WORKING WITH A

SPECIAL GROUPS IN A
COMPLEX ENVIRONEMNT
MS ASMA AFREEN
COMMUNITY NUTRITION
OVERVIEW
• Community Nutrition Professional And Diversity
• Working in a multicultural environment
• Preparing information for and counseling multiethnic groups
• Nutrition and HIV infection
• Food security
• Millennium development goals
Community Nutrition Professionals and
Diversity
• The diversity of peoples, religion, education and work
experiences creates challenges for community nutrition
professionals who attempt to meet the various nutritional
needs of diverse individuals and groups.

• The needs of the multiethnic society differ from the needs of

the subgroups for and complications of devastating disease
such as AIDS.
Cont….
• CNP need cultural competence to assess eating
behavior and NS

• And also to provide effective nutrition education

as a primary, secondary or tertiary intervention.

• These real life situations demand new skills,

increased knowledge and sincere efforts.
 The broad scope of diversity surrounding
the individual
These real life Religious
situations beliefs

demand new
skills, Marital Ethnic
status background
increased
knowledge
and sincere
efforts by
CNPs.
Military
You Income
experience

Work Geographic
experience location
Working in a multicultural environment
• Culture----- defined as the accumulation of group’s
beliefs, assumptions and values that direct the life style
of the group members.
• Beliefs stem from the knowledge, opinions and faith
individuals or groups have and often precipitate
common practices.
• Values are beliefs deemed important by an individual or
group, whereas assumptions are statements that are
taken for granted.
Values expressed by one culture may not be honored in
another culture.
 There are primary and secondary characteristics of a
BEHAVIO person’s identity. The primary characteristics of a person
Culture R
Actions can not be changed. These include, but are not limited
to: age, race, physical abilities, and gender.
KNOWLEDGE
While secondary characteristics of a person can change.
ATTITUDES
Thoughts/
Awareness
Values, Beliefs,
Judgments
These include, but are not limited to: marital status,
religion, and educational status.
We often meet people and only focus on the
characteristics that we can see, but we need to get
beneath the tip of the iceberg to truly get to know a
person’s individuality.
Remember, get to know a person beneath the tip of the
iceberg!
 CULTURAL ICEBERG

Race, Age, Physical Abilities, Gender, etc.

Marital Status, Religion/Spirituality, etc.

Ethnic Background, Nationality, Educational Status, Socioeconomic Status,

Language, Political Affiliation, Hobbies, Family Roles, Health Status, etc.
Cont…..
• Cultural sensitivity is awareness of one’s own cultural beliefs
and the ability to understand and to acknowledge the values
and customs of another culture.

• Cultural sensitivity during nutrition education sessions or

programs may simply mean that nutrition professionals do not
express their personal bias about individuals from ethnic
groups different from their own.
Cont……
• Cultural competence is the acquisition of knowledge and
requisite skills to identify and appreciate differences and
commonalities of various groups.

• Knowledge alone does not produce cultural competence.

• Understanding the codes and mores (way of life/civilization)

of a group and its numerous subgroups equips nutritionists
with powerful communication and evaluation skills.
CN Self evaluation about diversity
awareness
Do I
• Know about the rules and customs of different cultures?
• Feel equally comfortable with people of all background?
• Actively associate with those who are different from me?
• Find it satisfying to work on a multicultural team?
• Find change stimulating and exciting?
• Like to learn about other cultures?
• Show patience and understanding with individuals who speak
limited English?
• Feel that both newcomers and society need to make an effort to
change?
How to acquire cultural competence
Four stages identify the process of acquiring cultural competence:

1. Cultural awareness of one’s own values by self assessment

2. Cultural knowledge of the target group using books, lectures, film
and personal contact
3. Cultural skill in communication, interpretation, and definition of
the target group’s beliefs and customs;
4. An increased frequency of cultural encounters that expand
understanding and ease of communication while enhancing
respect.
Checklist for information gathering
Have you gathered information on and increased your
understanding of the following?
 The demographics of the target community
 The community’s economic and political concerns
 Major cultural beliefs, values and practices of the target
community
 Health problems of the community
 Other questions you have chosen to explore
2. Have you also consulted the following
sources?
Library sources,
• census data,
• Government document, reports and statistics
• Public health literature
• Behavioral and social science literature
• Local newspaper
Experts:::: academicians with knowledge or experience working with
specific ethnic or cultural groups.
• Health professionals who work in similar communities or with
similar problems
• Other professionals
• Individuals from the target community
Have you prepared your staff to work in the
community through the following activities?
• Summary of research findings in a report for your staff.
• Discussion of this information with staff’s input
• Exploration of staffs cultural attitudes and beliefs and how these
might influence staff member’s behavior in the community.
• Assessment of your staff and staff’s past experiences in working with
diverse communities to determine who has the necessary skills.
• Training and /or ongoing support for staff to help them resolve
personal and professional issues as they arise in the community.
Preparing information for and counseling
multiethnic groups
• All information intended to reach people of a particular
culture must pass through cultural filters before it is received
and acted upon.

• What is a filter? A cultural filter is not something you can see

or touch. Every person has a filter. This word describes all the
factors that affect how you see things the way you do and how
you react to the actions of others.
What factors can affect a filter?
Many factors affect a filter:
• Our ethnic background and/or culture.
• Our family background (such as being an only child or having a
large extended family).
• Our beliefs (such as religion, destiny)
• Our income level (comfortable vs. marginal).
• Our personal experiences (such as traumas, successes, and
education).
• Our values and choices (such as friends, community, faith, status).
• And many other factors such as physical appearance, health,
talents, and luck etc.
 Cont….
The picture provides a visual example of
how someone’s filter affects his or her
understanding of a word. One word may
mean different things to different people.
Here, the woman on the left is talking about
beef. Notice how each person who is hearing
the word “beef” thinks of it in a different
way.
The first man thinks of not eating beef
because he is a vegetarian.
The woman thinks of the part beef plays in
her religious observances and beliefs.
The other man thinks of how much he likes
to eat hamburgers made from beef.
Be careful not to make assumptions about
how people will understand a word or idea
based on their ethnicity.
Quick guide for cross-cultural counselling
Preparing for counseling

• Understand your own cultural values and biases

• Acquire basic knowledge of culture values, health beliefs and

nutrition practices for client groups you routinely serve.

• Be respectful of , interested in, and understanding of other

cultures without being judgmental.
Enhancing communication
• Determine the level of fluency language, arrange for an interpreter,
if needed.
• Allow the client to choose seating for comfortable personal space
and eye contact
• Avoid body language that may be offensive or misunderstood
• Speak directly to the client, whether an interpreter is present or not
• Choose a speech rate and style that promotes understanding and
demonstrates respect for the client
• Avoid slang, technical jargon, and complex sentences
• Use open ended questions or questions phrased in several ways to
obtain information.
• Determine the client’s reading ability before using written material
in the process.
Promoting positive change
• Build on cultural practices, reinforce the positive things and
promote change that are harmful

• Check for client understanding and acceptance of

recommendations

• Be patient and provide counseling in a culturally appropriate

environment to promote positive health behavior.
• Remember:
“Not all seeds of knowledge fall into a fertile environment to
produce change, some will take years to germinate”
Quick Self-Check Using the Cultural Competence Continuum
What Stage Are You Characteristics
In?
RED attitudes, behaviors, values, and practices that are
destructive to a cultural group

ORANGE lack of skill and knowledge to respond effectively to

the needs, interests and preferences of culturally and
linguistically diverse groups

YELLOW beliefs and practices that support viewing and treating

all people as the same

GREEN level of awareness about your strengths and areas for

growth to respond effectively to culturally and
linguistically diverse populations

BLUE has acceptance and respect for differences

PURPLE holds culture in high esteem

 Exploring Strategies to Enhance
Cultural Competence so…
Together, we can move Forward!

Celebrate what works!

What does your agency do or
what do you do to effectively
work with and serve the diverse
groups in your community?
East Indian ethnic and regional food
practices
• India , Pakistan---- part of subcontinent
• Bangladesh, Pakistan and India--- some similarities in food
practices.

Pakistan India
Majority Muslims, small 83% Hindu, 11% Muslims, 2% Christian, 2%
percentage are Christian, Sikh, 0.7% Buddhist, 0.5% jain, 0.4 parsi & Jews.
parsi & Hindu (1981 Indian census)
Hindu 80.45%,Muslim13.4%,
Christian 2%,Sikh1.89%, Buddhist 0.74%,
Animist, others 0.43%, Jain 0.46% (2001 census)
Urdu but English is widely Hindi, but English is widely used
spoken
Cont….
• The holy Vedic scriptures (believed by Hindus to be ageless)
categorize commonly used foods and emphasize the
connection between foods, moods, fitness and longevity
(Bhagavad Gita, 17th chapter: 2-22).

• Foods are divided into three major categories , depending on

the kind of mind altering , mood provoking and physiologic
influences they are believed to exert.
Cont…..
• Sattvic (purity) foods like milk and milk products (except
cheese made from rennet ), rice, ghee, wheat, most legumes
and some other vegetables, are believed to contribute to the
making of person who is sincere, enlightened, healthy and
long lived.

• Calling a person “Sattvic” is a high tribute.

Cont….
• Rajasic foods like some meats, eggs, and foods that are very
bitter, sour, salty, rich and spicy are believed to contribute
aggression, and a desire for power.
• Warriors were encouraged to eat these foods.

• Tamasic foods like garlic and pickled, preserved, stale, or

rotten foods, and alcohol and drugs used for pleasure and in
excess are believed to contribute to desire, meanness,
confusion, slowness and dullness.
Cont….

• Health related Hindu customs include yoga, a word that means

“to rein in” or “tune the body” which consist of structured
physical exercise and body positions best suited as a morning
workout; mental exercises, reputed to re-energize from daily
stresses; and controlled leisure activities
Ayurveda (the code of life & longevity)
Classical system of Indian medicine

• Widely used during illness

• Kapha foods---sugar, millet and buttermilk---thought to be

heavy, dense and mucus producing , avoided with respiratory
ailments.

• Vata or Vaya---gas producing foods like some legumes---

thought to be unpredictable & avoided during states of
distention.
Cont…..
• Hot ur Ushna foods include black gram or mung bean, ripe
eggplant and papaya are believed to promote digestion.

• Cool or Seeta foods …. To impart strength and

nourishment…..rice, cereals, wheat, mung beans, kidney
beans, most fruits and vegetables, milk from most animals
except goats, butter and ghee.
Potential medicinal effects of Asian Indian
spices and herbs
• Thought to have physiological effect in the body.
• Fenugreek—health benefits
• Asafoetida (heeng)---may contain sulfur compounds in its volatile
oil, which may protect against fat-induced hyperlipidemia, also may
contain coumarin constituent with anticoagulant activity.
• Capsicum, clove, ginger and onion---anticoagulant /antiplatelet
potential.
• Coriander----rich source of Vit C, Ca, Mg, K, Fe---hypoglycemic effect
• Cumin---hypoglycemic effect
• Garlic---(allicin, allyl propyl disupphide) improve blood glucose
control, increased serum insulin and improve liver glycogen storage.
Food security
• ‘the state of having reliable access to a sufficient quantity of
affordable, nutritious food.

• “Availability at all times of adequate world food supplies of basic

foodstuffs to sustain a steady expansion of food consumption and
to offset fluctuations in production and prices”.

• “Ensuring that all people at all times have both physical and
economic access to the basic food that they need”.

• "food security has declined dramatically in many developing

countries"
Food Hunger

• a weakened condition brought about by

prolonged lack of food
 FOOD SECURITY SITUATION IN PAKISTAN

Trends in Food
Production,
Availability
and Food
Security
Cont…..
WAY FORWARD
• The major hindrance in achieving food security in developing
countries including Pakistan is the high levels of poverty, and thus
poverty reduction is a most powerful tool to improve food security
that can be achieved through equitable economic growth.

(1) by enabling the poor to participate in the growth process and

increasing their access financial and productive resources and
providing them physical and market infrastructure;
(2) investing in human capital of the poor—provision of health and
education that enables them to take advantage of new
opportunities; and,
(3) investing in the social capital of the poor—network, norms, and
trust among members of communities that help coordinate and
cooperate for members‘ mutual benefit in the community
Cont….
• Increasing the agricultural productivity

• New programme interventions particularly in remote areas for

training technicians in agriculture and non-agriculture
enterprises also need to be initiated.

• a well organized food assistance program in food insecure and

low agricultural potential areas would enormously help reduce
poverty and enhance access to food
Cont…..
• the federal and provincial Ministries have to redefine their
boundaries .

• The policy-makers need to think and establish system

perspectives linking agriculture and non-agriculture sectors.

• This requires a close cooperation in policy, program

formulation and implementation between Agriculture and
other Ministries to foster rural and agriculture development in
general and food sector in particular.
Cont…..
Following are the priority research areas to be focused on:
• developing technologies both in terms of genetic modifications of
crops that improve water productivity and bring breakthroughs in
the use of saline water;
• improving systems‘ productivity by devising new practices for better
soil fertility management, soil and water conservation, water
harvesting, and integrated pest management, etc;
• research in human food-safety issues in plant and animal origin food
chain;
• developing technological packages to achieve low-cost and high
quality products;
• enhancing balanced use of fertilizer and increasing organic matter
availabilities; and
• encouraging small farmers‘ oriented corporate farming.
Cont….
• Role of the Government:

• Government should be proactive to the commodity crisis

rather than act when the crisis already happened.

• A separate food security fund should be created, rather than

diverting development resources in case the food production
is below the national demands.
Pakistan is no exception.

• To achieve food-secure and agricultural growth, Pakistan

needs to adopt a comprehensive approach towards
increasing productivity of all foods rather than merely
concentrating upon achieving just wheat-based food security.
The Millennium Development Goals
Cont…(2013 report)
• Under MDG1, Pakistan aims to halve by 2015, the proportion
of people living below the national poverty line, achieve full
and productive employment and decent work for all, and halve
the proportion of people who suffer from hunger.

• There has been a persistent downward trend in poverty

incidence over the past decade - the percentage of population
below the poverty line fell from 34.5 percent in 2001/02 to
12.4 percent in 2010/11 –
• and Pakistan is on track to achieve the MDG target with regard
to poverty.
Cont…
• Pakistan’s unemployment to population ratio increased from
27.1 percent in 2001/02 to 30.9 percent in 2010/11, making
the prospect of full employment by 2015 highly unlikely.

• Malnutrition, measured as prevalence of underweight children

under-5 years of age, decreased slightly from 40 percent in
1990/91 to 31.5 percent in 2011/12, but is still far off the MDG
target of less than 20 percent.

• With two out of three targets off-track, the country is unlikely

to achieve MDG 1.
THANK YOU