Human Development

Issues in Cultural Development

2012
Defining Culture
Overall, it is the shared language,
behavior, customs, symbols, knowledge
and pattern of comprehending reality, and
the ability to create and/or determine
history. (Nobles, 1986)

belief systems and value orientations
that influence customs, norms, practices,
social institutions, including psychological
[behavioral] processes (language,
caretaking, media, educational systems)
and organizations. (Fiske et al., 1998)
Inherent factors in these definitions:
Acknowledgment that all individuals are
cultural beings with a cultural, ethnic and
racial heritage
Idea that culture embodies a worldview
through learning and transmitted beliefs,
practices, and values (incl. religious &
spiritual)
Ways of living are informed and influenced
by historical, political, ecological, and
economic forces on groups
Fluid and dynamic in nature
Culturally universal phenomena, yet have both
specific and relative constructs
Core Elements of Culture
Sex (biological) & Gender (social)
Race/Ethnicity
Age
Language
Social Class/Socioeconomic Status
Level of Education
Religion, Spirituality
Sexual Orientation
Abled/Disabled Status

Cultural Transmission
Adaptation of term biological
transmission, in that via genetics
certain features are perpetuated over
time/generations through vertical
transmission (i.e., descent) (Cavalli-Sforza &
Feldman, 1981)
By extension, cultural groups
perpetuate behavioral features
through teaching & learning, including
vertical transmission, but also
horizontal and oblique
Vertical Transmission
In a more social context, vertical
transmission of cultural values,
norms, skills, beliefs, and motives,
etc. between parents to offspring
Difficulty in separating the biological
vs. cultural since ones biological
parent have typically also been
cultural parents
E.g., New international adoption
practices challenges this, especially
in the U.S.
Horizontal Transmission
Learning of cultural issues from
peers over developmental course
from birth to adulthood
Less overlap between biological and
cultural transmission
Exceptions?
Oblique Transmission
Learning of culture from other adults
and institutions (e.g., formal
education) either from ones own
culture or from other cultures.
Within ones own culture:
enculturation, socialization
Other cultures: acculturation
Enculturation
Roots in cultural anthropology
Individual is encompassed or surrounded by
ones culture, leading to shape and direction
of individual
Includes the network around the individual,
e.g., parents, family, other adults, peers,
Acquires, through learning, what is deemed
necessary within the culture
Less didactic; learning occurs without
specific teaching
Success: measured by cultural competency,
including language, rituals, values, etc.
Socialization
Roots in sociology/social psychology
Individual is shaped by deliberate
teaching
Taken together, enculturation and
socialization result in the development
of behavioral similarities within
cultures, as well as differences
between them
Crucial mechanisms to produce
similarities and differences at an
individual level
Acculturation
Often confused with enculturation
Difference lies in the idea that this
process involves cultural and
behavioral changes brought out
through contact with those belonging
to other cultures who may exhibit
different behaviors
Generally subsequent to enculturation,
and can occur at any stage in life (not
only in childhood)
Expectation within dominant culture
Acculturative Stress
Stress related to the process of
acculturation
Lowered mental health status
(anxiety, depression)
Feelings of marginality and alienation
Heightened psychosomatic
symptomatology
Identity confusion
Impact of Culture
What does it mean for medical
students?

Why is it an integral part of
medical education, training,
and practice?
Demographics in U.S.
According to the US Census, by 2015:
65% white/Caucasian (alone, or with
another category)
13% Hispanic/Latino
12% African American
4.5 % Asian/Pacific Island
4% Other
1.5% Indian or Alaskan Native
U.S. Demographics
Currently, residents of the US speak no
less then 329 languages, 32 million speak
a language other than English at home
(13%).
Asians, Latinos are the largest growing
groups in past 10 yrs; in some regions, out
number whites as largest racial/ethnic
groups.
Only 2.4% identify as multiracial, 42% of
those who do are under the age of 18,
meaning birthrate for multi-racial people
Impact of Culture
Overall, large genetic disparities among
culture groups, certainly based on
race/ethnicity, are few;
Majority of health disparities are relates
to environmental factors, including
sociopolitical factors and institutional
racism.
Physician attitudes and behaviors
toward cultural groups create healthcare
disparities

Factors Affecting
Relationships with Patients
Factors proximal to clinical processes
(e.g., clinician credibility, clinician-patient
attitudes, world view, values) are more
likely to be linked to continued treatment
and increased treatment efficacy than
those that are more distal to the clinical
process (e.g., patient-clinician ethnic
match, clinicians knowledge of different
cultures).


Several lines of research support the
influence of proximal factors over
more distal ones.
Areas such as:
Racial/ethnic identity development
Cultural mistrust
Acculturation


Cultural Sensitivity: Medical Settings
What does/could your doctor do to make you feel
comfortable/uncomfortable with him/her?
What makes you trust/not trust your doc? What
could he do to help you trust him/her more?
What does/could your doc do to show you respect
and be sensitive to your needs?
What could your doc do to show what she is
sensitive to your needs and is respectful of you
as an (ethnic group)?
What can docs do to become better at helping pts
from your racial, language, or cultural
background?

Components of Culturally
Sensitive Health Care
Core Components:
People Skills
Individualized Treatment Planning
Effective Communication (e.g.,
once daily in Spanish = 11 )
Technical Competence

Overall Findings
More than 20 verbal and nonverbal
physician behaviors were identified
such as friendliness, empathy, time
to be positively related to patient
health outcomes

Whats Being Done
Office of Minority Health - issued 14
national standards for culturally competent
health care which include physician
issues, as well as those related to the
environment of diverse health care
settings and populations.
Cross-Cultural Education designed to
improve patient-provider communication,
especially for racial/ethnic disparities
Accreditation bodies require it as part of
UME
Major Topics for Cross-Cultural
Medical Education
Overview/Concepts of Culture
Racism & Ethnic Stereotyping
Language (verbal, nonverbal, words, etc.)
Specific Cultural Issues (epidemiology,
patient expectations, traditions, family role)
Access Issues (transportation, insurance,
INS)
Socioeconomic Status
Gender Roles & Sexuality

Remember:
Must address social power relations, regardless
of group
Impact of poverty, systemic factors
Avoid making cultural competence an exercise
in learning about Others, one of voyeurism,
stereotyping, exoticization, and identification of
socially deviant features, e.g.:
Only women are affected by gender
Immigrants and ethnic groups have culture
Asian, African, and Indian groups as having race
Gays and lesbians as having a sexual orientation
Working class, poor as having a social class