Cultural Diversity in Health and Illness
There is something that transcends all of this I am I . . . You are you Yet. I and you Do connect Somehow, sometime.
To understand the “cultural” needs Samenesses and differences of people Needs an open being See—Hear—Feel With no judgment or interpretation Reach out Maybe with that physical touch Or eyes, or aura You exhibit your openness and willingness to Listen and learn And, you tell and share In so doing—you share humanness It is acknowledged and shared Something happens— Mutual understanding
—Rachel E. Spector
Cultural Diversity in Health and Illness
E I G H T H E D I T I O N
Rachel E. Spector, PhD, RN, CTN-A, FAAN Needham, MA 02494
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ISBN-13: 978-0-13-284006-4 ISBN-10: 0-13-284006-5
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Library of Congress Cataloging-in-Publication Data Spector, Rachel E. Cultural diversity in health and illness/Rachel E. Spector.—8th ed. p. cm. Includes bibliographical references and index. ISBN-13: 978-0-13-284006-4 ISBN-10: 0-13-284006-5 1. Transcultural medical care—United States. 2. Health attitudes—United States. 3. Transcultural nursing—United States. I. Title. RA418.5.T73S64 2013 610—dc23 2012012708
10 9 8 7 6 5 4 3 2 1
I would like to dedicate this text to
My husband, Manny; Sam, Hilary, Julia, and Emma; Becky, Perry, Naomi, Rose, and Miriam; the memory of my parents, Joseph J. and Freda F. Needleman, and my in-laws, Sam and Margaret Spector; and the memory of my beloved mentor, Irving Kenneth Zola.
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ABOUT THE AUTHOR xvii
UNIT I CULTURAL FOUNDATIONS 1
Chapter 1 Building Cultural and Linguistic Competence 3 National Standards for Culturally and Linguistically
Appropriate Services in Health Care 8 Cultural Competence 11 Linguistic Competence 11 Institutional Mandates 12 CULTURALCARE 13
Chapter 2 Cultural Heritage and History 19 Heritage Consistency 20 Acculturation Themes 29 Ethnocultural Life Trajectories 32 Commingling Variables 34 Cultural Conflict 36 Cultural Phenomena Affecting Health 37
Chapter 3 Diversity 43 Census 2010 45 Immigration 48 Poverty 54
Chapter 4 Health and Illness 62 Health 63 Illness 74
UNIT II HEALTH DOMAINS 85
Chapter 5 HEALTH Traditions 89 HEALTH and ILLNESS 91 HEALTH Traditions Model 92 HEALTH Protection 95 Health/HEALTH Care Choices 102
viii ■ Contents
Folk Medicine 104 Health/HEALTH Care Philosophies 108
Chapter 6 HEALING Traditions 120 HEALING 121 Ancient Forms of HEALING 123 Religion and HEALING 124 HEALING and Today’s Beliefs 136 Ancient Rituals Related to the Life Cycle 138
Chapter 7 Familial HEALTH Traditions 158 Familial Health/HEALTH Traditions 160 Consciousness Raising 171
Chapter 8 Health and Illness in Modern Health Care 178 The Health Care Provider’s Culture 179 Health Care Costs 182 Trends in Development of the Health Care System 187 Common Problems in Health Care Delivery 191 Pathways to Health Services 195 Barriers to Health Care 197 Medicine as an Institution of Social Control 199
UNIT III HEALTH AND ILLNESS PANORAMAS 207
Chapter 9 HEALTH and ILLNESS in the American Indian and Alaska Native Population 210 Background 211 Traditional Definitions of HEALTH and ILLNESS 213 Traditional Methods of HEALING 215 Current Health Care Problems 222 The Indian Health Service 228
Chapter 10 HEALTH and ILLNESS in the Asian Populations 238 Background 239 Traditional Definitions of HEALTH and ILLNESS 241 Traditional Methods of HEALTH Maintenance
and Protection 246 Traditional Methods of HEALTH Restoration 247 Current Health Problems 257
Chapter 11 HEALTH and ILLNESS in the Black Population 265 Background 266 Traditional Definitions of HEALTH and ILLNESS 270 Traditional Methods of HEALTH Maintenance
and Protection 271
Contents ■ ix
Traditional Methods of HEALTH Restoration 272 Current Health Problems 279
Chapter 12 HEALTH and ILLNESS in the Hispanic Populations 291 Background 292 Mexicans 294 Puerto Ricans 308
Chapter 13 HEALTH and ILLNESS in the White Populations 323 Background 324 German Americans 326 Italian Americans 330 Polish Americans 334 Health Status of the White Population 339
Chapter 14 CULTURALCOMPETENCE 345 CULTURALCOMPETENCY 351
Appendix A Selected Key Terms Related to Cultural Diversity in Health and Illness 354
Appendix B Calendar: Cultural and Religious Holidays That Change Dates 364
Appendix C Suggested Course Outline 367
Appendix D Suggested Course Activity—Urban Hiking 373
Appendix E Heritage Assessment Tool 376
Appendix F Quick Guide for CULTURALCARE 379
Appendix G Data Resources 381
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