Cultural Competence: A Lifetime Journey A Racial Harmony Immigration Forum Sault Ste. Marie Local Immigration Partnership February 20, 2014
2 Embracing Differences
Workshop Objectives: Today’s Objectives • Discuss the impact of personal biases, prejudice and discrimination on the ability to deliver excellent service to patients, families, and colleagues • Describe the relationship between cultural competence and service excellence in promoting health equity • Identify how the social determinants of health affect immigrants and refugees • Understand how health disparities are influenced by racism, marginalization and lack of access to quality care 3
Why are we here today? Why Are You Here Today? 4
The Reality Is… New York Times , March 22, 2002 “Subtle Racism in Medicine” “ . . . a disturbing new study by the Institute of Medicine has concluded that even when members of minority groups have the same incomes, insurance coverage and medical conditions as whites, they receive notably poorer care. Biases, prejudices and negative racial stereotypes, the panel concludes, may be misleading doctors and other health professionals.” 5
Sault Ste. Marie 6
7 What Does Culture Mean To You?
Iceberg Concept of Culture Festivals Clothing Music Food Literature Language Rituals • Above Ice VISIBLE Beliefs Values Unconscious Rules Assumptions Definition of Sin Patterns of Superior-Subordinate Relations Ethics Leadership Conceptions of Justice Ordering of Time Nature of Friendship Fairness Competition vs Co-operation Notions of Family Decision-Making Space Ways of Handling Emotion Money Group vs Individual NON ‐ VISIBLE 8
Christopher What are the visible and non-visible I suppose something that would not be perceived immediately would aspects of culture? be my having cancer. I don't have it anymore, I've been treated for it, but nonetheless, my experience with it has a large say in who I am. I am a humble person and I don't feel as if I love to share everything with everyone, just like my experience with cancer, though I suppose now I am telling everyone who reads this about my experience….I come off frequently as either being very formal and polite or as being coldhearted. The real me, however, is very emotional and understanding. When I got chemotherapy I saw children not even five years old with more severe cases of cancer or intestinal problems and I felt . . . I knew something was wrong with this, with young, innocent children being sick in the way they were, and I wished I could take their pain and suffering from them. From then on, I look at people with a different outlook, and I see how ignorant many people are from events like that, and it lifts me to a new level of understanding. 9
Why is health equity better than health equality? 10
Health Equity Equity in health care refers to ensuring quality care regardless of race, religion, language, income or any other individual characteristic. 11
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13 Key Definitions to Know
Cultural Competence and Health Equity Culturally competent health care is one strategy for addressing and ideally reversing health disparities 14
What is Cultural Competence? Cultural competence in health care describes the ability to provide care to patients with diverse values, beliefs and behaviors, including tailoring health care delivery to meet patients’ social, cultural and linguistic needs Health Research & Educational Trust (2011) 15
The Importance of Cultural Competence Yearly Immigration in Canada = 10,000 people (CIC, 2011)
The Importance of Cultural Importance of Cultural Competence Competence � Ontario is the destination of choice for 42% of all new immigrants to Canada (Stats Canada, 2010) � Toronto is the destination of choice for 33% of all new immigrants to Canada (Stats Canada, 2010) � By 2031, 63% of Toronto’s population will be members of racialized groups (Stats Canada, 2010) � 190 languages spoken in GTA 17
Top 10 Ethnicities: Sault Ste Marie, 2011 30,000 25,000 24,190 22,140 20,000 18,780 18,125 17,990 16,005 15,000 9,480 10,000 8,110 7,330 5,000 3,640 0 English Canadian French Scottish Irish Italian North German First Nations Ukrainian American (North Aboriginal American origins Indian) 18
Sault Ste Marie, Religion 2011 Baptist, 1,170 Anglican, 4,730 Other religions, 225 No religious affiliation, Traditional 18,080 (Aboriginal) Spirituality, 60 Muslim, 135 Jewish, 190 Hindu, 165 Catholic, 29,920 Other Christian, 7,000 Buddist, 25 United Church, 7,150 Presbyterian, 1,335 Christian Orthodox, 230 Lutheran, 1,980 Pentecostal, 1,230 19
Sault Ste. Marie 2011 Census Results for Non-Official Languages Non –Official Non-Official Mother Tongue Language Spoken Language Spoken Most at Home Regularly at Home Percentage of Respondents of 9% 2.8% 3% total SSM Population (6950 out of 78670 (2175 out of 78665 (2550 out of 78665 (non aboriginal) respondents) respondents) respondents) Total number of 51 40 43 languages identified (non aboriginal) 20
Language Mother Tongue Spoken MOST at home Spoken REGULARLY at home 630 540 200 165 160 135 115 105 90 75 60 60 60 50 45 40 35 35 35 30 30 30 30 25 25 25 20 20 20 20 20 20 20 15 15 10 10 10 10 10 10 5 5 5 5 5 5 5 5 5 5 0 0 0 21
2011 Sault Ste. Marie Visible Minorities Census (n=1270) Multiple visible Japanese Korean minorities 4% 3% 3% West Asian 0% Southeast Asian 3% South Asian 22% Arab 7% Latin American 9% Filipino 3% Chinese 25% Black 21% 22
Clinical Cultural Competence Framework Equitable hiring Organizational Supportive policies Cultural Competence Clinical Structural Cultural Cultural Competence Competence Improved Cultural On ‐ site Health competence interpreters training Outcomes Adapted from Betancourt (2003)
Final Review Culturally Competent Practice: What does it look like? 24
Social Determinants of Health 25
Perspectives on Power and Privilege 26
“Tackling health inequity is a matter of social justice; it is also essential in order to provide the best care possible. Preventive measures that improve the conditions in which people live can lengthen the people’s lives and year spent in good health, improve services and save money.” Sir Michael Marmot (2013). Working for Health Equity: The role of Health Professionals 27
Social Determinants of Health 28
What could we have done differently?
30 Communication Cross-Cultural
31 Assigning Meaning Discuss at your tables: What it What it might means to me mean to another Not making eye contact Often saying “YES” Spending time on small talk Arriving late for an appt./class/work Needing to consult family 31
32 The Joy Luck Club: Dinner Scene
33 Collaborative Conversation: A Communication Tool
34 Collaborative Conversations 3 Steps 2 Ingredients Key phrases Empathy - Two concerns I’ve noticed . . . Understanding Help me understand . . Tell me more . . Can you explain that a bit more? What else are you thinking? Define the Problem What I’m thinking . . . I’m concerned that . . . I’ve been considering . . Invitation to Win/win solutions Would you be open to . . .. Generate Solutions Could we consider . . . . What can we do about this? Let’s consider . . . What about . . . I wonder if there is a way . . . . (Greene & Ablon, 2006) 34
Cultural Assessment Tool Potential topics to explore: Communication (language/style) Health Related Beliefs and Practices Bio-cultural Variations and Cultural Kinship and Social Network Aspects of the Incidence of Disease Cultural Affiliation Nutrition Cultural Sanctions and Restrictions Religious Affiliation Developmental Considerations Values Orientation Educational Background 35 (Andrews & Boyle, 2003)
Potential Assessment Questions These questions, developed by Arthur Kleinman, MD, a professor of medical anthropology at Harvard Medical School, Cambridge, MA, will help you evaluate a culturally diverse population. Consider how you would need to adapt them for the individual patient or family member: 1. What do you call the problem? 2. What do you think has caused the problem? 3. Why do you think it started when it did? 4. What do you think the sickness does? 5. How severe is the sickness? Will it have a short or long course? 6. What kind of treatment do you think you (or the patient, if asking a family member) should receive? What are the most important results you hope to receive from this treatment? 7. What are the chief problems the sickness has caused? 8. What do you fear most about the sickness? (Saver, 2007) 36
37 Cross Cultural Communication
Cultural Assessment 38
Cultural Assessment Tool Potential topics to explore: Communication (language/style) Health Related Beliefs and Practices Bio-cultural Variations and Cultural Kinship and Social Network Aspects of the Incidence of Disease Cultural Affiliation Nutrition Cultural Sanctions and Restrictions Religious Affiliation Developmental Considerations Values Orientation Educational Background 39 (Andrews & Boyle, 2003)
Interpreter Services 40
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