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How does culture influence the decisions a provider may make when selecting an intervention?

All cultures have developed systems of beliefs to explain the cause of illness, how illness can be cured or treated, and who should be involved in the health care process. In other words, every culture has beliefs about health, disease, treatment, and health care providers. Culture plays a huge role in medical interactions. It influences how an individual might view an illness or treatment, for example, and affects how a physician should address an older patient. Culture may also affect the decision-making process. Cultural beliefs can affect how a patient will seek care and from whom, how he or she will manage self-care, how he will make health choices, and how she might respond to a specific therapy. Cultural issues play a key role in compliance, which is a person’s willingness to adhere to the doctor’s recommendations. Culture influences healthcare at all levels, including communications and interactions with doctors and nurses, health disparities, health care outcomes, and even the illness experience itself. People in some cultures believe illness is the will of a higher power, and may be more reluctant to receive health care. While many people of a culture hold common beliefs, practices and institutions, there can be many variations between individuals. Hispanics from several nations share a strong heritage that includes religion and family, but each subgroup of the Hispanic population may have its own cultural customs and beliefs. Subgroups may have a unique use of language, family roles, religion and spirituality, definition of illness, and the use of healing and treatment practices. Some from Hispanic cultures and other cultures may even believe in folk illnesses, such as the “Evil Eye” or Mal de Ojo that can heat the blood of the recipient to cause vomiting and diarrhea. While most Hispanics use primary care physicians and other cosmopolitan sources of health care, some still prefer home remedies as suggested by a folk healer or curandero.

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Explain how culture impacts provider attitudes? Does it? How will you assess your own attitudes about various cultures/races/groups? Culture does impact provider attitudes. Some providers may not agree with certain cultures, be bias or judgmental. By utilizing culture competence we are able to have an open mind and positive attitude when treating diverse populations. Having an open mind and positive attitude lets you understand the patient, open more treatment options for the patient and being sensitive to treat clients form other cultures in improving to

treat all clients and not just one culture. Understanding culture provides a positive health outcome that is patient centered towards the patients care. Assessing your own attitude with different cultures is having an open mind and not being bias. Becoming aware of their culture and beliefs and applying it to their care.

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Review the terms for this week and apply them to population health; for instance: cultural competence, cultural awareness, norms, values, Kleinman Explanatory Model, socioeconomic status, disparities, minorities, food dessert. Cul t ur al compet enceA set of congruent behaviors, attitudes, and policies that come together in a

system, agency, or among professionals and enable the system, agency, or professionals to work effectively in cross-cultural situations. I saboutourwi l landact i onst obui l dunder st andi ng bet weenpeopl e,t ober espect f ul andopent odi ffer entc ul t ur al per spect i v es ,s t r engt henc ul t ur al s ec ur i t yandwor kt owar dsequal i t yi noppor t uni t y .Rel at i onshi pbui l di ngi sf undament al t o c ul t ur al compet enc eandi sbas edont hef oundat i onsofunder st andi ngeac hot her ’ s ex pec t at i onsandat t i t udes ,ands ubsequent l ybui l di ngont hest r engt hofeachot her ’ s k nowl edge,usi ngawi der angeofcommuni t ymember sandr es our cest obui l dont hei r under st andi ngs .

Cultural competence is 

The capacity for people to increase their knowledge and understanding of cultural differences

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The ability to acknowledge cultural assumptions and biases

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The willingness to make changes in thought and behavior to address those biases

Cultural awareness Cultural Awareness is the foundation of communication and it involves the ability of standing back from ourselves and becoming aware of our cultural values, beliefs and perceptions.

Someone's cultural awareness is their understanding of the differences between themselves and people from other countries or other backgrounds, especially differences in attitudes and values. Norms Social norms are the customary rules of behavior that govern our interactions

with others. They are “common standards within a social group regarding socially acceptable or appropriate behavior in particular social situations, the breach of which has social consequences.” Your values are the things that you believe are important in the way you live and work.They (should) determine your priorities, and, deep down, they're

probably the measures you use to tell if your life is turning out the way you want it to. When the things that you do and the way you behave match your values, life is usually good – you're satisfied and content. But when these don't align with your personal values, that's when things feel... wrong. This can be a real source of unhappiness. Kleinman's theory of explanatory models is a set of questions care providers can ask during an assessment which provides insight into what is most important for the client in terms of their health, illness, and care. Try blending these questions into your discussion in an informal manner.        

What do you call your problem? What name do you give it? What do you think has caused it? Why did it start when it did? What does your sickness do to your body? How does it work inside you? How severe is it? Will it get better soon or take longer? What do you fear most about your sickness? What are the chief problems your sickness has caused for you (personally, family, work, etc.)? What kind of treatment do you think you should receive? What are the most important results you hope to receive from the treatment

Socioeconomic status (SES) is an economic and sociological combined total measure of a person's work experience and of an individual's or family's economic and social position in relation to others. When analyzing a family's SES, the household income, earners' education, and occupation are examined, as well as combined income, whereas for an individual's SES only their own attributes are assessed. However, SES is more commonly used to depict an economic difference in society as a whole.[1] Although the term disparities is often interpreted to mean racial or ethnic disparities, many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen to a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. Healthy People strives to improve the health of all groups

Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”6

Minority, a culturally, ethnically, or racially distinct group that coexists with but is subordinate to a more dominant group. As the term is used in the social sciences, this subordinacy is the chief defining characteristic of a minority group. As such, minority status does not necessarily correlate to population. In some cases one or more so-called minority groups may have a population many times the size of the dominating group, as was the case in South Africa under apartheid (c. 1950–91). The lack of significant distinguishing characteristics keeps certain groups from being classified as minorities. food deserts are generally considered to be places where residents don’t have access to affordable nutritious foods like fruits, vegetables, and whole grains. Instead of grocery stores or farmers' markets, these areas often have convenience stores and gas stations with limited shelf space available for healthy options — making nutritious foods virtually inaccessible for many families there. The designation considers the type and quality of food available to the population, in addition to the accessibility of the food through the size and proximity of the food stores. [5] In 2010, the United States Department of Agriculture (USDA) reported that 23.5 million Americans live in "food deserts", meaning that they live more than one mile from a supermarket in urban or suburban areas, and more than 10 miles from a supermarket in rural areas.[6] Food deserts tend to be inhabited by low-income residents with reduced mobility, this makes them a less-attractive market for large supermarket chains.[7] Food deserts lack suppliers of fresh foods, such as: meats, fruits and vegetables. Instead, the available foods are often processed and high in sugar and fats, which are known contributors to the United States' obesity epidemic.[8]

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What are the social determinants of health? How does a provider integrate knowledge of these social determinants of health into their practice? Why are they important? Social determinants of health are the conditions in which people are born, grow, live, work and age. They include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. It is important in being aware of these social determinants because it dictactacts the care of patients and their health outcome. For example, a child may be living in an environment that is low income with few resources of healthy food options or access to care related to their parents socio-economic status. Addressing their care will be dependent on their environment and what resources they have around them to utilize. Addressing social determinants of health is not only important for improving 1

overall health, but also for reducing health disparities that are often rooted in social and economic disadvantages. The provider can integrate knowledge of these social determinants of health into their practice by using assessment tools. Under the ACA, not-for-profit hospitals are required to conduct a community health needs assessment (CHNA) once every three years and develop strategies to meet needs identified by the CHNA. The CDC defines a community health assessment as “the process of community engagement; collection, analysis, and interpretation of data on health outcomes and health determinants; identification of health disparities; and identification of resources that can be used to address priority needs.” Under the ACA, the assessment must take into account input from people who represent the broad interests of the community being served, including those with public health knowledge or expertise. Some providers have adopted screening tools within their practices to identify health-related social needs of patients. For example, according to a survey of nearly 300 hospitals and health systems conducted by the Deloitte Center for Health Solutions in 2017, nearly 9 in 10 (88%) hospitals screen patients to gauge their health-related social needs, though only 62% report screening target populations in a systematic or consistent way. These hospitals are mostly screening inpatient and high-utilizer populations. The National Association for Community Health Centers, in coordination with several other organizations, developed the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) tool to help health centers and other providers collect data to better understand and act on their patients’ social determinants of health. 44

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Apply social justice theory to the provision of care; what does social justice mean when applied to health care? Social justice is the view that everyone deserves equal rights and opportunities —this includes the right to good health. Yet today, there are inequities in health that are avoidable, unnecessary and unjust. These inequities are the result of policies and practices that create an unequal distribution of money, power and resources among communities based on race, class, gender, place and other factors. To assure that everyone has the opportunity to attain their highest level of health, we must address the social determinants of health AND equity. Social justice should be applied in health care so that all individuals receive equal rights and equal care. Racism has been an issue in social justice and health care. Blacks and Hispanics have been enduring health inequities related to their care related to less access to care and resources as well as providers treating them different. Health care — More than 30 percent of direct medical costs faced by blacks, Hispanics and Asian-Americans can be tied to health inequities. Because of inequitable access to care and other health-promoting resources, these populations are often sicker when

they do find a source of care and incur higher medical costs. That 30 percent translates to more than $230 billion over a four-year period.5 In addition, studies have shown that clinicians tend to have more negative attitudes toward people of color, and unconscious racial bias among clinicians has been shown to lead to poorer communication and lower quality of care. 

What data sources are used to assess determinants of health?

Data can be a catalyst for improving community health and well-being. Understanding data on social determinants of health, such as income, educational level, and employment, can help focus efforts to improve community health. The following tools are supported by CDC resources; some tools include references to data sources outside of CDC.  Chronic Disease Indicators o Level of data: state, territory, select large metropolitan areas o The Chronic Disease Indicators enable public health professionals and policy makers to retrieve state and selected metropolitan-level data for chronic diseases and risk factors.  Interactive Atlas of Heart Disease and Stroke o Level of data: national, state, territory, county o The Interactive Atlas of Heart Disease and Stroke enables online county-level mapping of heart disease and stroke by race/ethnicity, gender, and age group. Maps can show social and economic factors and health services for the United States, specific states, or territories.  National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Atlas o Level of data: national, state, select territories o The Atlas provides interactive maps, graphs, tables, and figures showing geographic patterns and time trends of the reported occurrence of the following diseases: HIV, AIDS, viral hepatitis, tuberculosis, chlamydia, gonorrhea, and primary and secondary syphilis. The data are based on nationally notifiable infectious diseases in the United States and can be used to examine disparities.  National Environmental Public Health Tracking Network o Level of data: national, state, county

o The Tracking Network is a system of integrated health, exposure, and hazard information and data from a variety of national, state, and city sources. Maps, tables, and charts with data about environmental indicators (e.g., particulate matter in the air) are available.  The Social Vulnerability Index o Level of data: census tract o The Social Vulnerability Index uses U.S. census variables at tract level to help local officials identify communities that may need support in preparing for hazards, or recovering from disaster. Social vulnerability refers to the resilience of communities when confronted by external stresses on human health, stresses such as natural or human-caused disasters, or disease outbreaks. Reducing social vulnerability can decrease both human suffering and economic loss.  Vulnerable Populations Footprint ToolExternal o Level of data: state, county, city, census tract o The Vulnerable Populations Footprint Tool creates maps and reports that identify geographic areas with high poverty rates and low education levels—two key social determinant indicators of population health. Thresholds for target areas are adjustable, allowing the tool to be used in geographic areas where regional rates may be higher or lower than the national average. (Free registration required to log in to this tool.)

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How do ethics and public policy intersect? Ethics are rules that guide the decision-making process. These rules are rooted in religion, morality, law, education, experience, and human strengths and weaknesses. Policy making works through process, and good policy making should be all about ethical processes . Thus, to have the right ethics means having the right standards: recognising the standards expected of us, and to the best of our ability living up to these standards. Public policy: standards appropriate to the various instruments of rule and regulation governments use to manage public affairs. Being ethical means doing the right thing consistent with our agreed standards.

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What influence do you as a provider have regarding public policy? What ethical obligation do you believe you have?

Public policy is a set of decisions by governments and other political actors to influence, change, or frame a problem or issue that has been recognized as in the political realm by policy makers and/or the wider public. As a provider you are thinking of the public and doing the right ethical thing in making sure they have a positive health outcome in implementing policies. You are applying your values , ethics, research and knowledge into implementing policies. The study of public policy includes policy analysis or policy science, which identifies effective policy measures, policy instruments, which a government can employ, and the policy process, which analyses how a government comes to take a decision. Public policy includes directly or indirectly making ethical judgments. Ethical decisions are taken mainly by policy makers by selection and reconciliation of interests represented by individuals, groups, and organizations. Public policy is based on the balancing individual and social values. From those value arise its objectives, principles, and styles of policy implementation and intervention. All choices and decisions in public policy on each stages of policy cycle are ethical judgments because they presuppose that some things are more important than other, that some actions will have positive and other will have negative impact on society. Policy debates can be more productive by using ethical approaches. Ethics enables a systematic analysis of the rules and standards as well as the selection of rational public decisions....