These slides contain the lecture content for Week 9.

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Week 9 Lecture
Instructor: Gina Crosley-Corcoran, MPH
PBH 715 – Introduction to Social &
Behavioral Sciences

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HEALTH DISPARITIES, DIVERSITY,
& CULTURAL COMPETENCE

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Introduction
 This week we will be looking more closely at the
concepts of race, ethnicity, health disparities,
diversity, and cultural competence.
 There is still some debate about the concepts of race
and ethnicity and how these are defined and
determined.
 There is also much debate about the cause(s) of
health disparities – and thus how best to address it.

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The Concept of Race
 Traditionally, race has been based upon supposed
biological differences across racial groups
 There is little evidence to support this approach
 Genetic variation within groups is actually greater
than it is between groups
 Concept has been discarded by many disciplines, but
public health has, thus far, retained it
 Though this concept is used by public health and the
Census Bureau, it is poorly defined at best

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The Concept of Race
 In social sciences, race is viewed as a social construct
with very limited biological significance.
 Increasingly used to denote sociocultural groupings
 Changes the view of health disparities from biological
(genetic differences across races) to being part of
larger social inequalities
 Ethnicity is now used more frequently
 Refers to broader construct of social groups with shared
history, sense of identity, and cultural roots

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Health Disparities
 Steady improvements in health indicators in the US
have not been reflected in the morbidity and
mortality gap between African Americans and
European Americans
 Five models have been proposed to explain health
disparities

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Health Disparities: Models
• Disparities explained in terms of genetic variation across
populations
Racial-genetic model
• Disparities can be attributed to differences in prevalence of specific
risk or protective health behaviors
Health behavior model
• Differences in health status across racial and ethnic groups are
attributed to disproportionate percentage of minority groups are
found within lower socioeconomic class
Socioeconomic status model

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Health Disparities: Models
• Explains disparities in terms of structural, interpersonal, and
psychological stress experienced disproportionately by
members of socially disadvantaged groups
• Includes the impact of institutional and interpersonal racism
Psychosocial stress model
• Integrates a dual perspective
• Focuses on health implications of racially stratified societies
and on social construction of goals and aspirations within
minority groups
Structural-constructivist model

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Cultural Competence
 Refers to the ability of healthcare providers to deliver
culturally appropriate services to members of different
ethnic and linguistic group
 Expanded to include organizational level competence
 Includes attitudes, skills, behaviors, and policies that help
to ensure successful work across cultures
 Organizational cultural competence has been divided into
six stages that range from cultural destructiveness to
cultural proficiency
 Individual cultural competence ranges from denial to
integration

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Cultural Competence
 The assumption has been made that increased
cultural competence leads to decreased health
disparities
 Not accepted by everyone
 No evidence to support this assumption
 Cultural sensitivity
 Demonstrating basic empathy and sensitivity to patients in
general and treating them as individuals in a respectful and
caring manner
 The overriding belief is that all patients should be
treated as individuals, receiving respectful, caring
treatment regardless of culture/race/ethnicity

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Social Construction of Cultural
Diversity in Public Health
Location in the public domain
• Requires that issues be framed as the “common good”
• Must make successful claims that something is a serious “public health
issue” requiring resources and attention
• Work is inherently political and so influenced by politics in ways that private
healthcare is not
Epidemiology as the core discipline
• Based upon the assumption that health and disease states are not evenly
distributed across populations
• By design, separates people into groups based upon certain characteristics
(like race, gender, age)
• Program planning is population-based and tends to focus on marginalized,
“hard to reach” populations

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Social Construction of
Cultural Diversity in Public Health
Core values
Feed into construction
of diversity
Humanitarianism,
universalism, altruism
Basic
assumptions
Greater attention to
cultural diversity is a
good thing and will lead
to positive benefits for
the defined group
Can actually lead to
reinforcement of
negative stereotypes
and may draw unwanted
attention
Conflation of
diversity with
census categories
Set by directives of the
Office of Management
and Budget
Sociopolitical categories
which may have little or
no real meaning for
health-related purposes

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Summary
 Our focus this week has been on definitions of race
and ethnicity as well as cultural competence and
health disparities
 We have examined a variety of social constructs and
the potential impacts (positive and negative) of these
“definitions”
 These are concepts which are continuing to evolve
and will be a significant part of the future of public
health and your work as a public health practitioner

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Week 9 Assignment
Live Book
Discussions