Health care system interventions to increase cultural competence can include programs to recruit and retain staff that reflect the cultural diversity of their community, retain the use interpreter services or bilingual providers, provide cultural competency training for health care providers, provide linguistically and culturally appropriate health education materials, and create culturally specific health care settings. SECTION 2: IMPACT OF STEREOTYPING ON CLINICAL DECISION-MAKING Definition of stereotype
Stereotypes often have negative connotations and rarely represent the true picture of a person. One health implication of stereotypes is that therapists may resort to shortcuts with patient groups. These shortcuts could be based upon ethnicity, religion, socio-economic status, or disease state. Therapists may fail to explore how health is impacted by both individual and group- bound beliefs. These shortcuts can result in unintended consequences, such as naming and blaming patients, or labeling them as “bad,” “difficult,” or as “noncompliant.” from the disparate treatment of the subordinate group, and is able to maintain status, power, influence, and wealth. This is pertinent to health care because affluence is a positive predictor of health. The ability to have insurance and a cultural identity, as well as maintain a relationship with a primary care physician, predicts better health outcomes. Conversely, disenfranchised groups with limited access often have worse health outcomes. Stereotypical terms and ideas have existed for decades, if not longer. In the U.S., newcomers or immigrants have often been stereotyped using the same words or language. Immigrants from Italy, Ireland and Germany in the 1920s were stereotyped as lazy, dirty, promiscuous, drunk, deceitful, unable to show restraint (particularly with vices), intellectually inferior, and unworthy They were the “cheap labor” of their day – paid a mere pittance - yet helped to launch the Industrial Revolution. Living in decrepit tenements with few resources, their illnesses were attributed as innate traits - the erroneous belief was that they chose to live living in substandard conditions. This would be referred to today as “blaming the victim.” With many of these immigrants, acculturation and affluence dislodged these stereotypes; however, they do still exist in some areas. In addition to the overt use of stereotypes today, terms such as “weird,” “odd,” “exotic,” “different,” “foreign,” or “strange” are often used to stereotype others who appear to be outside of the norm. “Traditional” is a culturally relative term and depends upon whose tradition it is referring to. Most individuals see the world based on an interpretation that is usual, ordinary, or expected. If turkey is eaten at Thanksgiving dinner, then serving falafel would appear odd or unusual. Likewise, if a smile indicates agreement in a person’s experience, they are likely to read a smile that they receive as positive; although a smile may mean agreement, it can also express fear, disagreement, or derision. Learning the expectations that an individual has for a behavior (as well as how the behavior may be interpreted) is a skill for culturally effective communication. Young women from urban minority groups frequently receive testing for STIs, yet young women from the majority group in suburbs are tested with less frequency, even though both groups may be equally sexually active and at risk. The implication becomes that minority women are promiscuous and that white majority women have less risk for STIs.
A stereotype is a viewpoint or idea that conforms to a fixed or general pattern: it is a standardized mental picture that is held in common by members of a group and that represents an oversimplified opinion, prejudiced attitude, or uncritical judgment. For example: all men are tall; all women want to have children; boys are unemotional; girls are overly verbal. Stereotypes do not originate from self-description. Instead, they are imposed by others who define individuals. When a person does not fit a stereotype, language is often used, such as “you aren’t like other people within the group.” History and language of stereotyping When individuals outside of any group join a new group, there is pressure to “fit in.” The term used for this is acculturation . The opposite of acculturation is enculturation , or the retaining of group values, beliefs, and traditions from the group you were born into. For many years in the United States, the focus was on being acculturated as Americans. This involved speaking the English language, changing eating habits, altering daily routines, as well as adopting the habits and the mannerisms of other Americans. The ultimate success was the creation of a homogenous American culture. In reality, this was impossible and ultimately counterproductive. In geographical terms, Southern culture varies from that of Northern culture. Midwestern culture varies from that of New England’s. Floridians are different than Washingtonians. The range of acceptable differences, however, consists of attitudes, perceptions, and behaviors that are considered to be “American.” The current trend is to value the diversity of individuals and groups, and identify how the diversity of groups helps in our society’s creative problem solving and resilience. When addressing issues of similarity and dissimilarity, there are issues of xenophobia, classism, and ethnicism that play a powerful role on many members of our society. Xenophobia is a fear of outsiders. This can be based on how individuals look and dress - like all phobias, it is irrational. At its heart is a fear of groups of people. As other aspects of culture are learned, families often teach fear of others to their members. Classism is defined as a biased or discriminatory attitude based on a social or economic class. Classism is the “haves” and the “have-nots.” Ethnicism, racism, sexism and homophobia are all active elements in American society. Often what a society aspires to be is blurred with how it actually operates. At the heart of these - and other - “isms,” is the oppression of a minority group - or a group that is perceived to have less power or influence than the majority. The dominant group benefits Populations or groups at risk for stereotyping Stereotypes are often directed toward individuals who are perceived to be less powerful or subordinate. For example, an African-American man reports that his physician always puts on gloves and never examines him with a stethoscope, although he visits the doctor every two months to control his blood pressure. This leads to the presumption that this behavior is a result of the physician’s belief that the patient is not clean and is not worthy of quality care.
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