there as a substitute for interpersonal communication; that businesspeople are likely to get limited responses if technology is used as the sole mode of communicating, partly because the Chinese are reluctant to reply to messages from people they do not know. o A fourth issue concerns the impact of communication style in virtual encounters. For example, when communicating virtually with people who prefer indirect communication, and value harmony over honesty, virtual discussions (including e-mail exchanges) should avoid direct mention of issues that might cause loss of face for anyone involved.

Social, Historical, and Economic Contexts of Tourism

· As tourists, one may be stepping, unaware, into a situation where past or current social and political events influence the interactions they'll have with members of host culture. The extremes of these imbalanced relationships are represented in tourism in developing countries or in previously colonized countries where the legacy of colonialism still lingers. Tourism can result in increased crime, traffic problems, disruption of family life, alcohol and drug problems, crime, and sexual promiscuity. · The United Nations has focused on tourism as one way to address the severe economic imbalances in some developing countries (2.5 billion people live on less than U.S. $2 a day). o One of the projects outlined in the United Nations "2030 Agenda for Sustainable Development" is the Small Island Development States (SIDS), focusing on 52 islands in the Caribbean, the Pacific, the Mediterranean, the Indian Ocean, and South China Sea, where tourism accounts for 40 to 50 percent of annual gross domestic product (GDP) and the number of international tourists visiting SIDS reaches more than 40 million a year. · However, some UN experts are less optimistic about the potential of tourism to boost economies in poor countries. They estimate that only a fraction of the tourist money spent actually stays in the local community.

Communication Challenges in Tourism Contexts

· Being a student of intercultural communication in tourism contexts provides many interesting communication challenges, including (1) rising to the challenges of a foreign language, (2) following social norms and expectations, (3) dealing with culture shock, and (4) searching for authenticity.

Culture Shock

· Being in a new cultural context can often lead to culture shock—feelings of disorientation and distress. · Language challenges and differing social norms can trigger these feelings, of course, but sometimes seemingly mundane challenges like dining norms can also do it. · Of course, sometimes tourists have so little contact with the host culture that there is little opportunity for culture shock. o The degree of culture shock may also depend on how different the host culture is from the tourist's home culture. o On short-term trips, one's body doesn't have the time to adjust to new climate conditions or new foods or eating customs. And feeling fatigued or under the weather often can affect communication with others. · One should bear in mind that it is the tourist who is experiencing the culture shock; the problem is not the culture itself. o However, tourists who experience culture shock often take it out on the host community. o Perhaps it is not just the tourist who experiences culture shock, for the host population can suffer the same shock. The encounters might be stressful for both because both tourist and host are being confronted with new values and behaviors and uncertainty. o Both hosts and tourists probably experience more shock when they have limited previous intercultural experience.

Business Etiquette

· Business etiquettevaries from culture to culture and is related to differences in values and communication styles. · In general, most cultural groups tend to be more formal in business contexts than U.S. Americans are. o Latin Americans attach great importance to courtesy. A well-mannered person is described as muy educado in Mexico, and a prescribed set of behaviors is expected in business settings, including ritual handshaking with and greeting of staff members each morning. The same is true in many African countries. There, high-level officials and business executives expect to be treated with the solemnity and respect due their position. · In general, when conducting business in most cultures, one should be very careful to avoid excessive familiarity, especially in initial meetings; this means no slouching, putting one's feet up on a desk, or lounging in general. · Etiquette is a traditional value that pervades French society, and business etiquette is symbolized by properly engraved business cards, giving a professional title and academic credentials.

Imbalances of Power in Health Communication

· Communication between physician and patient is often marked by an imbalance in power with regard to medical knowledge and access to treatment. · Physiciansin health maintenance organizations (HMOs), which are increasingly common in the United States, can elect to refer or not refer patients to specialists. Physicians have power over patients in other ways as well. o For example, they can recommend certain treatments (and not others), order medical tests, and otherwise determine what kind of treatment the patient receives. · Thispower imbalance is built into the health care structure in the United States, but physician-patient communication also reflects these power differences. · Because patients may encounter many health care workers in a single day, cultural differences in communication may be exacerbated. o Some physicians would be amused, but others would be irritated by the perceived effort to challenge the power imbalance.

Communication Challenges in Business Contexts

· Communication challenges in business contexts can reflect cultural differences in work-related values, language issues, communication styles, and business etiquette, as well as issues related to diversity, prejudice, and discrimination.

Admissions, Affirmative Action, and Standardized Tests

· Debates over university admissions are not new. Because university resources are expensive and limited, admissions to universities are competitive. · Because of the economic importance of university degrees, admissions are important in empowering and disempowering cultural groups. Thus, many people struggled to break down barriers to university admissions that were based on nonacademic factors such as race. · Today, universities do not deny admission based on race. o Today, most universities do not discriminate based upon race, and many other characteristics. · In order to overcome some of the historical as well as contemporary reasons that have led to student bodies that do not reflect the demographic profiles of society at large, the civil rights movement led to the establishment of affirmative action policies. o These policies encouraged institutions to act affirmatively to ensure a more representative student body. · The emergence of the notion of reverse discrimination, or policies that disadvantage Whites and/or males, has become a rhetorical strategy to argue for more spaces for those dominant groups. · In contrast to the current downplaying of the importance of standardized tests in the U.S. college admissions, China places even greater emphasis on tests. This emphasis on these exams has tended to tilt college admissions in favor of those students from more elite backgrounds. · More recently, changes in the student body profile have led some admissions officers to give preference to men over women. Preferential admissions are not only about racial differences. · The reality is that because young men are rarer, they're more valued applicants. Today, two-thirds of colleges and universities report that they get more female than male applicants, and more than 56 percent of undergraduates nationwide are women."

Cultural Influences on Approaches to Medicine

· Different cultures bring different perspectives on health—how people stay healthy, as well as how they fall ill. · There are also many cultural differences about what might be considered something that needs medical attention. · Cultural attitudes about weight have changed over the years in the United States, as well as in cultures around the world. Once seen as a sign of wealth, today obesity is seen as a sign of medical disorder in need of medical treatment. o The debates over weight and what should be acceptable have been at the forefront of the Fat Acceptance Movement, a social movement that works to end discrimination against overweight people and the assumption that they are necessarily unhealthy or in need of medical treatment. · In the United States and many other westernized nations, the dominant model of medicine is based on biomedical science. All other approaches fall under the term, complementary and integrative medicine. · There are too many other approaches to medicine that would fall under complementary medicine than one can list here, but they are also seen as equally valid approaches to health care.

Educational Goals

· Education is widely perceived to be an important avenue for advancement in society. Yet, beyond the basic skills of reading, writing, and arithmetic, people need to think about the educational goals that various cultures establish. · There is no universal curriculum that all students follow. o Not surprisingly, educational goals for different cultural groups are largely driven by members' need to know about themselves and their society. o One's education necessarily frames one's worldviews and the particular ways of knowing. · Education, however, is not driven simply by the desire to teach and learn about ourselves. In colonial contexts, for example, the colonial power often imposed its own educational goals and system upon the colonized. o In so doing, this colonial educational system served educational goals that differed from what the colonized might have valued. § This displacement of educational goals had a tremendous impact upon the ways that these former colonial societies were formed.

Communication, Education, and Cultural Identity

· Even teachers who are not overtly racist may not have received the kind of education necessary to incorporate materials into the curriculum that reflect the diversity of their students. Nor have they been able to develop this curriculum. · The issue about the key role of education in creating one's identities was highlighted by James Loewen's best-selling book Lies My Teacher Told Me. o Japan has come under critique for the content of its history textbooks as well, particularly by South Korea and China. Both of these nations experienced Japan's militarism prior to Japan's pacificism after World War II.

Religion and Health Care

· Even when they are not facing serious illness or death, many people turn to religion or spirituality to help them try to understand the complexities of life. o When theyare ill, however, some people are driven to seek answers to questions that science cannot always answer. · Sometimes, spiritualityand/or religion can be helpful in the healing process; other times, it may be helpfulin facing death. · The role of religion and spirituality in health care is still a controversial topic, but today "more than half of the med schools in the country" offer courses in religion and spirituality, "up from just three a decade ago." o Yet the role of religion and spirituality in health care raises a number of issues about ethical ways to approach the topic of incorporating health practices into existing beliefs and helping patients avoid any pressure they may feel about their beliefs. · It is also important for health care professionals to avoid imposing their beliefs on patients. o Dr. Susan Strangl, a family-medicine doctor at UCLA, [had] a Muslim patient who needed medication but was observing Ramadan and couldn't drink or eat during the day. After taking a religious history—routine for all hospitalized patients at UCLA—Strangl chose a once-a-day medication that could be taken after sundown. · Whilereligious and spiritual beliefs vary widely,Drs. Koenig, McCullough, and Larson attempted to survey the studies available in this area and compiled the Handbook of Religion and Health Care. · The understanding of the role of religion and spirituality in health leaves behind many unanswered questions, but they do recommend the following seven specific strategies for physicians and other health care professionals in dealing with patients: o Take a religious history. o Support or encourage religious beliefs. o Ensure access to religious resources. o Respect visits by clergy. o View chaplains as part of the health care team. o Be ready to step in when clergy are unavailable. o Use advanced spiritual interventions cautiously. · Some physicians, however, argue against some of the previously suggested guidelines. o For example, Dr. Richard P. Sloan of the Columbia-Presbyterian Medical Center cautions against praying with patients: "It confuses the relationship. It may encourage patients to think a prayer is going to somehow improve their well-being. It certainly will improve their spiritual well-being but there's no evidence it's going to improve their health." o Sloan's biggest concern about health care professionals engaging in religious issues is "Manipulation of religious freedom. Restriction of religious freedom. Invasion of privacy. And causing harm. It's bad enough to be sick, it's worse still to be gravely ill, but to add to that the burden of remorse and guilt for some supposed failure of religious devotion is unconscionable."

Health Care as a Business

· It is important to remember that the healthcare industry in the United States is a huge business. · Rising health care costs have had a huge impact on how people think about medical resources and their distribution. o Medical debt is increasing as a factor in decisions to declare personal bankruptcy. o Medical debt is often referred to collection agencies far faster than other types of debt. · In response to growing costs and concerns about the U.S. health care system, President Obama signed the Patient Protection and Affordable Care Act into law on March 23, 2010. o Although sometimes derided as "Obamacare," this act marks a major change in health coverage. § It aims to reduce the number of uninsured (or under-insured) Americans and decreasing the rapid rise of health care costs overall. § Many of these changes will take place over a number of years, and the U.S. Department of Health and Human Services has set up a website to explain all of the changes: www.healthcare.gov. · Patients from countries where health care is provided by the government may be confused by the private health care system in the United States. U.S. Americans, too, can become lost in the maze of rules and regulations governing the access to specialists and special treatments.

Historical Treatments of Cultural Groups

· Historically, widespread ideologies about different cultures have fostered differential treatment for some groups, especially racial and ethnic minorities, by medical professionals. · In thepast, medical conclusions about alleged racial difference have justified a number of deplorable social practices, from slavery, to colonization, to immigration restrictions. · Differential treatment has caused some cultural groups to be justifiably suspicious of contemporary health care. o For example, the infamous Tuskegee Syphilis Project,conducted by the U.S. Public Health Service on unsuspecting African Americans in Tuskegee, Alabama, over a 40-year period, spurred some of these concerns. § In this study, Black patients who sought out medical care for syphilis were instead given placebos (sugar pills), but were not told that they were part of a study, simply to establish an experimental control group. § The purpose of the study was to explore how syphilis spreads in a patient's body and how it spreads in a population. § The Tuskegee Syphilis Project, among other studies and projects, has reinforced suspicion about the medical community from many marginalized communities. · The rise of AIDS(acquired immune deficiency syndrome) and HIV (human immunodeficiency virus) in the late twentieth century provoked new fears among gays and minorities that the medical community would again provide differential treatment. · The slow response to the AIDS epidemic by the federal government has been widely discussed and critiqued.

Intercultural Communication Training in Business

· How do businesses respond to the challenges that has been outlined so far—cultural differences in communication style, values, and issues of discrimination and prejudice in business contexts? The answer is that they often employ intercultural professionals, experts in an applied field of intercultural communication called cross-cultural trainingor diversity training. · Cross-cultural trainers tend to focus on cultural differences that affect business effectiveness in international business settings. o They conduct training sessions to help employees understand how value and communication style differences—say, between Japanese and German workers—can affect their working relationships and productivity. o They also provide guidance and suggestions for managing these differences and using the differences to improve working relationships and even bottom line profits. · Diversity trainers tend to focus more on racial/ethnic/gender differences and on power issues in domestic business context (i.e., in U.S. locations). o Many diversity trainers help multicultural workforces within the U. S. work more effectively. o They tackle issues of prejudice and discrimination, showing how these issues sometimes operate at an unconscious level and how workers sometimes unintentionally express prejudice and discrimination. § A first step for these trainers is to help employees identify some of the negative behaviors and develop an awareness of the issues; they then show the devastating effect these attitudes and behaviors can have on a workforce (conflict, absenteeism, etc.). § They also provide suggestions for improving relationships and productivity among culturally different employees. · One response to these cultural differences and communication challenges that is related to broad organizational strategies is a mentoring program.

Grading and Power

· In the United States, posting grades in this manner would be a violation of the Family Educational Rights and Privacy Act of 1974, also known as the Buckley Amendment. Students' grades are considered private information. · As in any other social setting, the classroom is embedded with cultural expectations about power relations. While there may always be a power difference in the communication between instructors and students, this difference can be greater or lesser in various cultures. · In the United States, for example, the relationships between instructor and students tend to be less formal than in other cultures. · Notions of "fair" and "unfair" are culturally embedded as well. The grading system in the U.S. is far from universal. Different cultures use different ways of evaluating student work.

Power Issues in Intercultural Business Encounters

· Intercultural communication occurs in many different types of business settings, including domestic contexts with multicultural workforces and international contexts. · The pressure to meet expectations of powerful Americanmultinational corporations has led some Indians to change their language and cultural practices. · Intercultural communication occurs in encounters with superiors, subordinates, and peers, and with customers and clients. Power is also evident in these encounters. · Although customers and workers come from diverse cultures, management ranks and boardrooms remain almost exclusively white male enclaves and there is some indication that diversity is actually decreasing—and the "heyday" of diversity in U.S. business leadership has come and gone. o Over the past four years, there has been a dramatic decline in the appointments of "New CEOs" (women, African Americans, Latinos, and Asian Americans) in Fortune 500 companies. o In terms of gender and social class backgrounds, men still outnumber women by a ratio of about 17 to 1 (almost 90 percent of the CEOs in 2015 were White men) and the large majority of the new CEOs come from privileged economic backgrounds. o Studies show that diversity is good for business. § Ronald C. Parker, the CEO of the Executive Leadership Council, gives several reasons. One is the common unconscious biases against people who don't look like a "typical" (aka White male) leader. § Parker explains that the White men at the top "are comfortable with their network of the people that they know, therefore the people that get those opportunities tend to look like them." § In addition, some companies committed to diversity haven't quite figured out how to effectively recruit, cultivate, and retain women and minority talent. § Finally, and ironically perhaps, an increase in diversity doesn't seem to promote more diversity but rather a feeling of "well that's taken care of," which actually leads to less attention to diversity and fewer diverse hires. · Business experts suggest that truly effective leaders realize that in order to be more successful in a diverse global marketplace, power needs to be shared. · Power relations can also play out on a more interpersonal level. · Communication across power divides can be very difficult, particularly when there is a cultural difference in how power is viewed or how power distance is expressed. o Cultural groups that believe in high power distance feel that an organization functions best when differences in power are clearly marked. o By contrast, cultural groups that believe in low power distance (as in most U.S. contexts) feel that power differences, though very real, should be minimized and that an egalitarian view is best.

Social and Political Contexts of Business

· It is important to consider the social and political contexts of business and to think about how social and political events can affect business encounters. o For example, terrorist attacks, both physical and in cyberspace, can have a tremendous effect on business encounters, both domestically and internationally. These acts can trigger a loss of confidence, and result in lost opportunities for intercultural contact, fear of contact, and suspicion about particular cultural groups. · It might also be considered how the current discussion on immigration affects intercultural communication. o Many economists have argued that the net impact of immigration is often positive, particularly in the United States and Britain. o Immigration issues affect intercultural business relations between immigrants and native-born citizens. Increased anti-immigrant feelings may lead to increased discrimination in the workplace. · Another political issue impacting intercultural communication in business contexts is the legislation related to same-sex marriage and policies related to transgender individuals, leading to suspicion, anxiety, and uneasy encounters between LGBT individuals and others in business contexts. o Thus, it is important to remember that each intercultural encounter occurs in a social and political contexts that goes beyond the few individuals involved.

Diversity, Prejudice, and Discrimination

· It may be interesting to identify cultural differences in workplace communication styles and values, but the real challenge is knowing how to work with these differences in a productive way. · Until recently, in most U.S. organizations, there was one dominant culture with a corresponding style of communication—White, Anglo Germanic, mostly Protestant, and male. o In terms of communication and values, this means it was individualistic and emphasized directness, honesty over harmony, and task completion over relationship building. o Individuals who held other values and used different communication styles often didn't fit in—or worse, were not hired or promoted. · Sometimes prejudice and discrimination are based on personal characteristics like names. The discrimination may begin even before one is hired. · Discrimination may also be based on skin color. There are few cases of blatant discrimination in the workplace today; rather (less explicit), discrimination based on race and gender now exists more at higher levels of organizations where criteria for advancement are more subjective—where it depends more on who you know than on your specific job skills. · Affirmative action (AA) policies are statutes that direct companies to hire a certain percentage of women and minorities. · Some minorities and women are grateful for the emphasis on diversity and the implementation of affirmative action policies. But other women and minorities, while grateful for a chance to compete, are troubled by the question of whether they are viewed as having been given advantages. · Companies have many reasons for addressing affirmative action and diversity issues. o There may be moral grounds—a need to address the long history of racism, sexism, and conflictual intergroup relations in the United States. There may be a feeling that it is the responsibility of those who have benefited from this historical pattern to begin to "level the playing field." o However, more often it is legal and social pressures—in the form of equal employment opportunity (EEO) laws, affirmative action (AA), and the Americans with Disabilities Act (ADA)—that cause companies to address affirmative action issues. o Finally, companies may address issues of multiculturalism and diversity because they think it will have an impact on their bottom line—profit.

Language Challenges

· Language is often the first challenge encountered by tourists. One cannot learn all the languages of the cultures where one might visit in a lifetime, and it can be frustrating not to be able to understand what is being said. · The expectations of various host cultures regarding language also may differ. Sometimes tourists are expected to get along using the host language, but other cultures provide more language assistance for travelers.

Language Issues

· Language issues can come into play in various ways in business contexts. · International business is sometimes conducted in English even when none of the participants speak English as a first language. · The same can be true in domestic business situations. With the growing cultural diversity in the workplace comes linguistic diversity. o To make working with a multilinguistic workforce easier, one shouldn't assume that, just because people are speaking a language other than English, they are talking about one. A second suggestion in working with a multilinguistic workforce is to speak simple, but not simpleminded, English. o A non-native speaker can better understand language that is spoken slowly and clearly, and that includes no big words. · Another potential language issue involves communication between deaf and hearing people.

Work-Related Values

· Many cultures (such as most U.S. cultures) are individualistic, while others (such as many cultures in Asia and in Central and South America) are collectivist—that is, they place more importance on the individual in relation to groups. o In countries with individualistic views, workers are expected to perform certain functions with clearly defined responsibilities; a clearboundary exists between their job and another person's job. o In collectivist countries like Japan, the opposite is true. That is, Japanese organizations do not necessarily define the precise job responsibilities assigned to each individual; rather, it's the job of a work unit, a section, or a department. o These culturaldifferences in values can present challenges to workers and management. o These value differences are not always hard and fast; international business experts acknowledge that, with globalization, many of these differences are blurred. · Most Americans think that hard work is a virtue that will eventually pay off. To the people of many other cultures, however, work is a necessary burden. o Culturalgroups that see work as having a low priority believe that, because work is necessary and takes up most of the daylight hours, ways should be found to make it more agreeable by creating a convivial workplace. o The different attitudes toward work can lead to intercultural communication conflicts in the workplace. · Another conflict in work-related values is based on the relative value placed on quality versus efficiency and practicality. For most Americans, efficiency and getting the job done for the lowest cost are the ultimate goals. However, people in many different cultures hold different views. o Americans would rather produce something expediently than elegantly (or exquisitely). One might explain these U.S. business values partly by the fact that the United States is a young country and that its people have less appreciation for history and time. · A related value has to do with whether the highest priority is placed on relationships or on task completion. In most work contexts in the United States, the most important thing is to accomplish the task. o However, in many cultures, work gets done because of relationships. o This seems to be the case in China where personal relationships are vital for business success. The importance of personal relationships is such that there is a special term, guanxi,which means a personal bond or connection that goes beyond social and cultural connections.

Social Issues and Education

· Manysocial issues are played out in the educational context and can influence the educational experiences of students. Schools and colleges are never outside of the societies and social attitudes in which they exist. · Although bullying is not necessarily an intercultural interaction, it can be exacerbated by cultural differences. o Many other students have experienced bullying and some have gone on to commit suicide. Because school attendance is compulsory, the bullied students are required to see their bullies day after day. · Racial intolerance is another important area where social issues arise can affect the educational experiences of international students. · While much of the scholarly literature on international students has focused on adaptation issues, some of the encounters can be difficult because of the intolerance of the host culture. · In the United States, the challenges of tolerance and intolerance can be an issue as well. · As the world grows smaller, it is important to strive to become a global citizen by profiting from one's interactions with others who are different. Education is one crucial site where this can happen. · As noted earlier, the development of educational institutions, as well as the educational process itself, is deeply embedded in any culture. As students and instructors meet in the classroom, cultural differences can lead to misunderstandings in communication. · It is important to recognize that the educational process reflects cultural power. · It is important to recognize that the structure of educational institutions, as opposed to the people in them, often plays a significant role in the way that power functions. · Some colleges require history or literature courses, but the history and literature that they teach might be Eurocentric, focusing on European or Western views of history and literature. · However, a Eurocentricapproach to education can create barriers to intercultural communication. o One response to this problem is to teach Afrocentric history, which centers on the African rather than the European experience and exposes African American students to an entirely different view of the world and their place in it.

Intercultural Communication in Educational Settings

· Much of the communication behavior in the classroom is not interpreted in the way it's intended to be by people from different cultural backgrounds. Education is deeply embedded in culture, and people's expectations for the educational process are a part of their culture.

Characteristics of Tourist-Host Encounters

· The chapter focuses on the tourist-host encounter. Experts suggest at least four fairly unique characteristics: they are short-term and transitory, commercialized, and often involve unbalanced power dynamics. · Second, most host-tourist interactions are commercialized. · Superficial interactions are predictable and ritualistic and offer few opportunities for tourists to engage in genuine social interactions with local people. · The final characteristic of tourist-host communication is the unbalanced nature of the interaction. o First, host and tourist have very different views on the meaning of tourism. o Also, tourists, hosts, and service providers often have different socioeconomic backgrounds, with the tourists more economically and socially privileged than those with whom they interact. · The end result then of power imbalances can lead tourists to be suspicious of locals and feelings of resentment at possibly being taken advantage of. However, many factors influence the imbalance between tourist and host.

International Negotiations

· Negotiating is a special communication task that occurs when business groups have both common interests in working together and conflicting interests which may prevent them from working together. Negotiation is the process of resolving the conflicts to a mutually satisfactory end. · There is abundant evidence that the cultural differences identified earlier (differences in work-related values, communication styles, and even business etiquette) have an impact on negotiation processes and outcomes. However, there are no comprehensive lists that identify all cultural patterns, and negotiators often find themselves relying on stereotypes and preliminary data. · Here are some basic dimensions of international negotiations that may be affected by cultural differences. o Cultural groups may differ in their view of the basic concept of the negotiation process. Some cultural groups may view negotiation as one party gaining at the expense of the other, while others see it as a process where parties place different values on each of the issue being negotiated and can then find effective trade-offs with each other. o Cultural groups may differ in the task or relationship priority: either a focus on the specific project at hand, where negotiators spend most time exchanging information regarding various alternatives (relationship is considered unrelated to task), or a focus on the relationship between the two parties. · It may be that U.S. American negotiators are recognizing how important relationships are to some cultural groups. o There may be a difference in the basis of trust. One side may believe that the other party will fulfill obligations because of a signed contract (trust is external to relationship), or because of the relationship between the two parties (trust is internal to relationship). o There may be cultural differences in the preferred form of agreement. One side may prefer agreement based on formal written contracts while the other side may prefer an informal agreement based on the historical and social context of the relationships.

Studying Abroad

· One might have encountered international students in one's classes, and one might know American students who have gone abroad to study and to experience another culture. · In fact, many universities offer study-abroad programsto give their students international experiences. However, study-abroad opportunities are not equally available or taken advantage of by all students. · Because the cultural norms in different educationalsettings vary widely, international students engage directly in issues relevant to intercultural communication. · Many students from former European colonies study at institutions in the former colonizing nation. o For example, Indonesian students may study in the Netherlands, Indian students may study in Britain, and Lebanese students may study in France.

Communication Styles

· Severalelements of communication style are especially relevant in business contexts. These include indirect versus direct, high versus low context, and honesty versus harmony. · People with a direct communication style simply ask for information from the appropriate person. However, a person with an indirect style might not feel comfortable giving information, particularly when a problem exists and there is a need to save face. o One wayto obtain information is for one to watch how others who are respected get information from one another and how they get it from one. o Observe how subordinates, supervisors, and colleagues give and obtain information, since the approach may vary with an individual's status or relationship. o In general, to have good intercultural business communication, people need to slow down and "sneak up" on information. Many Europeans don't get right to the point. · Closely related to indirect/direct communication is the notion of high-and low-context style. o Low-context communicators (most U. S. Americans) prefer to make information very explicit—expressed in words. o High-context communicators (many Asians and Africans) prefer to communicate more of the message nonverbally or contextually. o Thisdifference can result in challenging business encounters. · Honesty is not always the best policy in intercultural business contexts; relational harmony is more important in many countries in Asia and, in fact, sets the standard for communicators. o Communication scholar Wen Jia describes how effective communication is defined in China: The kind of communication behavior best at creating and sustaining harmony is regarded as the most effective and most competent communication in Chinese culture. o The focus here is not on truth, per se, but on achieving harmony. Achieving relational harmony inChina and many other Asian countries includes the notion of facework, especially the importance of saving another's face. · U.S. Americans tend to focus on saving their own face—maintaining self-pride, reputation, and credibility. o However, for many Asians, the concept of saving face is more about interdependence, achieving mutual honor and respect, not focused just for the individual but for the larger group, the family, or organization. o In a businesscontext, this may mean allowing other persons room to maneuver, and not saying the unvarnished truth. o There are also cultural variations in how truth is defined. In many businesses in Asia, there are a number of behaviors that would be considered acceptable in everyday practices, whereas in the United States they would be regarded as deceptive, perhaps even unethical.

Intercultural Relationship Building

· So manycultures emphasize the importance of relationships in effective business endeavorsthat a general guideline for intercultural business success might be: learn how to develop good relationships. · A recent study asked business managers for suggestions to develop good communication and business relationships in different countries around the world and found some interesting results. Themanagers all reported that relationships were important, though individualists (e.g., Europeans, New Zealanders, South Africans) tended to see relationships as central to achieving business goals, whereas collectivists (e.g., Chinese, Indians) saw relationships as more worthy just in themselves. o They emphasized two important general processes, building trust and reciprocal behavior, which varied along cultural lines. o In most intercultural business relationships, it's important to pay attention to people's places in the hierarchy and to recognize and respect symbols of authority, to know whose views may carry more weight and whose opinions must be asked before decisions are made.

Cultural Learning and Tourism

· Some tourist-host encounters do go beyond the superficial confines of the tourist role, and learning something about cultures is a goal of many tourists. · This may happen unexpectedly when sharing food, holding a long conversation, or simply participating in a meaningful slice of the local culture. o And one can learn something about the local culture even in a short time, by using many of the communication guidelines that has been covered in the textbook so far: being observant, being more conscious of one's own and others' communication, and being flexible and open to other ways of living. · A typeof tourismthat fits nicely with culture learning and ethical intercultural communication and that emphasizes positive economic, social, cultural, and environmental impacts in the tourist industry is called socially responsible tourism.

Attitudes of Hosts toward Tourists

· The attitudes of residents may range from retreatism, to resistance, to boundary maintenance, to revitalization and adoption. · Some communities that are not enthusiastic about tourism may simply practice retreatismor avoiding contact with tourists. · When people feel so invaded, they may resort to forms of resistance to tourist intrusions. Resistance may take fairly passive forms like grumbling and gossiping about tourists or creating denigrating stereotypes about difficult tourists. · Boundary maintenance to regulate the interaction between hosts and tourists is a common response among certain cultures within the United States, like the Amish, Hutterites, or Mennonites, that do not really desire a lot of interaction with tourists. · A final response of host to tourists is revitalizationand adoption. Some communities have been revitalized economically by embracing tourism—like colonial Williamsburg and many towns in New England that feature colonial architecture.

Roles for Teachers and Students

· The culture clash over learning styles (the different ways that students learn in different cultures) and teaching styles (the styles that instructors use to teach) is common as students increasingly travel to study in other cultures. · In many universities, for example, students are assigned books to read before the end of the term and take one exam at the end of the term, rather than getting a structured reading list and assignments along the way.

Culturally Specific Education

· The development of Minority-Serving Institutions (MSIs) is also relevant to intercultural communication, as their history and mission can be quite different from other institutions. o For example, the Morrill Act of 1890 established what are today known as HBCUs, or historically Black colleges and universities. Alabama State, Delaware State, South Carolina State, Tennessee State, Grambling State, and Howard are all examples of HBCUs. · The following are the other types of MSIs: o Hispanic-Serving Institutions (HSIs), which must have at least 25 percent Hispanic students and include institutions such as California State University, Bakersfield, and Texas State University. o Tribal Colleges or Universities, which are typically controlled by a federally recognized tribe or otherwise categorized as such under federal law, such as Diné College, which is run by the Navajo Nation. o Native American-Serving Nontribal Institutions, which are higher education institutions not run by a tribe but with at least 10 percent Native American enrollment, such as Montana State University-Northern and Northeastern Oklahoma A & M College. o Alaska Native and Native Hawaiian Serving Institutions (ANSIs and NHSIs), which are institutions with at least 20 percent Alaska Native students or at least 10 percent Native Hawaiian students, such as the University of Alaska Southeast at Sitka and Chaminade University of Honolulu. o Asian American and Native American Pacific Islander-Serving Institutions (AANAPISIs), which must have at least 10 percent Asian American or Native American Pacific Islander student enrollment and at least 50 percent of students are economically disadvantaged, such as the University of Guam and the University of Hawai'i at Hilo. · In addition to the many cultural communities that already exist in the United States, immigrants bring new challenges to the education system. o In 2001, the DREAM Act was first introduced into the U.S. Senate. § Also known as the Development, Relief, and Education for Alien Minors, this act would allow immigrants who were brought to the United States as children a pathway to permanentresidency by either attending a higher education institution or serving in the U.S. military for at least two years and receiving an honorable discharge without any criminal activities. · Another issue that stems from immigration is the issue of bilingual education. Again, different states have taken different paths to working with students who do not speak English. · Religious educational institutions are another site where cultural values can influence the educational experience. · Some religious groups have established educational institutions to further their values in the educational context. Like gender and race, religion can also shape the educational experiences of students.

The Search for Authenticity

· The issue of authenticityis often a challenge in tourist-host encounters, particularly for those engaged in cultural or heritage tourism. Tourists can mistakenly believe that they have seen the authentic culture—when in fact the locals have altered their cultural traditions in order to please tourists—presenting what some scholars call staged authenticity.

Political and Environmental Impacts on Tourism

· The political, health, and environmental impacts on tourism also needs to be considered. How political events can impact the tourism industry dramatically has been seen. · Terrorist attacks and political instability can have devastating consequences for tourism. o For example, Turkey has been a very popular tourist destination for Western tourists and Istanbul—one of the best travel destinations in the world. § However, the 2016 attacks on busiest airport and other Turkish sites severely damagedthe tourism industry there—already suffering from the impact of the Syrian war on its border. o Likewise, tourism in the North African countries of Egypt and Tunisia has also been hit hard and has seen sharp decline in tourists. o Egypt experienced the passenger jet loaded with a bomb in the beach resort of Sharm el-Sheikh. o Gunmen opened fire at holidaymakers in Sousse, Tunisia; and in another incident, terrorists killed 22 people at the Bardo museum in Tunis. · The enormous effect of natural disasters on travel and tourism also needs to be mentioned. In addition to devastating loss of life and human suffering, the 2016 earthquake in Nepal and the extensive flooding in Chennai, India caused widespread economic distress. · Experts have estimated the relative impact of various disasters on tourism. In general, it takes approximately 13 months for a place to recover from a terrorist attack, according to research from the World Trade and Tourism Council (WTTC).

SocialNorms and Expectations

· There are many cultural norms that have implications for intercultural communication between tourists and hosts. Some of the most relevant are norms about public social behavior and shopping. · Norms regarding nonverbal behavior vary dramatically from culture to culture. And expectations about public behavior are no exception, ranging from very informal, as in the United States, to more formal, as in many countries. Sometimes the norms are related to religious beliefs and traditions. · In some cultures, strangers are expected to greet each other and interact in the streets. o For example, inEgypt and many North African countries, there is a great deal of interaction in the streets, with shopkeepers greeting everyone and children interacting with strangers, especially tourists. o In the United States, strangers may interact in some public contexts, such as in a line at a checkout counter, on an airplane, or at a sporting event. And people may smile at strangers. o However, in some countries, such as those in Europe, there is much less smiling at strangers. o In Japan, there is very little interaction, verbal or nonverbal, among strangers in public. · Communicationnorms involved in shopping vary from culture to culture.One shopping norm has to do with touching merchandise. o In the United States, shoppers are expected to touch the merchandise and try on clothing before making a purchase. o However, in many cultures, one does not touch merchandise and tries on clothing only if one is almost certain to buy. This is true in most countries in Europe. o Similarly, in Japan, the relationship between customers and shop clerks is very businesslike. People speak only when necessary. · A second shopping norm has to do with bargaining. Expectations about bargaining also vary from culture to culture. o In most transactionsin the United States, for example, the price for the merchandise is set and is not negotiated. o However, in many countries, shoppers are expected to bargain; through the act of bargaining, people are connected. o Some tourists find this very challenging and, given the differences in resources between tourist and host, confusing.

Domestic Growth

· There is increasing demographic diversity in the United States, and the workforce, business ownership, and consumer trends are becoming increasingly diverse as well. Business employees today are older, more likely to be female, include a growing number of disabled employees, and more ethnically diverse than in the past. · According to recent reports, the number of businesses owned by minorities increased dramatically in the past 10 years. o Latino-owned businesses recorded the largest increase—a 46 percent increase. o Black or African American-owned firms increased by 35 percent. o Asian American-owned firms recorded an increase of 24 percent. · Women are also playing a larger role in the marketplace. There were more than 10 million women-owned businesses in the United States in 2016, generating over $1.6 trillion. o The number of businesses owned by women of color in the United States has increased even more dramatically, growing by 215.7 percent and increasing revenues by 193 percent. · Consumer trends are also increasingly diverse. African Americans, Latinos, Asian Americans, and Native Americans have a collective buying power of $2 trillion, more than doubling in the past 15 years. o Asian Americans, the most affluent ethnic group, recorded a 180 percent increase in buying power from 2000. o Businesses also realize the enormous buying power of people with disabilities. The U.S. Census estimates that about 13 percent of all Americans are disabled—and steadily rising with the return of wounded military veterans. · One other minority group with increasing buying power is the lesbian, gay, bisexual, and transgender (LGBT) community. o Regardless of attitudes toward same-sex marriage, many states in the United States are poised to profit from wedding revenues. · This increasing diversification in both the workplace and the consumer market has tremendous implications for intercultural communication—from the supervisors who manage diverse workers, to employees who work with diverse coworkers and customers, to marketing and advertising specialists who craft meaningful messages encouraging diverse customers to purchase products.

Tourism, Intercultural Communication, and Social Media

· What is the role of social media in intercultural tourist encounters? There are at least three answers to this question: o In gathering pre-departure information o In tourism marketing o During the tourism experience · First, tourists can be much better prepared for intercultural encounters with the vast amount of online information, especially produced for tourism marketing campaigns. · Social media and the Internet make travel preparation easy and efficient, with useful info and recommendations about currency, lodging, language, transportation, and what to expect in terms of food and local cultural customs. However, people also need to think about how destinations are "packaged" and marketed. · A third consideration is how tourists use social media while visiting other countries and cultures. · However, some tourists may use social media to such an extent that they have little interaction with host-country nationals.