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Chapter 2

Emerging Populations and Health

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Health Disparities
and Health Equality

Health disparities is an umbrella term that


includes disparities in health and in
healthcare.

Health equity is the accomplishment of the


highest level of health for all people.

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Emerging Populations

Ethnic minorities

Asian Americans/Pacific Islanders


Blacks/African Americans
Latinos/Hispanic Americans
Native Americans
Arab Americans

Homeless persons
Persons with HIV/AIDS

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Migration

Voluntary migration

Immigrants vs. refugees


Immigrants come for positive experience; refugees leave
negative homeland threat of injury/loss of life

Permanent vs. sojourner


Sojourners stay for a specific time then return to home
country

Involuntary migration

Fleeing or being forced out of homeland

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Ethnic Diversity

Race

Previously a categorization of people based on


physical properties and biological heredity
Arbitrary taxonomymore variation within race than
between races
Social constructnot useful to identify populations
for health/research purposes

Ethnicity

Sense of collective identity; distinctiveness


Sharing of customs, food, dress, language
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Ethnic Diversity (Cont.)

Ethnic group
Group set apart on basis of cultural/national origin
characteristics
Values/perceptions about health/illness
Socialization process within ethnic group

Minority group

People who receive disproportionately less wealth,


power, social status

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Culture, Values,
and Value Orientation

Culture

Cultural values

Shared patterns of values/behaviorsshaped by


cultural group
Unique cultural beliefs of what is valued that guide
decisions and behavior (such as health values)

Value orientation

Values learned by socialization by group and that


reflect overall beliefs of that group
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Cultural Competency

Culture may have impact on peoples

Health
Healing
Wellness belief systems
Perceived causes of illness and disease
Behaviors of seeking health care
Attitudes towards health care providers.

Cultural competency is one of the major


elements in eliminating health disparities.

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Barriers to Health Care


for Diverse Populations

Transcultural nursing (Leininger (2002))


transform health care for diverse populations
Health care barriers for diverse populations
Lack of insurance
Availability of health care facilities/resources
Inadequate transportation
Complexity of health care system
Fragmentation of care
Attitudes of health care providers and incongruent
beliefs between patients/providers

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Folk Healing
and Professional Care

Self-care: 70% to 90% population; mild illnesses


Professional health care system

Folk healing practices

Reflect beliefs, values, treatment of cultural group

Ethnocentrism

Specialized training; remuneration for services

Practice of viewing other ways as inferior or unnatural


Obstacle in therapeutic provider-patient relationships

Holism

Incorporates family and support system in care


Considers patient viewpoint
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Arab Americans

Background
Three major waves of immigration from late 1800s to
1960s
Three largest groups: Lebanese, Syrians, Egyptians
Religions: Christianity, Judaism, Islam

Health concerns and care issues

Adult-Onset Diabetes Mellitus


Coronary artery disease
Role of acculturation
Mental health
Teenage smoking

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Arab Americans (Cont.)

Barriers to care

Religious belief and practices


Cultural norms/modesty
Gender issues regarding providers
Communication difficulty
Folk remedies
Lack of culturally competent providers

Selected health-related cultural aspects

Role of religion
Importance of family; male-dominated family structure
Present-oriented

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Asian Americans/
Pacific Islanders

Background

Two waves of migration


Largest groups: Chinese, Koreans, Filipinos
Diverse origins, cultures, lifestyles
Value education

Health concerns and care issues

Hesitancy to seek early diagnosis/screening


Higher rate of tuberculosis
Mental health problems due to adjustment issues
Lower rate of obesity, hypertension
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Asian Americans/
Pacific Islanders (Cont.)

Barriers to care

Poverty
Stress in intergenerational relationships
Cultural norms that prevent health care seeking
Loss of social networks
Poor access to services

Selected health-related cultural aspects

Value of collectivism vs. individualism


Family most important social institution; respect for elders
Cultural value of passivity to avoid conflict
Taoism: Foundation of Chinese medicine achieving harmony
Use of folk medicine/alternative treatment modalities common
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Latino and/or Hispanic Americans

Background
Largest ethnic group; relatively young population
Mexican, Puerto Ricans, Cubans most common
Large diversity within Latino population

Health concerns and care issues

Higher incidence of

Stomach cancer
Diabetes mellitus
Cardiovascular disease
HIV
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Latino and/or Hispanic


Americans (Cont.)

Barriers to care

Highest uninsured rate of any U.S. racial/ethnic group


Use/receive less preventative health care
Lack of interpreter services in health care
Lack culturally appropriate health care services
Reliance on folk systems of healing

Selected health-related cultural aspects

Family supersedes individual needs


Spiritual strength important
Hot and cold concept of disease
Disease attributed to supernatural or psychological causes
Folk remedies used in combination with Western medicine
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Blacks/African Americans

Background

Involuntary migration history


American slave system facilitated racism/alienation
Recent substantial progress; inequities remain

Health concerns and care issues

Higher cancer deaths


HIV
Hypertension
Obesity
Mental health concerns
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Blacks/African Americans (Cont.)

Barriers to care

Poverty
Lack of health insurance
Inadequate or unsafe environments

Selected health-related cultural aspects

Centered on family and religion


Family needs to be involved in care
Churches important in promoting health
Use traditional healing approaches
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Native Americans/Alaskan Natives

Background

Native to North/South America for thousands of years


Experience minority group status; lower education
and income levels compared to other groups

Health concerns and care issues

Linked to social and economic conditions


Smoking, substance abuse
Deaths: unintentional injuries, cirrhosis, homicide,
suicide, pneumonia, diabetes

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Native Americans/Alaskan Natives


(Cont.)

Barriers to care
Difficult access to care
Underserved population

Selected health-related cultural aspects

Present-oriented; take one day at a time


Value cooperation over competition
Share resources
Value familiesform kinship systems
Believe health exists when person is in harmony with
nature
Traditional health practices important (shaman)
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Homeless Persons

Characteristics

Transience of instability of place


Instability or absence of connections to family
Instability or absence of housing
More homeless families, adolescents, and veterans

Causes of homelessness

Changing housing markets


Lack of employment opportunities for undereducated
Inadequate support for persons with mental illness
Poverty
Substance abuse
Contraction of safety netcuts in program funding

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Homeless Persons (Cont.)

Health concerns and care issues


Basic survival issues
Respiratory and infectious diseases
Dental and vision problems
Mental health concerns (substance/drug abuse)

Barriers to care
Access
Affordability
Lack of transportation
Poverty

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Strategies to Address
Homelessness

Multifaceted approaches

Residential programs
Supportive services for chronically ill
Role of community health nurses
Training
Developing sense of community within homeless
population
Development of public/private partnerships

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Persons with HIV/AIDS

Overview

Over 1 million persons in United States affected


Affects all ethnic groups, sexual orientations
Adults over 50 years old fastest growing cohort

HIV strategies

PreventionMost Important!
Rapid diagnosis
Symptom management

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Persons with HIV/AIDS (Cont.)

African Americans most severely affected


population
Barriers to treatment
Communication gap between health care professionals
and at-risk populations
Socioeconomic factors such as poverty
Cultural values, stigma
Personal values and attitudes, behaviors
Political influences

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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HIV and the Role of Culture

Fatalistic orientationperception that the person has no


control over his or her life

Family

African Americans and Asian Americans have this perception


Leads to lower participation in screening programs
Deterrent in seeking early diagnosis; fear, shame, or
stigmatization
Commitment to family strong motivator for helping afflicted
family members

Prevention strategies

Must consider cultural influences and beliefs

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Responses to Health Challenges


of Emerging Populations

The nations response

Healthy People 2020: Nationwide health promotion/disease


prevention agenda
Office of Minority Health: Eliminate health disparities
Additional minority health initiatives

Nursings response

Major nursing organizations: Commitment to development of


culturally competent care
Professional journals with transcultural and cultural diversity
focus
Educational materials for nursing
Ongoing nursing education/staff development
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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