Definitions ? Studies of race and health frequently invoke?racism, prejudice, and discrimination?as possible reasons for high levels of morbidity and mortality among and among o

Chapter 11: PSYCHOSOCIAL IMPACT OF CULTURALLY INCOMPETENT HEALTH CARE

Learning objectives

After reading this chapter you should be able to:

•   Discuss the importance of the healthcare system adapting to the culturally changing climate of the United States.

•   Understand the difference between prejudice, discrimination, and racism and how they can potentially impact the experience of individuals from minority groups who receive culturally incompetent services.

•   Understand how culturally incompetent care can cause psychological dilemmas for patients.

•   Describe how healthcare providers’ awareness of microaggressions can aid in the delivery of culturally competent health care.

Introduction

The cultural landscape of the United States is changing, the healthcare profession has been attempting to adapt to this change on multiple levels (e.g., education curriculum, licensing exams, accrediting requirements) to ensure all consumers of health care receive equal treatment from their healthcare provider. Yet, consumers still receive culturally incompetent services from healthcare professionals.

This chapter will take a look at the psychosocial impact of culturally incompetent health care.

Definitions of Culture

Hays (1996, p.133)

“all the learned behaviors, beliefs, norms, and values that are held by a group of people passed on from older members to newer members, at least, in part to preserve the group”

Duckworth, Iezzi, Vijay, and Gerber (2009, p.64)

“culture is conceptualized as better capturing race, ethnicity, and other group influences that contribute to the attitudes, beliefs, behaviors, and goals held by a given individual”

Why is culture important?

Culture has always been used with race. What does the racial composition of the US look like now compared to what is projected in 2050?

Right now, Whites are the majority while BIPOC (Black, Indigenous and People of Color) make up the minority but it is projected that in 2050, Whites will be in the minority.

Why is this data important?

In addition to the increase of racial and ethnic minority groups, other underrepresented groups are either growing and/or making their presence known, for example, lesbian, gay, bisexual, and transgender individuals; non-Christians; the economically disadvantage; and the disabled.

The cultural evolution is evolving rapidly. Unfortunately, many institutions are neither keeping up with nor making necessary changes to adapt to the increasing cultural diversification of the United States.

Cultural factors (e.g., sexual orientation, religious beliefs, social class, and native language), although not well acknowledged in the literature, also contribute to the gap in health care and health status between various groups.

It is important to consider the psychosocial effects of patients who encounter racism, prejudice, and discrimination from their various healthcare providers.

PREJUDICE, DISCRIMINATION, AND RACISM

Prejudice is a baseless and usually negative preconceived belief, opinion, or judgment toward a group of people or a single person because of their membership in a certain group. Prejudice can be based on a number of identifiers such as gender, race, religion, age, sexual orientation, and socioeconomic status.

Discrimination is multifaceted and can operate at the individual, institutional, or structural level. Burgess, Ding, Hargreaves, van Ryn, and Phelan (2008, p. 895) defined it as follows:

In general, individual discrimination refers to behaviors of one group (e.g., racial/ethnic group, gender) intended to have harmful or unequal effect of the members of another group; institutional discrimination refers to the policies of the dominant group that are intended to have a harmful or unequal effect on minority groups, and structural discrimination refers to policies of the dominant group which are not intended to be harmful or unequal but, in practice, have a differential or harmful effect on minority groups.

Jones (1972) defines racism as “the transformation of race prejudice and/or ethnocentrism through the exercise of power against a racial group defined as inferior, by individuals and institutions with the intentional or unintentional support of the entire culture”

Individual racism is best known to the American public as overt, conscious, and deliberate individual acts intended to harm, place at a disadvantage, or discriminate against racial minorities; institutional racism is any policy, practice, procedure, or structure in business, industry, government, courts, churches, municipalities, schools, and so forth, by which decisions and actions are made that unfairly subordinate persons of color while allowing other groups to profit from the outcomes; and cultural racism is defined as the individual and institutional expression of the superiority of one group’s cultural heritage (arts/crafts, history, traditions, language, and values) over another group’s, and the power to impose those standards upon other groups.

AVERSIVE RACISM

A subtle form of bias in which “aversive racists consciously endorse the principle of racial equality and regard themselves as non-prejudiced but also possess unconscious negative feelings and beliefs about particular minority groups” (Dovidio et al., 2008, p.2)

RACIAL MICROAGGRESSIONS

“are brief and commonplace daily verbal, behavioral, and environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults to the target person or group” (Sue et al., 2007, p. 273).

Three types of racial microaggressions: microassault, microinsult, and microinvalidation.

(See ebook for more detailed explanation and cases to help you understand)

PSYCHOSOCIAL OUTCOMES OF CULTURALLY INCOMPETENT CARE

Sue et al. (2007) described four dilemmas that arise for both Whites and people of color when a racial microaggression occurs:

1. clash of racial realities

2. the invisibility of unintentional expressions of bias

3. perceived minimal harm of racial microaggressions

4. the catch-22 of responding to microaggressions.

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Further reading

Excerpt taken from: Understanding Racial and Ethnic Differences in Health in Late Life: A Research Agenda.

Studies of race and health frequently invoke racism, prejudice, and discrimination as possible reasons for high levels of morbidity and mortality among and among other racial and ethnic minorities. Definitions of these terms vary, and no definitions are universally accepted.

Various types of racism have been described personal, which may be considered the same as prejudice ;institutional, involving a set of environmental conditions, such as housing market conditions, that favors one group over another; and cultural, referring to shared beliefs about the superiority of one group over another. Racism also often involves control by one group over resources that another group wants or needs.

Discrimination refers to unequal treatment based on group membership. What actual perceptions, attitudes, or behaviors these constructs refer to depends on the context—the nature and timing of events, their frequency, severity, and duration, whether they are acute or chronic—and on how they are perceived and interpreted, whether intent is attributed, and how they may later be distorted in memory.

Prejudice, discrimination, and racism could affect health in several ways. First, discrimination could determine a group's living conditions and life chances, affecting such areas as education, employment, and housing. As we note above, low socioeconomic status is one of the most important predictors of adverse changes in health status, though the specific mechanisms by which low status compromises health have yet to be adequately elucidated. Similarly, all the mechanisms by which discrimination limits economic and social opportunities still need to be fully accounted for, but that it has historically had an effect on minority socioeconomic status is unquestioned.

Second, discrimination could lead to differences in access to and quality of health care. Third, the experience of specific incidents of unfair treatment on the basis of race or ethnicity may generate psychic distress and other changes in physiological processes that adversely affect. Fourth, some of the coping strategies that people use as they grapple with inequitable living conditions and a hostile psychosocial environment, such as internalizing negative stereotypes or using drugs and alcohol may also impair physical and psychological functioning.

National Research Council (US) Panel on Race, Ethnicity, and Health in Later Life; Bulatao RA, Anderson NB, editors. Understanding Racial and Ethnic Differences in Health in Late Life: A Research Agenda. Washington (DC): National Academies Press (US); 2004. 7, Prejudice and Discrimination. Available from: https://www.ncbi.nlm.nih.gov/books/NBK24680/

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