Complementary Alternative Approaches to Public Health Chpts 7-13

History of Hispanics in the United States

At the end of the Spanish-American War in 1898, the United States acquired Puerto Rico and has retained sovereignty. The Jones-Shafroth Act in 1917 established Puerto Ricans as U.S. citizens. • In the Caribbean, many Cubans and others have risked their health and lives trying to enter the United States by turning to smugglers who charge high fees, or they may resort to making homemade boats or traveling through foreign countries such as Mexico. History of Hispanics in the United States • According to the 2013 U.S. Census Bureau population estimate, there are roughly 54 million Hispanics living in the United States; 16.9% of the U.S. total population. - Fifty-five percent of Hispanics lived in California, Florida, and Texas as of July 1, 2013. • In 2012, among Hispanic subgroups: - Mexicans (64.3%) - Central and South Americans (14.9%) - Puerto Ricans (9.4%) - Cubans (3.7%) (U.S. Census Bureau American Community Survey, 2012) History of Hispanics in the United States (continued) • Hispanics tend to highly value the family. Families are very close, broadly defined, and emotionally and financially supportive. This characteristic is referred to a "famalismo." -The eldest male is typically the authority figure, and gender roles are traditional. - Important decisions are made by the whole family, not the individual, because they tend to have a collectivist type of social structure. - Respect (respeto) is fundamental to communication and relationships. -Elders are trusted, shown respect, and viewed as authority figures within the community. They often provide child care for the grandchildren. History of Hispanics in the United States (continued) • Hispanics place higher value on individuals as opposed to institutions. • They tend to trust and cooperate with individuals they know personally, and many dislike impersonal and formal structures. • Hispanic customers may identify a healthcare worker by name rather than by job title or institution. In a professional situation, many Hispanics expect to be addressed formally (e.g., Mrs. Martinez), but also personally (e.g., How are your children?) • The length of the social interaction is often viewed to be less important than the quality. History of Hispanics in the United States (continued) • With regard to communication, Hispanics tend to avoid conflict and criticism because they prefer smooth social relations based on politeness and respect. • Overt disagreement is not considered to be appropriate behavior. • Many Hispanics are characterized by warm, friendly, and affectionate relationships. • Personal space is close and frequently shared with family members or close friends. • Many Hispanics, particularly if they were not raised in the United States, may avoid direct eye contact with authority figures or in awkward situations. Many will nod affirmatively but not necessarily mean agreement. Silence may mean failure to understand and embarrassment about asking or disagreeing. History of Hispanics in the United States (continued) History of Hispanics in the United States (continued) • Family is considered a reliable source of health information and can be influential in health-seeking behaviors. • They generally have a fatalistic worldview and an external locus of control and this effects their help-seeking behaviors as well. • Poor health is believed to be the fault of the individual and hence illness is a punishment from God. History of Hispanics in the United States (continued) • Expressing negative feelings is considered impolite, therefore Hispanics may not complain when health problems occur. • Modesty and privacy are important to them. • Sexuality issues are difficult to discuss. Often the word for sex (sexo) is not even used; tener relaciones (to have relations) is used instead

Policy Changes and Laws (continued)

California • Assembly Bill 1195 requires mandatory continuing medical education courses to include cultural and linguistic courses. • SB 853 requires commercial health plans to ensure members' access to linguistic services and to report to state regulators steps being taken to improve the cultural competency of their services. • Medi-Cal, requires all health plans providing services for Medicaid patients to ensure their linguistic needs are met, including 24-hour access to interpretive services and documents in native languages.

dancing

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Tips for working with American Indian and Alaskan Native Populations

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TERMINOLOGY

Called by many terms such as Indians, American Indians, Native Americans, indigenous Americans, the U.S. Census Bureau now identifies this population as anyone having origins in any of the original peoples of North and South America who maintains a tribal affiliation or community attachment. • Probably none of these terms are accurate because they are derived both from mistaken identity of peoples by Columbus as East Indians and the subsequent naming of the country after a post-Columbian Italian explorer and map maker, Amerigo Vespucci. Alaskan Native people prefer to be referred to by the society with whom they themselves identify, e.g., Navajo and Blackfeet prefer being identified with their specific tribe or nation. • American Indian and Alaskan Native refers to a classification of people and broad group of cultures such as when someone refers to "European." It is intended as a neutral and all encompassing term for pre-Columbian cultures located in North America.

Terminology

and applies to persons having origins among any of the original peoples of Europe, the Middle East, or North Africa. • That is a very broad area that encompasses numerous ethnic and cultural groups. That have fundamentally shaped life throughout the United States and as a result shaped the delivery of health care as well. This chapter addresses the dominant culture of the United States that can generally be described as European-Mediterranean. • This cultural group is generally aligned with what the U.S. Census Bureau's terms as "whiteThis chapter addresses the dominant culture of the United States that can generally be described as European-Mediterranean. • This cultural group is generally aligned with what the U.S. Census Bureau's terms as "white" and applies to persons having origins among any of the original peoples of Europe, the Middle East, or North AfricaThat is a very broad area that encompasses numerous ethnic and cultural groups. That have fundamentally shaped life throughout the United States and as a result shaped the delivery of health care as well

Increasing Access to Health Care

Lack of access to the modern health care system is generally based on economic barriers. • In March 2010, President Obama signed a comprehensive health reform, the Patient Protection and Affordable Care Act (ACA) into law. • ACA intended to make preventive care—including family planning and related services—more accessible and affordable.

Caring for Hispanic Patients

Make sure to greet and acknowledge everyone in the room, even the children. • Do not act rushed during the appointment. • It is better to ask "How can I serve (help) you today?" Rather than "How are you?," which may be taken as a greeting and be answered "Fine and you?" • Avoid instant familiarity, especially when meeting a new person such as during an initial office visit

Healing Traditions, Healers, and Healing Aids (continued)

•Roma (continued) −Some diseases are caused by spirits or the devil. One spirit, called Mamioro, spreads disease among dirty houses, so keeping a clean home is imperative. The devil has been known to cause nervous diseases. Herbs and rituals are utilized to address these problems.

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Strategies for Reducing or Eliminating Health Disparities (continued)

Additional strategies include: • Research • Improving the Environments of People Affected by Health Disparities • Increasing Access to Health Care • Improving Quality of Care • Policy Changes and Law

Healing Traditions, Healers, and Healing Aids

Many healing traditions and rituals focus on harmony, and the overall purpose is to bring participants into harmony with themselves, their tribe, and all of life. • Healing occurs when someone is restored to harmony and connected to universal powers. • Traditional healing is holistic; focuses on the person, not the illness, so the process does not focus on symptoms or diseases, because it addresses the total individual. Healing Traditions, Healers, and Healing Aids (continued) • Plants: American Indians use herbs to purify the spirit and bring balance to people who are unhealthy in spirit, mind, or body. A few of the herbs will be covered here: - Sage: Believed to protect against bad spirits and to draw them out of the body or the soul. American Indians use sage for many purposes, such as to heal problems of the stomach, colon, nasal passages, kidneys, liver, lungs, pores of the skin, bones, and sex organs; to heal burns and scrapes; as an antiseptic for allergies, colds, and fever; as a gargle for sore throat; and as a tea to calm the nerves. Healing Traditions, Healers, and Healing Aids (continued) - Cedar: A milder medicine than sage. It is combined with sage and sweetgrass to make a powerful mixture used in sacred ceremonies. Cedar fruit and leaves are boiled and then drank to heal coughs. For head colds, cedar is burned and inhaled Cedar: A milder medicine than sage. It is combined with sage and sweetgrass to make a powerful mixture used in sacred ceremonies. Cedar fruit and leaves are boiled and then drank to heal coughs. For head colds, cedar is burned and inhaled. Cedar: A milder medicine than sage. It is combined with sage and sweetgrass to make a powerful mixture used in sacred ceremonies. Cedar fruit and leaves are boiled and then drank to heal coughs. For head colds, cedar is burned and inhaledCedar: A milder medicine than sage. It is combined with sage and sweetgrass to make a powerful mixture used in sacred ceremonies. Cedar fruit and leaves are boiled and then drank to heal coughs. For head colds, cedar is burned and inhaled Healing Traditions, Healers, and Healing Aids (continued) - Tobacco, often smoked in medicine pipes, is one of the most sacred plants to American Indians. When they smoke sacred tobacco and other herbs, their breath, which they consider to be the source of life, becomes visible. - used in some way in nearly every cure - smoked pure and is not mixed with chemicals - Peyote is a spineless, dome-shaped cactus (Lophophora williamsii) that is native to Mexico and the southwest United States. Peyote has a history of ritual religious and medicinal use among certain American Indian tribes going back thousands of years. Peyote is legal only on Indian reservations because of its spiritual and healing properties. Healing Traditions, Healers, and Healing Aids (continued) • Ceremonies such as sand painting, False Faces, medicine wheels, and dancing are used to help groups of people return to harmony; they are not used for individual healing • Many American Indians first consult a medicine man in belief that the treatment from the traditional healer is better than from health care establishments. Healing Traditions, Healers, and Healing Aids (continued) • Sweat lodges: Used for healing and balancing. They are considered to: - Clean one's body - Help sweat out illness or disease • Hot stones covered in water are placed in a small, confined, dark enclosure, creating a steam bath. The stones, considered by American Indians to be their oldest living relatives, are usually lava rocks that do not break when heated. They use sweat lodges in many ways, such as before spiritual undertakings, to bring clarity to a problem, to call upon helpful spirits, and to reconnect with the Great Spirit.

Considerations for Health Promotion and Program Planning (continued)

Considerations for Health Promotion and Program Planning (continued) • Be aware that many Amish do not have health insurance. • Transportation can be challenging for Amish as many travel via horse and buggy. • Telephones are not permitted in the Amish home, which may delay communication. • In working with Roma Americans, the following issues should be considered: Understand that illness is an issue for the entire society, and the entire clan will be involved in visiting the sick person in the hospital. Considerations for Health Promotion and Program Planning (continued) Recognize the primacy of the elders in the family and the clan in making decisions. Always remember the importance of what is considered to be clean and unclean and provide separate soap, washcloths, and towels for the upper and lower body parts. Understand that this population is mistrustful of non-Roma people and things. Understand that Roma Americans are an ethnocentric culture and believe that they must be provided with the best doctors and treatment even if such treatment is not indicated. Considerations for Health Promotion and Program Planning (continued) • A number of points that should be considered when dealing with Arab and Middle Eastern Americans in health care include the following: • Arab and Middle Eastern Americans prefer treatment by a medical provider of the same gender, especially for women. • Arab and Middle Eastern Americans consider nurses to be helpers, not healthcare professionals, and their suggestions and advice are not taken seriously. • Arab and Middle Eastern Americans prefer treatment that involves prescribing pills or giving injections rather than simple medical counseling. Considerations for Health Promotion and Program Planning (continued) • Orthodox Muslims follow a halal (Muslim diet), which prohibits some types of meat, like pork, and medications and foods that contain alcohol. • Meat needs to be prepared according to Islamic requirements. • Also, provide for religious requirements for prayer as often as five times a day, starting before sunrise and ending at night, and provide fasting during the holy month of Ramadan between sunrise and sunset. • Although those who are ill are exempted from this practice, devout Muslims may desire to fast anyway. Considerations for Health Promotion and Program Planning (continued) • Allow for receipt of food into the right hand for Muslim patients. The left hand is considered to be unclean because it is used for cleaning during toileting. • Respect modesty and privacy. • Allow for visits and input by the imam, a prayer leader. Tips for Working with the EuroMediterranean Population • The European-Mediterranean culture is so diverse that rather than provide tips for each sub-culture, this section includes tips for caring for peoples of all cultures. • Every person is unique, so place yourself in your patients' shoes and consider their unique beliefs, needs, and concerns as you interact with them. Treat your patients as they would like to be treated. • Ask your patients if this is their first visit. If so, take a few moments to orient them. Patients who are new to the system may not know the roles of their health care team, how to report for an appointment or other health care matters that patients already in the system may know

Introduction

Europeans "discovered" America and fashioned to a new lifestyle that became the dominant model for the modern United States lifestyle. • They brought a mix of cultural practices and fundamental beliefs in part based on Christianity, Judaism, and Islam. • The current health system in the United States reflects much of the views of this population.

Health Disparities

Health Disparities • Healthy People 2020 is designed to achieve four overarching goals: 1.Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. 2.Achieve health equity, eliminate disparities, and improve the health of all groups. 3.Create social and physical environments that promote good health for all. 4.Promote quality of life, healthy development, and healthy behaviors across all life stages.

Tips for Working with the EuroMediterranean Population (continued)

Tips for Working with the EuroMediterranean Population (continued) • If English is the patient's second language, or the patient is deaf/hard of hearing or has vision impairment, make sure to involve an interpreter in all of your care discussions. • Do not rely on family members to translate health information. Your patients may include many family members in their care and care decisions. • Use the terms "partner" or " spouse " rather than "husband" or "wife" to avoid making assumptions about sexual orientation. Ask about preferences before acting. Pay attention to patient cues and follow their lead. If they do not establish eye contact or refuse to shake your hand, a cultural custom or spiritual belief may be guiding their behavior. Tips for Working with the EuroMediterranean Population (continued) • Ask your patients how they would like to be addressed, and remember to continue calling them by their preferred name. • Tell your patients why you think they are meeting with you after you ask them why they think they are there. Ask your patients what their goals are for their visit. Remind them they are an active partner in their care plan. • Ask what cultural, religious, spiritual, or lifestyle beliefs may impact the kind of health care the patient wants to receive and document these preferences so other providers can honor them. Continuity of cultural appropriateness within the care team is essential. This is particularly important when you ask who else in their life needs to be involved in making medical decisions about care. Tips for Working with the EuroMediterranean Population (continued) • Ask the patient to "teach back" the information you give them and then document their understanding. • Offer choices for treatment options. • Use open-ended questions (instead of yes/no questions) to make sure you and your patients share a common meaning. • Acknowledge and respect your patients' interpretations of their illnesses. Tips for Working with the EuroMediterranean Population (continued) • Listen carefully. When you talk with your patients, let them know you are listening by nodding your head that you understand. Maintain eye contact if that is their norm, or avoid eye contact if that is their norm. • Remain on the same physical level as much as possible with your patient. Tips for Working with the EuroMediterranean Population (continued) • Explain to your patients what you are writing as you take notes. After you are done taking their medical history, give your patients another opportunity to bring up something they may have omitted or did not feel comfortable talking about at first (especially if this is their first visit with you). They may feel more comfortable discussing something further into the visit. • Tell your patients what you are doing and what they will feel if you are doing an exam, procedure, or other care that involves physically touching them. Summary • People who are characterized as EuropeanMediterranean, or generally associated with the group defined as white by the U.S. Census Bureau, a

American Indian and Alaskan Native Populations in the United States

(continued) • Most tribes generally believe in a Supreme Creator and also have lesser deities and mediators between the spirit world and the earth. • They believe that people should try to maintain constant, daily harmony and contact with the Creator and treat all life (people, animals, plants, rocks, rivers, rainbows, etc.) with respect. • They are a family-based people, taught to respect their elders and obey them. • Elders are seen as people with much knowledge and are considered to be the head of the household lly believe in a Supreme Creator and also have lesser deities and mediators between the spirit world and the earth. • They believe that people should try to maintain constant, daily harmony and contact with the Creator and treat all life (people, animals, plants, rocks, rivers, rainbows, etc.) with respect. • They are a family-based people, taught to respect their elders and obey them. • Elders are seen as people with much knowledge and are considered to be the head of the household.Men are considered to be the leaders of the house and viewed as the leaders of the tribe, protectors, and fighters. • Women are viewed as the people who are responsible for housework and to teach the children the ways of the people. • Children have to learn the traditions of the tribe and community and have to respect the elders. • Older family members keep an eye on the new generation to make sure that they are following traditions. • They believe in living as a community. To be a member of the community, a person does not need to be from the same tribe or even have blood relations with anyone from the community.

Caring for Hispanic Patients (continued)

After you have explained something to your patient, use inquiring comprehension checks such as, "Tell me what I am proposing to do" because "Do you understand?" may be misunderstood as an insult. • Remember Latinos embrace alternative therapies and healers. • Also remember that decisions may need to be made in consultation with family members who may not be present.

Pregnancy, Birth, and Child Rearing

Although Hispanics have more conservative attitudes toward sexuality than whites or blacks, they are more likely to enter sexual relationships at a young age. • In 2010, Hispanic females aged 15 to 19 had a birthrate higher than any other racial or ethnic group and was approximately twice as high as non-Hispanic whites. • At the prenatal state avoiding foods that are considered "hot" (spicy or physically hot) by their culture is thought to be beneficial because they believe hot foods can cause the baby to be born with spots and be susceptible to rashes. • During labor and delivery medication is thought to be detrimental to the baby as is screaming during labor. Make-up is not worn during the labor and delivery. Pregnancy, Birth, and Child Rearing (continued) • Some Hispanic traditions hold that the mother and child should be in the "Quarentena" for about 40 days after the birth. • Child rearing is consistent with the concepts of formality, distinctly defined parental roles, and extended family. • Older children often have significant responsibility for younger siblings or relatives, and are often actively engaged in the care of older members of the family. Pregnancy, Birth, and Child Rearing (continued) • Grandparent involvement in child rearing not only helps the parent but also helps engender a deep sense of family loyalty in the child and a sense of responsibility for providing extended social support to other family members, including the elderly. • Adolescents report similar levels of conflict and cohesion with their parents as teenagers of other groups. Nutrition and Diet • Many Hispanics retain core elements of the tra

Pregnancy, Birth, and Child Rearing

Although each American Indian and Alaskan Native culture had its own beliefs and rituals, there are many descriptions of child birth practices involving the pregnant woman secluding herself, with perhaps a woman helper, and having private birth experiences out of the sight of men. • Early accounts of the childbirth practices of the American Indian population indicate that pregnant women were to limit their activities and watch their diet and behavior to protect the baby. • Certain foods might affected the fetus and cause unwanted physical defects.

History of American Indian and Alaskan Native Populations in the United States

American Indian and Alaskan Native people are descendants of the first humans who migrated fromAsia and Europe to North America about 30,000 years ago. • The European migration initiated what is sometimes called the Columbian Exchange and began in the 15th century. - Horses were introduced from Europe - Potato, tomatoes, and corn were transferred from Americas - Diseases exchanged in both directions

Nutrition and Diet

American Indian and Native Alaskan populations believe that certain foods are sacred. - Some believe the Great Spirit Hashtali gave the people corn as a present, so it is considered to be sacred. - Another sacred food is blood soup, which is made from a mixture of animal blood and corn flour cooked in broth. • At marriage ceremonies, the bride and groom exchange food instead of rings. Diet and food practices have changed possibly more than any other group in the United States and generally resembles that of the U.S. white population. • Yet some American Indian food is now part of the diet of the general population, including succotash in the South, wild rice dishes in the northern Plains, pumpkin soup in New England, chili in the Southwest, broiled salmon in the Pacific Northwest, and corn on the cob in most areas of the country. • For Alaskan Natives, there is continued substantial reliance on many subsistence foods such as fish, terrestrial mammals, marine mammals, and wild plants. American Indian and Alaskan Native populations experience similar mental disorders in rates to the overall population. • The most significant mental health issues are depression, substance abuse, and anxiety, including posttraumatic stress disorder. • In some groups, alcoholism and illicit drug use disorder rates are much higher than the U.S. average. Even among groups of American Indians/Natives with high rates of alcohol abuse, most Indian people are not alcoholics. • However, American Indians/Alaskan Natives have rates of binge drinking higher than the national average. • Often physical concerns and psychological concerns are not separated. • Emotional distress may be expressed in different ways. The words "depressed" and "anxious" were not part of the American Indian/Alaskan Native languages

Behavioral Risk Factors and Common Health Problems

Behavioral Risk Factors and Common Health Problems • Amish − Many have few behavioral risk factors due to various healthpromoting behaviors, which, among the adult population, include low rates of tobacco use and alcohol consumption, high levels of physical activity, and low levels of obesity. However, the Amish are cautious and conservative and may refuse health care services. • Roma − In Romani culture, the larger a person is, the luckier he or she is considered to be. − A thin person is considered to be ill and to have poor luck. Behavioral Risk Factors and Common Health Problems (continued) •Roma − As a group, many are resistant to immunization because it does not comport with their beliefs regarding purification. Thus, they are at risk for many communicable diseases. − Their diet is high in fat and salt. A great percentage smoke and are obese. These practices put them at risk for cardiovascular disease, hypertension, and diabetes. − The closeness of living conditions leads to an increased risk of infectious diseases such as hepatitis. − Romani children are more likely to be born prematurely or with low birth weight, and the increased incidence of consanguineous marriages has led to an increased risk of birth defects. Behavioral Risk Factors and Common Health Problems (continued) •Middle Eastern − As a group, Arab and Middle Eastern Americans face the same health concerns as the majority of European Americans. − Recent immigrants may be at greater risk for certain inborn genetic disorders as a result of interfamily marriages. − Otherwise, their health risks mirror the majority of the population, with heart disease and cancer among the major morbidity factors. − Smoking is highly ingrained in the Arab culture and hence, they have high smoking rates. − Due to modesty, screening rates are low. Behavioral Risk Factors and Common Health Problems (continued) • 10 leading health problems for European peoples may be directly related to living a comparatively affluent lifestyle. The leading causes of death include: 1.Heart disease 2.Cancer 3.Chronic lower respiratory disease 4.Stroke 5.Unintentional injuries 6.Alzheimer's disease 7.Diabetes 8.Influenza and pneumonia 9.Nephritis, nephrotic syndrome, and nephrosis 10.Suicide Qui

Behavioral Risk Factors and Common Health Problems (continued)

Behavioral Risk Factors and Common Health Problems (continued) • The 10 leading causes of death among American Indians and Alaskan Natives in 2010 were as follows: 1. Cancer 2. Heart disease 3. Unintentional injuries 4. Diabetes 5. Chronic liver disease and cirrhosis 6. Chronic lower respiratory disease 7. Stroke 8. Suicide 9. Nephritis, nephrotic syndrome, and nephrosis 10. Influenza and pneumonia

History of American Indian and Alaska Native Populations in the United States (continued)

Many steps were taken to "civilize" these populations and to change their cultural practices: - Prohibiting them to speak their native language - Creating Indian boarding schools to keep children from their tribal setting • The Indian Citizenship Act of 1924 gave U.S. citizenship to American Indians, in part because: - Many wanted to see them merged with the Aeps were taken to "civilize" these populations and to change their cultural practices: - Prohibiting them to speak their native language - Creating Indian boarding schools to keep children from their tribal setting • The Indian Citizenship Act of 1924 gave U.S. citizenship to American Indians, in part because: - Many wanted to see them merged with the American mainstream - The service of many American Indian and Alaskan Native veterans in World War Imerican mainstream - The service of many American Indian and Alaskan Native veterans in World War

Nutrition and Diet

Nutrition and Diet • The worldview of the majority culture in the United States contributes both to improve health and harm it. • A self-sufficient and autonomous individual is free and is expected to take care of his or her own health. • The importance of individual achievement has led many to be highly active in pursuing health through nutrition regimens, physical fitness routines, and commercial programs. Nutrition and Diet (continued) • For those without discipline, the "problem solving through science" approach has resulted in commercial health care providing cosmetic surgery to enhance beauty, sex appeal, and weight loss through such cosmetic procedures as lip enhancement, breast implantation, and liposuction and intestinal bands to reduce weight and improve appearance. • On the other hand, a cultural emphasis on autonomy allows for self neglect and abuse such as smoking and drinking to excess.

Strategies for Reducing or Eliminating Health Disparities (continued)

Goal 4: Cultural and linguistic competency. Improve cultural and linguistic competency and the diversity of the health-related workforce. • Goal 5: Data, research, and evaluation. Improve data availability, coordination, utilization, and diffusion of research and evaluation outcomes. Strategies for Reducing or Eliminating Health Disparities (continued) • HHS Action Plan to Reduce Racial and Ethnic Health Disparities • Includes transforming health care and expanding access • Builds on the provisions of the Affordable Care Act related to expanded insurance coverage and increased access to care • Include 5 goals • Five goals include: 1. Transform Health Care 2. Strengthen the Nation's Health and Human Services Workforce 3. Advance the Health, Safety, and Well-Being of the American People 4. Advance Scientific Knowledge and In

Healing Traditions, Healers, and Healing Aids

Healing Traditions, Healers, and Healing Aids • Amish −The Amish have been known to utilize reflexology, which is the practice of applying pressure to specific parts of the feet and hands to affect the nervous system. The Amish utilize chiropractic procedures and brauche practices in which the brauche healer lays his hands over a patient's head or stomach while quietly reciting verses to "pull out" the ailment. −Amish women try to limit their use of technology, even during pregnancy and while giving birth. Healing Traditions, Healers, and Healing Aids (contin

INTRODUCTIONS

Communities are based on the tradition of strong family relationships (referred to as familismo). • Building on a general framework of respect and Catholic beliefs, there is a sense of class and hierarchy within Hispanic families. • Others are integrated into their community through understanding and the development of rapport between friends and business associates. • Modern medicine and traditional practices are used within a context of cohesive families and mutual support

Healing Traditions, Healers, and Healing Aids

Healing Traditions, Healers, and Healing Aids • Hispanics generally look to standard primary care doctors and facilities for care. • On a secondary basis, Hispanics may rely on some traditional healing traditions. • Hispanic cultures view illnesses, treatments, and foods as having hot or cold properties, although how these are ascribed may vary by country of origin. • Some Hispanics consider health to be the product of balance among four body humors (blood and yellow bile are hot, phlegm and black bile are cold)

Considerations for Health Promotion and Program Planning (continued)

Considerations for Health Promotion and Program Planning (continued) • Holistic thinking is common and should be used to identify appropriate and acceptable prevention and treatment plans. • Try to accommodate complementary and alternative forms of healing. • Do not be surprised or offended by a hand shake that is softer or gentler than you are accustomed to. • Be patient with silence, and give the listener time to reflect on what you said prior to responding. Considerations for Health Promotion and Program Planning (continued) • Prolonged eye contact should be avoided, because it is viewed as being disrespectful. • Work with the families and remember that elders are respected. • Do not encourage or try to reward competitive behavior, because cooperation is valued by these cultures. Considerations for Health Promotion and Program Planning (continued) • Do not appear to be in a hurry, because it may give a negative impression of you. • Do not interrupt the person who is speaking, because it is considered to be extremely rude. • Keep nonverbal communication to a minimum. • With the exception of a hand shake, touch is not usually acceptable. • Remember that listening is more valued than speaking. Considerations for Health Promotion and Program Planning (continued) • Be aware that suspicion and mistrust may exist. • When developing community programs, involve the community members. • Be aware of superstitions such as unlucky and lucky numbers and colors. • Consider the incorporation of talking circles in

Tips for Working with the Hispanic Population

Convey respect and some formality combined with demonstration of personal interest. • Traditional family values, diet, reliance on modern medicine, and respect for authority should be encouraged and reinforced. • It may be useful to mention the importance of retaining traditional values and practice rather than abandoning them to be more like the majority in the U.S., which could be detrimental to their health both physically and mentally. Cari

Cultural-Bound Illnesses

Cultural-Bound Illnesses • A unique part of the Amish culture is Rumspringa, which means "running around." This practice is the focus of a documentary directed by Lucy Walker entitled Devil's Playground. Walker describes Rumspringa as a time when adolescents are free to explore the world outside of the Amish culture. Rumspringa is practiced by young males and females between the ages of 16 and 21 years. During this period, individuals may partake in activities of their choosing, which may include drinking alcohol, using illicit drugs, and experimenting with sexual activities. Rumspringa ends when the young person makes the decision to either live in the outside world or become baptized within the Amish community. • Roma and recent Middle Eastern immigrants may be at increased risk of birth defects due to inter-marriage.

Cultural-Bound Illnesses

Cultural-Bound Illnesses • Susto (literally "fright" in Spanish): Illness that occurs from a frightful experience. It is similar to anxiety in modern medicine. Symptoms include withdrawal from social interactions, listlessness, not sleeping well, and loss of appetite. • Mal de ojo (aka evil eye): Illness that is a result of an envious glance from another individual. It mostly affects children. It has been defined as a hex caused by a gaze from a more powerful or stronger person looking at a weaker person. • Empacho (blocked intestines): Describes stomach pains and cramps that are believed to be caused by a ball of food clinging to the stomach due to altered eating habits, eating spoiled food, overeating, and swallowing chewing gum. Healing Traditions,

Death and Dying

Death and Dying • The great variety of subcultures within the European population results in a variety of beliefs and rituals associated with death. • Overall, the philosophy of being autonomous does transfer to death as well, e.g., use of advance directive, hospice programs, and other end-of-life care issues. Mentally competent patients have the right to refuse medical care and make decisions on life-extending treatments, such as artificial life support. The Death with Dignity Act is another example of this end-of-life autonomous decision making. • A great many Christians associate death with old age and something that will be handled later and is not necessary to think about today

Death and Dying

Death and Dying • There is a great variety of beliefs across the various populations. • Some cultures do not speak of death, dying, or of negative outcomes to medical procedures, because any mention might cause a negative outcome. • Other tribal communities have no difficulty speaking directly about death or dying situations, and wish to have all the information available (e.g., some Pueblo, Lakota, northern plains, mid-western, and northeastern tribes). Death is a natural part of the circle of life.

Death and Dying

Death and Dying • Women tend to care for the seriously ill and dying while men tend to stay close but are usually somewhat separate from actually providing care. • Death rites are derived from Catholic Church customs and generally include confession and last rites. • Based on both family respect and religious custom, funerals usually involve burial and often include a wake or social gathering where food is served and the life of the deceased is remembered positively and without grim morning. • Latino patients have lower rates of advance directive care than non-Hispanic whites, but this is attributed to language barriers rather than mistru

Death and Dying (continued)

Death and Dying (continued) • Muslims, on the other hand, are taught to believe death may occur any day and thus the importance of five daily prayers. • Upon death, most will be cremated or buried with some, such as the Irish, celebrating life with wakes, and others, such as Jewish and Muslims, expressing various degrees of seriousness and sadness. • After death, some Christian-based believers may establish elaborate burial events and monuments while Muslims conduct prompt and simple and modest burials. • The first year after death is often seen as a year of mourning and remembrance. Muslims especially honor the death for 40 days after death. Muslim women are not allowed to visit cemeteries. Cultural-B

Healing Traditions, Healers, and Healing Aids (continued)

Healing Traditions, Healers, and Healing Aids (continued) •Amish (continued) •Women use a medley of herbs, called 5-W, five weeks before their pregnancy ends. These herbs include a mixture of red raspberry leaves, black cohosh root, butcher's broom root, dong quai root, and squaw vine root. The formula is believed to ease the labor by quieting the nerves and relaxing the uterus. •Roma •Health treatment is the prerogative of the older women of the clan who are known as drabarni, women who have knowledge of medicines. Roma diseases are not connected to gadje diseases and can only be cured by Roma treatments.

TERMINOLOGY

Subgroups are know by various terms since Hispanics are from 20 different countries - Latin America: countries in the Americas that speak languages derived from Latin, e.g., Spanish, Portuguese, French - Hispanic (derived from the Spanish word Hispano): an ethnic group sharing culture derived from the Spanish - Latino: everyone from Latin America, e.g., people from Brazil (who speak Portuguese) - Hispanic: not a race but an ethnic distinction Chicano: more exclusive term used solely in reference to people of Mexican

Euro-Mediterranean Americans in the United States (continued)

Euro-Mediterranean Americans in the United States (continued) • One result of these cultural and religious practices is a variety of dietary practices and restrictions. Eating fish on Friday, not eating pork ever, avoiding alcohol, and fasting for fasting for periods of time are practices in a variety of beliefs. • Due to their majority in population, the EuroMediterranean population culture dominates the political process at all levels of government and controls all government regulation of health care in the country.

History of Euro-Mediterranean Americans in the United States

Europeans purposefully came to North America to gain wealth and opportunity and avoid harassment or economic hardship. • Early settlers included Spanish, French, and English in what is now the lower 48 states and Russia in the area what would become Alaska. • None came to integrate and adapt to the peoples already on the continent. • Compared to the population of Europe, North America seemed empty and wild. • All came prepared to be self-sufficient and focused on establishing communities of their own kind and eventually being free from the control of European countries.

Healing Traditions, Healers, and Healing Aids (continued)

Healing Traditions, Healers, and Healing Aids (continued) • Curandero (or curandera for a female): Traditional folk healer or shaman who is dedicated to curing physical and/or spiritual illnesses. The curandero is often a respected member of the community and is highly religious and spiritual. • Santeria (aka Way of the Saints): An Afro-Caribbean religion based on beliefs of the Yoruba people in Nigeria, Africa. The traditions have been influenced by Roman Catholic beliefs. Practices include animal offerings, dance, and appeals for assistance sung to the orishas, which resemble the Catholic saints. • Espiritismo is the Spanish word for "Spiritism." It is the belief in Latin America and the Caribbean that good and evil spirits can affect human life, such as one's health and luck

General Beliefs About Causes of Health and Disease Prevention (continued)

General Beliefs About Causes of Health and Disease Prevention (continued) • Amish −The Amish believe that sin is the cause of illness; therefore, their approach to health care in the United States is unique compared to other white Americans. −They tend to approach health care as organically as possible with the use of holistic, natural, herbal, and folk medicine, which are readily accessible in Amish communities. • Roma −Their beliefs regarding health and illness stem from two concepts: impurity and fortune. The first concept is related to the ideas of wuzho (pure) and marime (impur

Pregnancy, Birth, and Child Rearing

Generally, self-reliance and autonomy lead to a view that children are raised to adulthood and "leave home." • Family relationships do continue, however there is a looser association to what is called "extended families" in other cultures. • Parents have independent authority over their own children and grandparents are not necessarily as influential as in extended families

Summary

Summary • People who are characterized as EuropeanMediterranean, or generally associated with the group defined as white by the U.S. Census Bureau, are not composed of just those of northern European desc

Healing Traditions, Healers, and Healing Aids (continued

Healing Traditions, Healers, and Healing Aids (continued) •Middle Eastern −Almost all Middle Eastern people believe in maintaining good health through hygiene and a healthy diet. −Many are modest and may refuse treatment by practitioners of the opposite gender. This modesty of women contributes to low rates of screenings, e.g., Pap tests, mammograms. −Iraqis have a significant history of traditional healing practices. • Cumin, in conjunction with various other ingredients, is used to treat fever, abdominal pain, and tooth pain. • Respiratory complaints are treated with honey and lemon. • Infertility can be treated by a placenta being placed over the doorway of the infertile couple's home. Healing Traditions, Healers, and Healing Aids (continued) •Middle Eastern −Many believe pregnant woman should satisfy their cravings, otherwise they will develop a birthmark in the shape of the food that they crave. − Middle Eastern diets have the following characteristics: •Dairy products. The most common dairy products are yogurt and cheese; feta cheese is preferred. Milk is usually only used in desserts and puddings. •Protein. Pork is eaten only by Christians and is forbidden by religion for Muslims and Jews. Lamb is the most frequently used meat. Many Middle Easterners will not combine dairy products or shellfish with the meal. Legumes, such as black beans, chickpeas (garbanzo beans), lentils, navy beans, and red beans, are commonly used in all dishes. Healing Traditions, Healers, and Healing Aids (continued) • Breads and cereals. Some form of wheat or rice accompanies each meal. • Fruits. Fruits tend to be eaten as dessert or as snacks. Fresh, raw fruit is preferred. Lemons are used for flavoring. Green and black olives are present in many dishes, and olive oil is most frequently used in food preparation. • Vegetables. Vegetables are preferred raw. Healing Traditions, Healers, and Healing Aids (continued) •Middle Eastern − The Mediterranean diet pyramid is shown in Figure 11.1. Behavi

Health care reform

Health care reform includes strategies and steps to eliminate health disparities. • Strategies include diversifying the health care workforce, changing policies, training healthcare professionals in cultural competence, and conducting research.

General Beliefs About Causes of Health and Disease Prevention

Health is generally viewed as being and looking clean, being able to rest and sleep well, feeling good and happy, and having the ability to perform in one' s expected role as mother, father, or worker. • A person's well-being depends upon a balance in emotional, physical, and social factors, and when they are not in balance, illness occurs. • Some attribute physical illness to los nervios, believing that illness results from having experienced a strong emotional state and try to prevent illness by avoiding intense rage, sadness, and other emotions. Worldview • Hispanics tend to value closeness, so touching and embracing is common. • Sustained eye contact with an older person is considered rude; direct eye contact with superiors is viewed as being disrespectful. This may not be relevant to second and third generational Hispanics. • Using formal names and greeting with a handshake is a sign of respect and hence, it how healthcare providers should address and greet Hispanics. Worldview (continued) • Inquiring about family before discussing the health issues is a way of gaining trust. Healthcare providers should engage in "small talk" before addressing the patient's health concerns. • Hispanics tend to be present-oriented, which is why disease prevention may not be a priority. • They have a fatalistic worldview and believe that their health is in God's control.

Hispanic Paradox

Hispanic Paradox • In 1986, Kyriakos Markides coined the expression "Hispanic epidemiological paradox" for the surprisingly good health outcomes for Hispanics. • Mortality among Hispanic males was 26% lower in 2012 than non-Hispanic white males. • Mortality among Hispanic females is 39% lower for non-Hispanic white females. • In 2013, a review of 58 studies showed Hispanic populations had a 17.5% lower risk of mortality compared with other racial groups. General Beliefs About Causes of Health and Disease Prevention • Health is generally viewed as being and looking clean, being able to rest and sleep well, feeling good and happy, and having the ability to perfo

History of Euro-Mediterranean Americans in the United States (continued)

History of Euro-Mediterranean Americans in the United States (continued) History of Euro-Mediterranean Americans in the United States (continued) • Self reliance and autonomy has forged the health care system based on individual insurance coverage and the belief the individuals should take proper steps to take care of themselves and their family without interference from others. • Development of the scientific method and the industrial revolution contributed to a concept that man could analyze nature and identify or invent solutions to almost anything from curing diseases, such as yellow fever, to developing ways to sustain biologic organisms, such as man in space. • Overlaying these is a predominant and fundamental Christian belief in charity and taking care of the truly needy by originally providing charity hospitals and ultimately universal emergency medical care by local governments. History of Euro-Mediterranean Americans in the United States (continued) • The structure of the Affordable Care Act is still fundamentally influenced by the free enterprise, self reliant view of European Americans with health insurance available through "free marketplace" health exchanges operated by states or, to some people's dismay, the federal government. • While not participating in the initial territorial conquest and political development of the united states, the peoples of the Middle East and North Africa immigrated to participate in the opportunities in the country. • These peoples brought a culture based on the third great religion, Islam, which traces its beliefs to Abraham Judaism and Christianity. The culture has contributed to both the science and ethics of health care in the United States. Euro-Mediterranean Americans in the United States • European Americans represent about 72% (223.6 million) of the current population of the United States. • The population is a diminishing percentage of the population states as Hispanic and Asian populations grow. • The Census Bureau projects that by the year 2060, white Americans will comprise less than 50% of the total United States population. Euro-Mediterranean Americans in the United States (continued) • The culture of Euro-Mediterranean people is not uniform and is made up of a rich complexity of cultures scattered throughout the country, with the highest concentrations in Midwest and Northeast, especially Maine, New Hampshire, Vermont, Iowa, North Dakota, West Virginia, Montana, Idaho, Wyoming, and Colorado. • The fundamental constitutional rights to freedom of religion, speech, and association have fostered a great variety of religious and cultural practices, including Catholic, Protestant, Muslim, and a great many other religious cultures that exist throughout the United States.

Increasing Access to Health Care (continued)

Increasing Access to Health Care (continued) • Tax credits, mandates, and making pre-existing conditions covered are some ways the ACA is intended to improve access to care and make it more affordable. Accessibility is not just related to financial barriers. • Poor neighborhoods tend to have a lower person-tohealthcare provider ratio than more affluent regions. • Rural regions also tend to have limited providers or require longer travel to see one. Possible solutions? • Telemedicine • Incentives and competitive salaries to providers who work with low-income regions • Training community members as peer educators and outreach workers

Mental Health

Mental Health • Acculturation into the U.S. society also may have a negative impact on the mental health of Hispanics. • U.S. born and long-term residents have significantly increased rate of mental disorders compared to recent Hispanic immigrants. This also applies to increases in rates of substance abuse. Mental Health (continued) • Findings from a 2013 study showed Hispanics had the highest rates among 12th graders for use of a number of substances including marijuana, inhalants, ecstasy, cocaine, crack, salvia, Vicodin, methamphetamine, crystal methamphetamine, over-the-counter cough/cold medicines, and tobacco using a hookah. • Hispanic students generally have lower rates than white students of misusing any of the prescription drugs. • 16% of Hispanic adults reported suffering from a mental illness the previous year

Mental Health

Mental Health • Mental health, as in other cultures, carries stigma and misunderstanding. • The focus on individual rights and self-determination is evident in the care and treatment of mental illness. For instance, only if the state can show that people are likely to be harmful to themselves or others are they compelled to receive treatment. • While the mentally ill are generally allowed to be autonomous, the culture does not necessarily fully neglect the mentally ill. The Christian cultural value of charity and assisting others often leads to establishing charitable programs, such as homeless shelters and meal programs for the poor including many mentally ill persons. D

Strategies for Reducing or Eliminating Health Disparities

National Stakeholder Strategy for Achieving Health Equity: Five goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities and other underserved groups reach their full health potential. • Goal 1: Awareness. Increasing awareness of the significance of health disparities, their impact on the nation, and the actions necessary to improve health outcomes for racial, ethnic, and underserved populations Goal 2: Leadership. Strengthen and broaden leadership for addressing health disparities at all levels. • Goal 3: Health system and life experience. Improve health and health care outcomes for racial, ethnic, and underserved populations.

Nutrition and Diet

Nutrition and Diet • Many Hispanics retain core elements of the traditional Hispanic diet. • Hispanics' typical diet is high in fiber with beans and grains (rice) as staple foods. Beans are eaten as a source of protein rather than meat. • Leafy green vegetables and dairy are not a usual part of their diet. • Family life has traditionally occupied a central place in Hispanic culture and has contributed to dietary behaviors supporting home preparation of meals and families eating together. • Spanish-speaking households have more healthful diets than those who speak English as a primary language. Nutrition and Diet (continued) Figure 7-1: Food pyramid for traditional Latino diet Mental Health •

Summary (continued)

Summary (continued) • Many of the culture-bound illnesses have been discussed, such as empacho and susto, along with treatment modalities, which include the treatment of hot and cold illnesses. • Various types of healing systems have been discussed, such as curanderismo and Espiritismo.

QUICK FACTS

PG 194 pg 219 The prevalence of obesity among female Mexican American adults during 2007-2010 was larger than the prevalence among female white, non-Hispanic adults during the same years. • In 2010, the largest prevalence of diabetes was among Hispanic and non-Hispanic African American adults compared with the prevalence among white, non-Hispanic and Asian adults. • During 2009-2010, prevalence of periodontitis among Mexican American adults aged 30 years and older was among the largest compared with white, non-Hispanic adults of same the age group.

Policy Changes and Laws

Policy Changes and Laws • Policies and laws that mandate cultural competency training for medical professionals: • New Jersey, Senate Bill (SB) 144 requires medical professionals to receive cultural competency training to receive a diploma from medical schools in the state. • Washington, SB 6194 in 2006 requires all medical education curricula in the state to include multicultural health training and awareness courses

American Indian and Alaskan Native Populations in the United States (continued)

Populations use many different languages. - The Census Bureau recognizes 169 indigenous Native North American languages but these are spoken by less than half a million. • The Alaska Native Language Center currently reports 20 known native languages. • Many languages will go extinct by the next generation. • The median family income for American Indian and Alaskan Natives is $39,664, as compared to $67,892 for non-Hispanic.

Increasing Access to Health Care (continued)

Tax credits, mandates, and making pre-existing conditions covered are some ways the ACA is intended to improve access to care and make it more affordable.

The 10 leading causes of death among Hispanics/Latinos in 2010 were as follows:

The 10 leading causes of death among Hispanics/Latinos in 2010 were as follows: 1. Cancer 2. Heart disease 3. Unintentional injuries 4. Stroke 5. Diabetes mellitus 6. Chronic liver disease and cirrhosis 7. Chronic lower respiratory disease 8. Alzheimer's disease 9. Nephritis, nephrotic syndrome, and nephrosis 10. Influenza and pneumon

Pregnancy, Birth, and Child Rearing (continued)

Pregnancy, Birth, and Child Rearing (continued) • Children are generally free to grow up and marry who they wish and earn a livelihood of their own choosing and are expected to become independent. • Culture affects the administration of public health programs, e.g., immunizations that have been scientifically proven for common illnesses such as measles must confront parent's rights to self determination in raising their own children with "opt out" procedures established in several states.

Quick Facts

Quick Facts • Euro-Mediterranean Americans (whites) lead other major populations in heart disease (11% of the population) and especially compared to Asian Americans at only 6.7%. • Euro-Mediterranean Americans lead all other major populations with incidence of cancer (8.5%) compared to Asian (3.5%) and Hispanic (3.8%). • Euro-Mediterranean Americans have the lowest percentage of members with diabetes especially compared to Hispanics (12%) and African Americans (12.5%). • Euro-Mediterranean Americans lead all other groups in heart attacks (3.1%) except Indigenous groups (American Indian/Alaskan Native) who have had 3.8% of the population suffer the condition. Quick Facts (continued) • Euro-Mediterranean Americans have a few percentage suffering from stroke (2.4%) than all other groups except Asian (2.1%). • 68% of the Euro-Mediterranean population over age 20 is overweight, with 34% of the men and 32% of the women being obese. • One third of the adult Euro-Mediterranean American population has hypertension (33.1% men, 33.7% women). • Although teen pregnancy rates have been declining for all ethnic groups, Euro-Mediterranean teens have a pregnancy rate about half (18.6 per 1,000) that of African American (39 per 1,000) and Hispanic (41.7 per 1,000). Quick Facts (continued) • The traditional Mediterranean diet is characteristic of the traditional cooking style of countries bordering the Mediterranean Sea. The diet was associated with: • A reduced risk of death from heart disease • A reduced risk of death from cancer • Reduced incidence of Parkinson's disease • Reduced incidence of Alzheimer's disease Considerations for Health Promotion and Program Planning • When working with members of the Amish community, the following recommendations should be considered to improve cultural understanding: • Be cognizant of the cultural differences this group has with society as a whole. • Recognize the importance of privacy. • Recognize that Amish people might not understand lifestyle activities and events as you consider to be everyday occurrences. • Be cognizant of the formality of family relationships. • Explain all procedures and instructions to ensure understanding.

Worldview

Worldview • Being in harmony is important. • Group success is more important than the success of the individual. • Many tend to see property as communal. • A strong sense of connectedness and an understanding of the world comes from the cycles and natural rhythms of life. • Health is achieved through balance. Autonomy is important yet illness is viewed as a family matter. • Participation in religious ceremonies and prayer is believed to promote health. • Many generally have a fatalistic view, which may prevent them from preventive actions, such as participating in health screenings, and receiving treatment for health issues. • Many do not recognize silent disease—in another words if there are no symptoms then one is not ill. This also can be another barrier to having health screenings done and with treating illnesses that are "invisible" such as cancer.

Quick Facts

Quick Facts • In 2010, the percentage of American Indian/Alaskan Native (AI/AN) adults aged 50-75 years who reported being up-to-date with colorectal cancer screening was 11 percentage points less than the percentage screened among white adults. • In 2010, the AI/AN birth rate among females 10-19 years of age was the third largest, following African Americans and Hispanics. • In 2011, AI/AN and non-Hispanic white adults were among those with the largest prevalence, frequency, and intensity of binge drinking, compared with other racial/ethnic populations. • Although smoking prevalence remained highest among AI/AN youth and adults during 2009-2010, smoking declined from 17.2% to 13.6% in youth and from 42.2% to 34.4% in adults from 2006-2008 to 2009-2010. Quick Facts (continued) • In 2010, AI/AN and Hispanic adults had the highest age adjusted mean number of physically unhealthy days in the past 30 days compared with other racial/ethnic populations. • In 2010, the preterm birthrate for AI/AN infants (13.6%) was higher than for white (10.8%) and Asian/Pacific Islander infants (10.7%). • During 1999-2010, drug-induced death rates in the 30-39 year age group were highest among AI/AN compared to other racial/ethnic populations. • In 2009, the homicide death rate was highest among nonHispanic blacks (19.9 deaths per 100,000), followed by AI/ANs (9.0 deaths per 100,000). Quick Facts (continued) • In 2011, the age-standardized percentage of AI/AN adults living in poverty was among the largest compared with non-Hispanic whites. • In 2010, prevalence of unemployment among adults aged 18-64 years was highest among non-Hispanic blacks (16.5%) and AI/AN (15.8%) (Office of Minority Health, 2013). • In 2008, the infant mortality rate was 53% higher for AI/AN women (8.42 infant deaths per 1,000 live births) compared with non-Hispanic white women (5.52 infant deaths per 1,000 live births). Quick Facts (continued) • In 2009, AI/ANs had the highest motor vehicle-related death rates. Among males, the AI/AN death rate was approximately 2-5 times the rates of other races/ethnicities. Among females, the AI/AN motor vehicle-related death rate was approximately 2-4 times the rates of other races/ethnicities. • Although the 2009 overall suicide rates for AI/ANs were similar to those of non-Hispanic whites, the 2005-2009 rates among adolescent and young adult AI/ANs aged 15-29 years were substantially higher. • In 2011, the age-standardized prevalence of not completing high school among adults aged 25 years and older was the second largest for AI/Ans, second to Hispanics and similar to African Americans. Considerations for Health Promotion and Program Planning • Understand that American Indian and Alaskan Native people use their tribal names when referring to themselves, so it is advised that healthcare professionals ask individuals or groups how they prefer to be addressed. • Recognize that there are varying degrees of acculturation levels, so healthcare professionals need to assess where the patient or client is on the continuum of acculturation. • Recognize that there is great diversity among the tribes, so do not make assumptions.

Research

Research • Increase knowledge • Identify and share best practices • Identify what is working and also what is not • Obtain more specific information about subgroups within cultures

Research

Research • Increase knowledge • Identify and share best practices • Identify what is working and also what is not • Obtain more specific information about subgroups within cultures Gather information about a range of contextual variables, beyond socioeconomic status alone, that have been found to be explanatory in health differences, such as: • Social support, social networks, and family support • Levels of acculturation • Social cohesion • Community involvement • Perceived financial burdens Discrimination • Differences in the health status of foreign-born versus U.S.-born individuals

Improving the Environments of People Affected by Health Disparities

Residents of socially and economically deprived communities experience worse health outcomes on average than those living in more prosperous neighborhoods. • Minorities are more likely to live in poor neighborhoods. • Policies are needed to reduce or Policies are needed to reduce or eliminate environmental inequalities

General Beliefs About Causes of Health and Disease Prevention (continued)

Roma (continued) • They have very strict traditions about what is polluted and how things are to be kept clean. Secretions from the upper half of the body are not polluted, but secretions from the lower half are polluted. • Because gadje (non-Romas) do not practice body separation, they are considered to be impure and diseased. • Fortune plays a role in health. Good fortune and good health are thought to be related. Illness can be caused by actions that are considered to be contaminating and, therefore, create bad fortune. General Beliefs About Causes of Health and Disease Prevention (continued) • Roma (continued) • Roma Americans distinguish between illnesses that are of a gadje cause and those that are part of their beliefs. Gadje illnesses can be cured by gadje doctors. Hospitals are avoided by Roma Americans because they are unclean and are separate from Roma society. • Illness is a problem to be dealt with by the entire clan. Therefore, if a clan member is hospitalized, family and clan members are expected to stay with them and provide curing rituals and protect them. General Beliefs About Causes of Health and Disease Prevention (continued) • Roma (continued) −Women are considered to be unclean during pregnancy and for a number of weeks after delivery. Childbirth should not happen in the family home because it can cause impurity in the home. Therefore, delivery in hospitals is accepted in the culture. −Older members of a family are very important in health care decision making; they are considered the authority in the family and carry great weight in all decisions. General Beliefs About Causes of Health and Disease Prevention (continued) •Middle Eastern •Health beliefs arise from the long-standing traditions of the great Islamic healers of the seventh and eighth centuries. •Western theories from Hippocrates and Galen came to Arab medicine through trading routes and were incorporated into the Arabs' knowledge base. They advanced human knowledge of anatomy, physiology, and medical treatments. •Tenets of allopathic medicine form the basis of most Arab beliefs about health and illness. •Muslims consider an illness to be atonement for their sins, and they receive illness and death with patience and prayers. Death is part of their journey to meet Allah (God)

American Indian and Alaskan Native Populations in the United States (continued)

Since 1972, IHS has embarked upon a series of initiatives to fund health-related activities in offreservation settings. • Currently, the IHS funds 33 urban Indian health organizations, which operate at sites located in cites throughout the United States. • In 2010, almost 28% of American Indians/Alaskan Natives spoke a language other than English at home

Pregnancy, Birth, and Child Rearin

Some newborns are ceremonially plunged into water on a daily basis for up to two years to gain strength. • Children are considered to be specially linked to the spiritual world, and in general are indulged rather than punished. • Corporal punishment was clearly the exception rather than the rule, although ridicule or fear of the supernatural might be used to produce obedience. • The transition from childhood to adulthood is well-defined. For girls there are sometimes rituals surrounding the onset of menstruation. For boys, whose passage through puberty is a less biologically evident, there are more elaborate ceremonies such as the huskinaw, a rigorous physical trial.

broad range of people

The broad range of people and their cultures that existed in North America at the time of its "discovery" by Christopher Columbus includes American Indian and Alaskan Natives. • "American Indian or Alaskan Native" refers to a person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. Introduction • Called by many terms such as Indians, American Ind

American Indian and Alaskan Native Populations in the United States

There are 566 federally recognized tribes and over 100 state recognized tribes. • The federal government provides health care services to federally recognized tribes through the Indian Health Service. • 36% of the IHS service area population resides in nonIndian areas; 600,000 are served in urban clinics. The urban clientele has less accessibility to hospitals, health clinics, or contract health services provided by the IHS and tribal health programs in tribal areas.

Cultural-Bound Illnesses

There is no particular illness associated with American Indian and Alaskan Native peoples, but there are many associated illnesses derived from cultural response to acculturation with Europeans. - Alcohol, for instance, is now a significant problem for a high percentage of people. It was plied to the tribes for trade and subjugation. - The onset of early smoking may have resulted from the loss of traditional economic and cultural ways such as reduction or elimination of right- of- passage into adulthood. - Blatant prejudice has contributed to conditions symptomatic of poor, undereducated, purposely marginalized peoples of any minority classification. There are a couple of illness attributed to American Indian and Alaskan Native peoples that actually may not be culturally based. - Ghost sickness: A psychological condition in which a person has an obsessive fear and preoccupation with the death of person who meant a great deal. This can be associated with a person 's concern that proper burial rites were not followed and the deceased may not be able to move forward in the afterlife. Some attribute this to a severe cases of grief and morning and concern about burial practice may be just one of many concerns that might trigger the condition among any population. Heartbreak syndrome: Attributed to American Indian and Alaskan Native populations but it is more probably a general human condition; a condition involving sudden onset of heart pain and even damage shortly after an intense event such as a death of a loved one or a divorce

Worldview

Worldview (continued) • In general, European Americans are a low-touch culture. Unless they are close friends, people of the same sex, especially men, do not generally touch each other. • Personal space is important; they generally do not stand or sit close to one another. If healthcare providers physically distance themselves from a patient who is culturally programmed for close personal space, the provider may be viewed as cold. Worldview (continued) • Disclosure of personal information is common. European Americans may share very personal information, such as sex or drug use, with people who they do not know very well. • Punctuality is important; do not like to wait as it wastes time. "Time is money" is a common philosophy. People in this culture generally believe that they have control of their future, and hence, do not adhere to the fatalistic belief. • Culture is generally future oriented, but they do like to wait so it has become a fast and " on demand" culture. Pregnancy, Birth, and Child Rearing • Generally, self-reliance and auto

Tips for Working with American Indian and Alaskan Native Populations

Tips for Working with American Indian and Alaskan Native Populations • Be warm and friendly; make the patient feel that you genuinely care about them. • First meeting is extremely important because it sets the basis of your relationship. • With the patient's consent, involve the family as they play a crucial role in the patient's outcome and the support of family will help speed recovery and raise social wellbeing. Do not rush the patient. • Silence is valued and is not necessarily a negative behavior. Sometimes the patient may require time to think and respond to a comment. Tips for Working with American Indian and Alaskan Native Populations (continued) • Time is viewed more passively and the people are more task conscious as opposed to time conscious. • Eye contact is used in varying degrees and should be limited. • Respect traditional healing ways and diagnosis; work to accommodate their beliefs. • Show great respect to the elderly. In many cases, the elders are not accustomed to the modern health care facilities, the new atmosphere, the noises, the caregivers and types treatment; for many of them it may be their first trip to a medical facility so it is important to ease their mind and explain procedures. Summary • American Indian and Alaskan Native populations have a history of being conquered by other nations, having foreign cultures impose upon their way of life, and being the victims of discrimination. • They have been able to hold on to their traditional culture in many ways. • They continue to express their traditional values within their villages by maintaining close-knit families and using traditional healing modalities to prevent and heal illness. • Unfortunately, both groups experience major health disparities, such as high incidence of suicide, alcoholism, cancer, unintentional injuries, diabetes, and mental illness. Summary (continued) • These populations do not believe in the germ theory as the cause of disease, although some Alaskan Natives are adopting this belief system. • They have various approaches to healing, such as sweat baths and ceremonies, and their common behaviors, risk factors, and illnesses. • There is a vast amount of diversity within these groups, so it is important not to generalize.

General Beliefs About Causes of Health and Disease Prevention

Traditionally health was a continual process of staying strong spiritually, mentally, and physically; strength keeps away or overcomes the forces that cause illness. • People must stay in harmony with themselves, other people, their natural environment, and their creator. Adhering to traditional and tribal beliefs and obeying tribal religious codes is another part of staying healthy. • Violating tribal tenets or laws has consequences like physical or mental illness, disability, ongoing bad luck, or trauma. The violation must be set right before harmony and health can be restored. • Beliefs about the causes of illness are beginning to shift

History of American Indian and Alaskan Native Populations in the United States

Vast differences in culture caused misunderstanding and conflict. - Europeans viewed land as something to be held by an owner with groups of people having territory - American Indians generally viewed land as unbounded except for physical barriers and something to be used but not owned History of American Indian and Alaskan Native Populations in the United States (continued) History of American Indian and Alaska Native Population In 1906, the Homestead Act granted land to the following individuals: "Indian or Eskimo of full or mixed blood who resides in and is a native of said district, and who is the head of a family, or is 21 years of age; and the land so allotted shall be deemed the homestead of the allotted and his heirs in perpetuity and shall be inalienable and nontaxable until otherwise provided by Congress." • Under the Alaska Native Claims Settlement Act of 1971, 40 million acres of land and nearly a billion dollars was awarded to Alaskan Natives

General Beliefs About Causes of Health and Disease Prevention

•Euro-Mediterranean Population in General −Generally, disease prevention and health maintenance are viewed from the "germ theory" view that scientific methods and physical or chemical treatments can be used to prevent and cure illness. −Health can be developed and maintained by making advances in understanding biology and science. −Science can and must discover cures and it is just a matter of time before proper preventive practices and medical interventions can be developed to address most health issues.

plants and herbs

pag 190

medicine bundles

pg 188

Peyote

pg 191

Six Factors and Common Health Problems (continued)

sixFactors and Common Health Problems (continued) • Life expectancy among Hispanics is two years longer than whites (CDC, 2015). • Hispanics also have lower mortality rates in seven out of the 10 leading causes of death, even though they are twice as likely to be economically under the poverty line and three times more likely to be without health insurance. • Hispanics have markedly reduced mortality from cancer (-28%) and heart disease (-25%

Strategies for Reducing or Eliminating Health Disparities (continued)

• Improve cultural competence: A set of congruent behaviors, attitudes, structures, and policies that come together to work effectively in intercultural situations • The culturally competent organization: • Values diversity • Conducts cultural self-assessments • Is conscious of and manages the dynamics of

Strategies for Reducing or Eliminating Health Disparities (continued)

• Improve cultural competence: A set of congruent behaviors, attitudes, structures, and policies that come together to work effectively in intercultural situations • The culturally competent organization: • Values diversity • Conducts cultural self-assessments • Is conscious of and manages the dynamics of Is conscious of and manages the dynamics of difference • Institutionalizes cultural knowledge • Adapts services to fit the cultural diversity of the community served

History of Euro-Mediterranean Americans in the United States (continued)

• Indigenous populations were simply displaced to make room for the new European arrivals, but Europeans were subject to displacement and conquest themselves. • The French and English and eventually the Spanish and English Americans engaged in wars to settle territorial claims. • Throughout the country's development, but particularly in the late 1700s and after, significant numbers of people immigrated to what is now the United States, to escape economic hardship and war

History of Euro-Mediterranean Americans in the United States (continued)

• Partly due to limited ability to communicate and primarily due to a culture of self-reliance and initiative, challenges and hardships were expected to be addressed locally without particular guidance from leaders in Europe. • Settlement was occurring shortly after the onset of the "age of enlightenment" in Europe and rational practical problem solving reinforced a belief that problems could be understood and solutions found by individuals applying their own intelligence, although the help and guidance of a Christian god was often sought and welcomed. • A persistent belief in the righteousness of their acts and entitlement as free persons to exploit essentially free natural resources contributed to the spread of the population throughout the continent with confidence and self-assurance.

Healing Traditions, Healers, and Healing Aids (continued)

•Amish (continued) −Amish women prefer to use nurse midwives and lay midwives, and to have home deliveries, because it limits the use of technology as well as reduces the number of visits to the doctor, which may be costly. −Women practice certain folk traditions during pregnancy to prepare themselves for giving birth. These practices include not walking under a clothesline because that is believed to cause a stillbirth. Another practice includes not climbing through a window or under a table because both can cause the umbilical cord to wrap around the baby's neck. Healing Traditions, Healers, an