Chapter 4 discusses cultural competency in relation to immigrant populations and public health, emphasizing the importance of understanding diverse cultural backgrounds to improve health outcomes. It outlines four key concepts: cultural knowledge, awareness, sensitivity, and competence, and addresses the challenges faced by immigrants, including language barriers and health disparities. The chapter also examines historical immigration policies and their impact on community engagement in public health practice.

1. Chapter 4
Culture Competency and CEOD Process: Immigrant
Populations, Health Care, Public Health, and Community
Defining and Exploring Culture
A group or community with whom one shares common
experiences that shape the way they understand the world
Can include groups:
Born into
Gender
Race
National origin
Class
Religion
Moved into
Moving into a new community
Change in economic status
Change in health status

2. Four Concepts Associate With Culture:
Cultural knowledge / the knowledge of cultural characteristics,
history, values, beliefs and behaviors of another ethnic or
cultural group
Cultural awareness / being open to the idea of changing cultural
attitudes
Cultural sensitivity / knowing that differences exist between
cultures, but not assigning values to the differences
Cultural competence / having the capacity to bring into its
systems different behaviors, attitudes and policies and work
effectively in cross-cultural settings to produce better outcomes
Learning Culture
Be more aware of your own culture
What is your culture?
Do you have more than one culture?
What is your cultural background?
Learn about other’s culture
Make s conscious decision to establish friendships with people
from other cultures
Put yourself in situations where you will meet people of other
cultures
Examine your biases about people from other cultures
Ask questions about the cultures, customs and views
Read about other people’s cultures and histories
Listen and show caring

3. Observe differences in communication styles and values; don’t
assume that the majority’s way is the right way
Risk making mistakes
Learn to be an ally
Understanding Culture for Community Engagement,
Organization and Development (CEOD)
U.S. communities are becoming more diverse
Racial profiling & stereotyping will be key discussion points
when engaging and developing communities in public health
practice and may be harmful because they can impede
communication, engagement and development
Racial profiling / a law enforcement practice of scrutinizing
certain individuals based on characteristics thought to indicate a
likelihood of criminal behavior
Stereotyping / a fixed, over generalized belief about a particular
group or class of people (Cardwell, 1996)
CEOD and Cultures of the Future
Questions to help engage, organize and develop a healthy
community of the future:
If you could have your ideal community right now what would
it look like?
If you can’t have your ideal community right now, what will be

4. the next steps in building the kind of cultural community you
desire?
Who lives in the community right now?
What kinds of diversity already exist?
How will diversity be approached in your community?
What kinds of relationships are established between cultural
groups?
Are the different cultural groups well organized?
What kind of struggles between cultural groups exists?
What kind of struggles within cultural groups exists?
Are these struggles openly recognized and talked about?
Are there efforts to build alliances and coalitions between
groups?
What issues do different cultural groups have in common?
Culture Building and Context
Contextualization / communicating or providing a service in
such a way that it addresses the needs of the people it seeks to
serve
Principles that will create a favorable environment for building
diverse communities:
Every person needs to feel included and important
Guilt/blaming does not work in fostering diversity
Treating everyone the same may be unintentionally oppressive
(learn about cultural difference and treat appropriately)
Keep a spirit of hope on all issues
Team building
Welcome differences among groups
“How” content is delivered is often more important than “What”
the content is

5. Engage families, organizations, institutions and neighborhoods
The Demographic Challenge: Birth Dearth or Population
Bomb2000 Census2010 CensusChange (%)U.S. Population281.4
million308.7 million+27.3 million (9%)
Non-Hispanic White
Hispanic
Black
Asian194.6 (69%)
35.3 (12.5%)
34.7 (12.3%)
10.2 (3.6%)196.8 (64%)
50.5 (16.3%)
38.9 (12.6%)
14.7 (4.8%)+2.3 (1.2%)
+15.2(43%)
+4.3 (12.3%)
+4.4 (43%)

6. Immigration Policy and Practice in the US: A Historical
Perspective
The McCarran Walter Act of 1952
The Hart-Cellar Act of 1965
The Illegal Immigration Reform and Immigrant Responsibility
Act of 1996
The 1996 Welfare Reform Act
The 2009 CHIP Reauthorization Act
Results of September 11, 2001 for immigration
The Response of Native Born to Immigrant
Nativism / intense opposition to an internal minority on the
grounds of its foreign connections
Racism / a belief that race is the primary determinant of human
traits and capacities and that racial differences produce an
inherent superiority of a particular race
Ethnocentrism / characterized by or based on the attitude that
one's own group is superior
Assimilate / to absorb into the culture or mores of a population
or group
Health Status of Immigrant Populations
Immigrants tend to have more positive health behaviors and
fewer negative health behaviors when compared to the U.S.

7. born population.
Over successive generations, immigrants tend to becomes more
“American” in habits, which can result in “unhealthy
assimilation”
Language barriers play a large role in adverse health outcomes
for many immigrants
Poverty and lack of education also plays a negative role in
health status
The Irony of Health Care for Immigrants: The Inequity Surprise
Uninsured: Immigrants = 12.3 million 26.6% of total uninsured
Immigrants spend one half to two thirds the medical
expenditures of native-born Americans, even when fully insured
Contrary to stereotype, immigrants as a group are sparing users
of health services
California, Texas, Florida and New York account for 58.8% of
uninsured immigrants in U.S.
The uninsured (immigrants and native born) are responsible for
only 2% of the cost of health care in U.S.
Health disparities must be addressed to improve the health
status of the nation
Those Because insurance companies negotiate rates with
providers and hospitals, patents with insurance are charged
significantly less than those without coverage (Those least able
to pay are charged the most)
The 2010 Health Reform Law / Affordable Care Act is expected
to expand coverage for poor uninsured, mainly through the
expansion of Medicare and CHIP, but will not address
undocumented immigrants

8. Generational Differences & Generational Change
Over successive generations, European Immigrants become
more closely approximated to the host population progressively
erasing deficits in education attainment, economic achievement
and health status along seven dimensions:
Cultural
Structural
Marital
Identity
Prejudice
Discrimination
Civic assimilation
Asian and White European fare better than other immigrants of
color
Cuban Americans are the most successful Hispanic group
Effecting Change and Establishing Dialogue: Organization as
Education
Cross cultural care for immigrant patients
Humility
Empathy
Curiosity
Respect

9. Sensitivity
Awareness of outside influences
After reading Chapter 4 and reviewing the powerpoints,
You will need to post your comment as respond to the 3
comments by no more than 2-3 Complete Sentences. I Looking
on the depth, not the length of your comments
Need to Respond to this:
1. L. S.
America as a nation is becoming more and more diverse and
globalized as the years as go on. Which means without
immigration none of this could be possible and we now see
more diverse communities throughout America. I do believe
having some policies set in place are needed to regulate
possible things like over population or more families and
individuals could live in poverty. But immigration isn’t bad
either if regulated safety and properly we as a nation could and
have benefited from it either economically, socially, or
politically. This could also lead to healthier communities
because there are things people in United States don’t know
(medical or technology) that an “immigrant” might do. Some
might say immigration is a stressors on education and health
resources because of the language and culture barriers. But I
simply think the government should fund more jobs in those
communities to help with some the barriers we are dealing with
today. To ensure that proper care for those people in these
communities.

10. Need to Respond to this:
2. J. K.
‫ج‬‫نموذ‬ ‫ال‬ ‫ى‬‫ل‬ ‫أع‬
Immigration is becoming more of a norm in the 21st century and
it is helping the U.S. communities to become more open-minded
and diverse. There are different cultural aspects that are brought
here because of immigration that have positive influences on the
economy and our communities. As immigration increases,
maybe racial profiling and stereotyping will decrease. The
attitudes and values brought over along with things like
language and culture will hopefully increase peoples cultural
sensitivity overtime and help shape the future of public health
in the United States to be more successful because of diversity
and togetherness.
‫ج‬‫نموذ‬ ‫ال‬ ‫فل‬ ‫س‬ ‫أ‬
Need to Respond to this:
3. J. J.
‫ج‬‫نموذ‬ ‫ال‬ ‫ى‬‫ل‬ ‫أع‬
In the 21st century, America has become more diverse than
ever, this will continue to happen, no matter the government
tactics or what close minded people would rather want. This
will continue to happen so we should all find positive ways to
integrate as much as possible, instead of the opposite. With this,
a lot of helpful information can rise to the forefront once
everyone realizes what actually important, community health is.
Assimilations of other cultures would be very beneficial. When
you think about some of the major health problems globally,
America does not have great rankings among other countries
(especially considering all the information and resources
America has). Truly understanding and having empathy for
immigrants cost nothing and adopting customs/ideas from other
cultures can’t hurt.

11. EXAMPL:
L. W.:
My target population is going to high schoolers with an
intellectual or developmental disability within Bowling Green,
KY. I chose this community because there is a lack of
preparedness for these individuals when transitioning from a
high school schedule to an adult life schedule. Many people do
not know, but when an individual with a disability turns 21
years old, they are no longer welcome back at their high school.
So whether your birthday is on the first day of school or the last
day of school, the day after you turn 21, you are no longer
permitted to be back in the high school. The challenge with this
is that since there is so little emphasis on transition, this slaps
many of these students in the face since they have had a routine
ingrained into their life since they were very young. For anyone
who's ever had a relationship with someone with a disability, it
is a known fact that this community best thrives on a consistent
schedule. So when that schedule is abruptly changed, behavioral
and emotional issues are often the after math while coping with
the adjustment. So for my project, I wanted to create a
coalition that would emphasize the need for transition from high
school to adult life. I believe that reaching out to relevant
organization leaders who advocate for these individuals, mental
health professionals, state leaders such as Matt Bevin, high
school teachers and even parents affected by these changes, we
can get insight and enough data to get a motion rolling for
change. By getting this information from these people, it will be
easier to build this program up with as many of sides of the
intervention as we'll have! Of course, then goals and strategies
will be created and utilized to build up the program.
By using the MAPP model, I will be thoroughly implementing
and promoting a program to instill change. By going through all
six phases of the MAPP model, you are insuring that you are
covering all of your bases in an organized fashion, while
challenging yourself to think of issues that may arise later, and
how to solve those issues. Since MAPP relies on partnerships

12. and participation from members, this is also a great way to
network and to use people's strengths to further your cause.
Hearing out your colleagues is important, and in fact, is part of
the 3 keys to MAPP!
THE Respond :
Dear L. W. :-
I realy appreciated your thinking about the target population
that going to high schoolers with an intellectual or
developmental disability within Bowling Green, KY, and how
you can improve this target by using the MAPP model. So, you
have a great idea about the target and you uesed the concept of
the MAPP that is a shift from a focus on the agency to a focus
on the community and the entire public health system. So, when
you discusses your target community, try to bring everyone’s
collective wisdom together to be hand by hand with you to
achieve a better society and great future for those people who
have the disability and facing difficult when they try to enter
the high school. Therefore, by gathering all of the assets and
resources within the community, the community is able to
determine how best to use collective wisdom to create a
healthier community. This MAPP process is a new way of doing
business, and improve our community life by a great strategic
planing tool.
greetings,
The Other Exampl :
K.B.
The 12 Ethical Principles are very very similar to the 10
essential public health services. These ethical principles are
clarifying the distinctive elements of public health. They make
the services and principles clear to communities and
populations that they serve and give a standard that these
services should be held accountable to. The 12 principles also
define as a society what public health does for the community
and population that they serve.
The `12 principles of public health practices are based upon the
11 values and beliefs of public health. The values and beliefs

13. are a foundation for the principles to be built upon. The 11
values are assumptions of public health practice that are the
underlying for human and civil rights that are the underpinning
for the 12 principles.
Going into a community it is important to remember that the
members of the community have the best insight into what is
going on. These individuals have rights that have to be
respected. The individuals of the community must have trust in
the information that I am giving them, so adequate resources
and information are required. Collaborating with other health
agency to make a web of resources also help the education
process become more effective. Making sure it is prominent that
the purpose of the efforts is to better the community and that all
individuals can become involved. Empowering those individuals
to take control makes the program and efforts more effective. I
would need to make sure that every individual has the
knowledge and resources to make the decisions to make
changes. I would need to make sure all public health services
were available to the community. Following the code of ethics
would also lead to all conflicts and disputes being handled
properly.
THE Respond :
Dear K.B: I support your argument that 12 Ethical Principles
and ten essential public health services have major similarities.
However, I would like to understand some of the strategies used
by the public health departments in making codes guiding their
services and principles known to communities and populations
they serve. I also agree that values and beliefs play a significant
role in the development of public health principles.‫لفسأ‬
‫ج‬‫نموذ‬ ‫ال‬