Abstract
Cultural sensitivity is an issue that is central to health and ethnicity, and also to creating programs for disease prevention and health promotions for varying ethnic and racial populations. The rationale, under which programs for promoting health are build, is based on three basic observations; the varying patterns in the predictors of the behaviors of health, different groups show; the differences in the rates of disease prevalence as indicated by various ethnic and racial groups; and the patterns exhibited by the same groups in the prevalence of risk factors imposed by their behaviors. The differences between the prevalence rates and risk factors are significant in providing for the rationale or reason for prevention programs that have been targeted. The differences exhibited by the health behavior predictors on the other hand, are very important in providing a basis for the tailored programs (Laura, Ramirez, Baker & Metzler, 2008).
Introduction
Health care that is culturally sensitive does just not involve simple prescriptions and formulas that provide one with a comprehensive and definitive single answer like normal health care does; rather multicultural health care requires one to completely understand and comprehend several significant principles upon which health care is build, in addition to the different ways in which culture and multiculturalism might affect these principles (Morales, et al., 2002). It is therefore, the duty and the responsibility of a health care giver to understand the needs of a community, beliefs and culture apparent in such a community, in addition to the active interest most patients have to participate in their own healthcare, the importance of a good relationship between a physician and a caregiver, and the many advantages of establishing approaches that are open minded in delivering care. These are important aspects in building communities that are healthier. Building communities that are healthy is one of the many objectives of the approach by public health in understanding the fact that, the well being and health of the members of a community are related to cultural, social, physical, environmental, economical, and many other factors; and that community engagement and participation are indispensable in improving the quality of life and health of that particular community (Laura, Ramirez, Baker & Metzler, 2008).
As of today, cultural diversity and multiculturalism in health care delivery is both incomplete and limited in responding to the various challenges in health in the low income urban groups in the US. In these urban communities, numerous challenges present themselves, which limit health and well being of the people. Such challenges include poverty, bad housing, unemployment, dirty streets, and toxic air. As a result of such tremendous challenges in these communities, community health centers must be able to prioritize on more than just being culturally reflective or sensitive to these groups. They must increase and expand their organizational responsibility as active community participants and incorporate their activities with those of other non- health organizations seeking to oppose and do away with the spatial and local signs of inequality (Morales, et al., 2002).
The purpose of this paper therefore, is to identify and discuss the few resources available in Houston, that address the needs of political, social, cultural, and health care; in addition to pin pointing the various implications of culture and ethnicity on the utilization of health care.
Demographic Data of the Houston Cultural Community
Houston is one of the best examples of a multicultural city in the United States. The reason for this multiculturalism is partly because of its many strong industries and academic institutions, in addition to being a major Port city in the country. The city has a wide variety of languages; more than ninety languages. The city also is believed to harbor the youngest populations in the United States, mainly because of the high rate of immigrant influx into the city. In the US, Houston is the third largest in Hispanic population as well as in Mexican population. In Texas alone, Houston is the largest in Hispanic population. It is estimated that more than 400,000 illegal immigrants live in Houston, in the Greater Houston region (Houston city, Texas, 2005).
The city, in addition to its large populations of Hispanics, also holds the largest Pakistani and Indian nationalities in the US. In addition to this, the Nigerian population is also the largest in the nation, occupying more than 2 percent of the city’s total population. According to the census contacted in 2010, the white’s population of the city amounted to 50.5 percent of the total population, with 25.6 percent of these being whites of non Hispanic backgrounds. 23.7 percent of the city’s population was occupied by the African Americans, with the native Indians making up 0.7 percent of the population (The City of Houston Health Disparities Data Report, 2008). Asians occupied a significant part of the city with their population percentage being 6, with that of the Pacific Islanders being the smallest; 0.1 percent. 15.2 percent of the population was taken up by some other race, with 0.2 percent of this population being taken up by non Hispanics. 3.3 percent of the city’s population was made up by individuals originating from two or more races. Generally, 43.8 percent Houston’s population was made up by people who had Latino or Hispanic origins (Houston city, Texas, 2005).
The city is diverse with a continuously growing and large international community. With such diverse cultures, religion in the city is also diverse, each cultural group adopting their own religion. Catholics and Protestants attract the largest populations. The city is also divided politically, with the balance of power often shifting between the Democrats and Republicans. However, the politics of the various regions in the city are determined by the wealth of the individuals; for example, the low class and the minority groups are largely Democrats and so are the city’s middle class groups. The high class and wealthier groups are mainly republicans. According to the Houston Area survey carried out in 2005, non Hispanic whites, who accounted for more than 68 percent of the population of Harris County where declared Republicans, while most of the non Hispanic blacks, who accounted for more than 89 percent of the county, were found to be Democrats or in favor of the Democratic politics. The survey also showed that more than 62 percent of the Hispanics in the Harris County were in favor of the Democratic politics or Democrats themselves. The Latino or the Hispanic ethnic groups in Houston have lower educational attainment levels and as a result, they experience higher levels of poverty than any other ethnic group in Houston (Houston city, Texas, 2005).
Health Care Resources in Houston
Houston has numerous health care resources, including one of the largest research and health care institution in the US, Texas Medical Center. In addition to this, the center has more than 47 member institutions, which are all non profit organizations. These organizations provide for the community with preventive and patient care, education, research, and national, local, and international community health.
These institutions include more than 13 hospitals, two medical schools, two specialty institutions, 4 nursing schools, and public health, dentistry, and pharmacy schools. It is in this centre where one of the largest air emergency services was created; Life Flight, and where one of the best inter- institutional transplant program is based (Houston city, Texas, 2005).
Some of the research and academic institutions at the Texas Medical Center include Baylor College of Medicine, MD Anderson Cancer Center, UT Health Science Center, The Methodist Hospital, Memorial Hermann Hospital, UH College of Pharmacy, and Texas Children’s Hospital. Most of these health care institutions have been considered for ranks in several medical awards. The Menninger Clinic is also another health care provider closely associated with The Methodist Hospital System and Baylor College of Medicine; it specializes in psychiatric treatment (Houston city, Texas, 2005). Access to effective health care among the minority groups is one of the major challenges in Houston city; limited access in turn affects the outcomes of the population’s health. Asian and Hispanic populations are some of the most affected populations in Houston because of limited access to medial care. This is because they experience the most obstacles to significant health care. For example, a big percentage of this population does not have any health insurance or a constant source of medical care and are not able to afford most of the medical services on offer (The City of Houston Health Disparities Data Report, 2008).
Health Status of the Cultural Population
The African American population in this city experiences worse health, than the other ethnic groups, for numerous health indicators (The City of Houston Health Disparities Data Report, 2008). Some of these health indicators include higher rates of being obese or over weight, higher infant mortality rates, HIV/ AIDs, diabetes, and several other sexually transmitted diseases. Other health indicators include higher mortality rates for a number of conditions like cancer, heart disease, diabetes, and stroke. The Latino or Hispanic population on the other hand, experiences worse outcomes, than the white ethnic groups in Houston, for several health indicators. A number of these indicators include higher mortality rates resulting from obesity, diabetes, kidney diseases, and tuberculosis. They also have decreased access to health care for preventive services. The white population also experiences worse outcomes for a number of health indicators than any other racial groups in Houston. Examples of these include higher mortality rates from diseases such as chronic lower respiratory disease, suicide, heart disease, breast cancer, and Alzheimer’s disease (The City of Houston Health Disparities Data Report, 2008).
Health Benefits and Risks in the Cultural Group
Several cultural factors affect health in Houston, both positively and negatively. Some of these factors include socio- economic, age, climate, gender, and race. A number of studies have indicated that ones status in socio economics affects their health in many ways, especially in terms of income and education (The City of Houston Health Disparities Data Report, 2008). Individuals with a lower status in socio- economy experiences health outcomes that are poor than those experienced by the others because of their challenged ability to afford basic needs and necessities such as medical care, nutritious food, health insurance and safe and quality housing. An individual’s socio- economic status also affects their opportunities to acquire education and thus employment; and as a result the individuals living context is affected negatively through limited availability of resources, which further exposes such people to health risks. According to a survey carried out by the Texas Department of State Health Services, populations like the Hispanics and the blacks in Houston were the most likely individuals to report the status of their health as poor or fair, unlike the white populations, who reported their health status as good (The City of Houston Health Disparities Data Report, 2008).
Another factor that can affect ones health is their race, in regards to discrimination and racism. For example, the racism found in institutions can indirectly or directly affect the health of an individual through limiting their opportunities to gain education, employment, social opportunities, and housing. These inequalities found in most structures of the societies can result to minority groups to become segregated and have smaller access to high paying jobs and quality education. As a result, these individuals are forced to live in environments that pose greater health hazards like hazardous waste, and limited resources like public transport. Racism also has a direct effect on a person’s health in regards to their physical and mental health, causing increased tension, stress, heart disease, smoking, depression, and drug and alcohol abuse (The City of Houston Health Disparities Data Report, 2008).
The age of an individual is also another significant factor in determining their health status. For example, in Houston, studies have shown that Latino or Hispanic youths are more likely to become overweight than the other populations. Premarital sex has also become another worrying trend among the youth in Houston. This can affect the health of the concerned parties through various ways. It could have outcomes like teenage pregnancy, sexually transmitted diseases, cervical cancer and even mental instabilities. The gender of individuals also determines ones status of health. For example, cervical cancer affects the female generation more while obesity affects the Hispanics young male mostly (The City of Houston Health Disparities Data Report, 2008). The climate can also bring about distasteful outcomes in the health status of many people in Houston. The climate in the region attracts violent thunderstorms that result to tornados. These can affect the health of many through contaminating drinking water with dirty water from sewages and the sea, resulting to water bone disease.
Overall Global Goals of Care and Rationale
A health care system is a term used to refer to an organization of institutions, resources and people who deliver services in health care to meet the needs of health of a particular population. There are many goals that many healthcare givers have in mind while providing their patients with health care services. Such goals include cure, rehabilitation and restoration, maintenance and even ensuring the comfort of a patient while in their death bed. According to WHO, the ultimate goals for each one of the various health care givers is better and improved health (World Health Organization, 2000). As a result the organization has pinpointed several elements that health providers should observe. Such elements include decreasing social disparities and exclusions in health care, increasing the participation of the stakeholders, organizing all the available services in health care around the expectations and needs of the patients, pursuing and identifying various policy dialogue models, in addition to integrating health services into all sectors of public policy reforms. To WHO, the goals of any health care system are responsiveness to the needs of the population, good health, and fair contribution financially, to the health services offered to these populations (World Health Organization, 2000).
Expected Social Supports in the Community
There are a number of social supports available in the community. Some examples include emotional support, esteem support, informational support and tangible support. Informational support is the kind of support given through advice, sharing and gathering information. Tangible support on the other hand is offering support to some one by taking on some of their responsibilities so that they can deal with a particular problem. Such support includes bringing someone food or cooking for them when they are sick, or helping them brainstorm for a solution. Esteem support is the kind of support given to some one through encouraging them or giving them confidence. This helps patients believe in themselves and therefore, enhances their recovery. This is very common with life coaches. Emotional support can be offered through hugs, empathizing or giving someone a pat on the back for encouragement (Brown, Nesse, Vinokur & Smith, 2003).
Influence of Religion
There are various religious beliefs common to the folk religion and main stream religions in the Hispanic population. These concepts are significant determinants of one’s perception of origin, treatment of illness and origin. Most contemporary Hispanics belief that God is always involved in an illness. This as they belief, is because various religious entities like Folk Saints can negatively affect ones health. This means that these religious entities are also capable of giving one their wellness back. In most Hispanic cultures today, folk religion and traditional religion co exist as a single system that is significantly involved in the system of health care delivery. Most Hispanics in Houston have extended kinships and as a result they influence each others perceptions of health care choices and illness (Crumrine & Morinis, 1991).
Effect of Cultural Beliefs
The Hispanic populations in Houston have a long history of using alternative health care delivery systems. These practices and systems are very diverse and complex, and are commonly known as the ‘Curanderismo’ cultural system. The body of this cultural system in Houston is composed of both female and male folk healers. Most studies have shown that a person’s decision to visit a ‘Curandero’ is usually influenced by the physical, personal, emotional, and economic troubles in that individual’s life. In most cases, Hispanics seek the services of the traditional folk healers when medical therapy proves insignificant. It is the observation of various studies that most chronic ailments in the Mexican- American populations go untreated. As a result, diabetes, arthritis, hypertension, and other similar chronic ailments are common in the client- patient load of most curanderos (Zavaleta, 1998).
How Health Care Decisions Are Made Within the Family
Through out the history of the Hispanics and other Mexican American populations, the cohesiveness and the resilience of the ‘Hispanic Family’, has always been a thing of admiration; it is for many the single determinant of what is the best choice for an individual, and what is the best, for their culture. The family in most Hispanic homes therefore, has remained as some sort of cultural super- glue, for many years despite many efforts to discredit it. The decisions made in these families have diverse effects on the health of the individuals. This is because most Hispanic families perceive mistrust or fear of the mainstream health care delivery system, such as social services agencies and hospitals. In treating an individual from such a family therefore, requires the involvement of the whole multi generational Hispanic extended family. This is because decisions are made by the family and not by an individual (Trotter & Chavira, 1981).
Factors Affecting Health Care Utilization
There are various aspects that influence how a certain ethnic population will utilize health care resources. Some of these include the availability of the resources themselves, the socio- economic factors such as climate, education, poverty, employment, and age, of the population in question, the accessibility to the health care providers, racial segregation and discrimination, the age demographics of the population, their cultures, their religion and beliefs, and their location (Richard & Marmot, 2003).
Summary/ Conclusion
Inequalities in the quality of health care given to minority populations can occur. Examples of such inequalities include; minority groups are more likely than the other ethnic groups, to be diagnosed with, more serious diseases, patients whose socio- economic statuses are low are less likely to receive health care services for serious diseases like diabetes, than other people with higher socio- economic statuses. It is very important to note that such health care disparities and inequalities impose a very heavy price, both for the society and for the affected individual. This is because such disparities to access to health care can lead to inequality in the quality of the health care services availed to such individuals. For example, it is very difficult for people with an Asian or Hispanic background, those who are from low socio- economic status, to communicate with physicians and access important information on health care. As a result of this, opportunity to access and get preventive care for a condition, are missed or denied (The City of Houston Health Disparities Data Report, 2008).
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