9: Community Health in Diverse Racial and Ethnic Populations Communities in the US
- Page ID
- 116389
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)The United States is an increasingly diverse country, with states like California at the forefront of culturally-responsive approaches to community health. Seven states (as of 2020 Census data) are already majority-minority states (states where non-Hispanic whites make up less than 50% of the population): Hawaii (the only state that has never had a white majority), New Mexico, California, Texas, Nevada, Maryland, and Georgia. In at least 14 states, the child population is majority non-white. The complex needs of diverse communities have important implications for US public policy and public health, leading to innovations in culturally- and linguistically-appropriate care.
- 9.1: Goals for this Module (also known as learning outcomes)
- This page educates students on U.S. diversity and its public health implications, emphasizing a 1985 minority health report. It covers government racial categories, health data collection challenges, and minority socio-demographics. Key topics include combating health inequities, the role of socioeconomic status, and cultural competence in healthcare. The module also analyzes COVID-19's varied effects on racial groups and introduces the "immigrant paradox" in health outcomes.
- 9.2: Chapter 10 in ICPH- Community and Public Health and Racial/Ethnic Populations
- This page analyzes the health status of major non-white racial and ethnic groups in the U.S., focusing on African Americans, Asian Americans, Native Americans, Pacific Islanders, and Latinos. It highlights the importance of cultural competency and socioeconomic factors in health disparities while acknowledging potential over-generalizations.
- 9.6: Racial and Ethnic Classifications
- This page examines the changing definitions of "minority" and "majority" in the U.S. amidst increasing racial diversity, predicting non-White populations will become a majority by 2060. It argues that race is a social construct and criticizes U.S. Census classifications for oversimplifying identities. The text underscores the importance of recognizing diverse ethnic backgrounds as diversity grows, highlighting its impact on health statistics and social identity.
- 9.7: Issues with Data and with the Classifications
- This page discusses the limitations of health data, such as incomplete information and inconsistent racial self-identification. It highlights the ACA's goal to enhance data collection for health equity while noting public health authorities’ opposition to eliminating racial categories.
- 9.8: Snapshots of the Health of Racial and Ethnic Groups in the US
- This page analyzes the classification of races and ethnicities in the US, addressing data-related challenges. It summarizes the health conditions of various minority groups, including immigrants and refugees, across racial and ethnic lines. Furthermore, it includes a map depicting predominant ancestries in US counties as per the 2010 Census.
- 9.9: Americans of Hispanic Origin- Health overview and leading causes of death
- This page discusses the growth of the Hispanic or Latino population in the US, making up 17.4% of the total, though growth is slowing due to decreased immigration. This younger demographic typically has lower education and income levels than whites. The "Latino Paradox" indicates that Latino immigrants often have better health outcomes than their native-born counterparts. Factors contributing to this include healthier individuals immigrating, strong family support, and healthier dietary habits.
- 9.10: African Americans- Health overview and leading causes of death
- This page discusses the demographics and challenges faced by African Americans, who made up 14.3% of the US population in 2014, predominantly in southern states. Despite educational achievements, they encounter obstacles to higher education and have the lowest median household income of all racial groups. Historical injustices have led to mistrust in health services, while cultural factors shape their health behaviors.
- 9.11: Asian Americans and Pacific Islanders- Health overview and leading causes of death
- This page discusses the Asian American population, which was 6.3% of the US in 2014, with growth in the West. It highlights socioeconomic disparities in educational attainment and health beliefs centered on balance and community responsibility. The cultural practice of mask-wearing during COVID-19 illustrates a collective identity, while the unique needs of Pacific Islanders, previously overlooked in data until 2010, underline significant barriers in healthcare access for these communities.
- 9.12: American Indians and Alaska Natives- Health overview and leading causes of death
- This page discusses the original inhabitants of America, American Indians and Alaskan Natives, who represent diverse tribes and make up less than 2% of the U.S. population. It highlights the U.S. government's relationship with their healthcare, managed by the Indian Health Service for 566 tribes and additional tribal health initiatives. Major health concerns for this population include heart diseases, cancer, and diabetes.
- 9.13: Immigrant and Refugee Health
- This page examines the refugee crisis, emphasizing the U.S. legal obligation to support those escaping persecution. It differentiates between refugees and asylees and notes the large, diverse global refugee population resettling in the U.S. Health challenges for refugees often stem from trauma and poverty, differing from those of immigrants. While political backing for refugee programs has varied, there remains general public support for assisting refugees in need.
- 9.14: Minority Health and Health Inequities (disparities)
- This page emphasizes the importance of closing health disparities in the US for public health, as highlighted in the Healthy People initiatives. It defines health disparities as differences in outcomes among populations, often influenced by racial and ethnic inequities. Historical reports, like the 2002 Institute of Medicine findings, have prompted actions addressing these issues.
- 9.15: Health Disparities in Specific Health Conditions
- This page highlights six critical health issues from the Race and Health Initiative: infant mortality, cancer, cardiovascular diseases, diabetes, HIV/AIDS, and immunization rates. These issues drive health disparities, some of which have improved, like influenza vaccination, while others, particularly cancer, persist due to complexity. The text emphasizes the need to explore the connections between these disparities, social determinants of health, and the impact of community health initiatives.
- 9.16: Social Determinants of Health and Racial and Ethnic Disparities in Health
- This page discusses social determinants of health, focusing on the relationships among race, ethnicity, education, and income. It emphasizes that higher education leads to better job opportunities, higher income, and improved health literacy, thereby enhancing health and well-being. Attending City College is specifically noted as a beneficial factor for health, underlining the overall positive impact of education on individual health outcomes.
- 9.17: And now... cultural competence and cultural humility
- This page focuses on cultural competence and humility, offering practical tools for application. It also discusses the effects of Covid-19 on various racial and ethnic groups in the US during the pandemic year.
- 9.18: Cultural Competency
- This page discusses cultural competency in healthcare, highlighting its importance for effective cross-cultural interactions. It emphasizes the need for understanding and respecting diverse values and beliefs, as defined by key health organizations. The evolution of healthcare systems has made cultural competency vital for improving health outcomes, requiring organizations to adapt to the needs of diverse populations rather than just changing patient behavior.
- 9.19: Cultural Humility
- Dr. Melanie Tervalon and Dr. Jann Murray-Garcia introduce "Cultural Humility" in medical education as a more viable alternative to "cultural competency." They argue that mastering diverse cultures quickly is unrealistic. Cultural humility focuses on self-reflection, addressing power dynamics, patient-centered care, and building respectful community partnerships, emphasizing ongoing learning and responsiveness to diverse patient needs while acknowledging individual limitations.
- 9.20: Cultural Barriers to Care
- This page discusses the traditional view of medical culture as seeing patient culture as a barrier to compliance, contrasting it with recent research that highlights how medical culture itself can create barriers. It emphasizes that providers' assumptions about communication and understanding may conflict with diverse cultural practices, and varying hospital policies can further complicate patient care.
- 9.21: Culturally and Linguistically Appropriate Services (CLAS) Standards
- This page outlines the CLAS Standards designed to promote equitable and culturally responsive public health and healthcare services. It highlights the importance of respecting diverse cultural beliefs and communication needs in care delivery. The implementation of these standards necessitates transformations in governance, leadership, workforce, communication, and accountability. Additionally, it references an optional video that provides an overview of the National CLAS Standards.
- 9.22: Health Inequities in the Pandemic
- This page highlights the widespread impact of Covid-19, emphasizing health inequities faced by vulnerable groups like older adults and racial minorities. It examines how social and economic factors worsened these disparities during the pandemic and addresses the global effects on immigrant and refugee communities.
- 9.23: What does a successful response look like?
- This page discusses initiatives to mitigate Covid-19's impact on racial and ethnic communities, highlighting vaccine distribution for Native Americans, the influence of Black doctors in African American communities, and the United in Health campaign in San Francisco's Mission District. It also notes preparedness efforts in Chinatown, showcasing resources aimed at addressing health inequities during the pandemic.