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Cultural Diversity in Health and Illness (7th Edition), by Rachel E. Spector
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The seventh edition of this well-respected book continues to promote an awareness of the dimensions and complexities involved in caring for people from diverse cultural backgrounds. Completely revised and updated, it examines the differences existing within North America by probing the health care system and consumers, and examples of traditional health beliefs and practices among selected populations. An emphasis on the influences of recent social, political, and demographic changes helps to explore the issues and perceptions of health and illness today. An essential for any health-care professional, this book sets the standard for cultural perspectives.
- Sales Rank: #276156 in Books
- Brand: Brand: Prentice Hall
- Published on: 2008-07-19
- Original language: English
- Number of items: 1
- Dimensions: 8.97" h x .76" w x 6.01" l, 1.15 pounds
- Binding: Paperback
- 432 pages
Features
From the Back Cover
The seventh edition of this well-respected book continues to promote an awareness of the dimensions and complexities involved in caring for people from diverse cultural backgrounds. Completely revised and updated, it examines the differences existing within North America by probing the health care system and consumers, and examples of traditional health beliefs and practices among selected populations. An emphasis on the influences of recent social, political, and demographic changes helps to explore the issues and perceptions of health and illness today. An essential for any health-care professional, this book sets the standard for cultural perspectives.
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FEATURES INCLUDE:
- Pocket Guide to Assessment and Health Tradition available online for downloading
- Companion Website www.prenhall.com/spector with activities, test questions, and more
- New Research on Culture feature depicting recent studies related to cultural competence
- New photographs displaying examples and icons of various cultures
- New learning outcomes at the beginning of every chapter
- Expanded content on the influence of spirituality and religion on health in cultural contexts
- Updated chapter on the health care delivery system including discussions of barriers and alternatives
- Demographic background discussion of each of the U.S. Census Bureau's categories of the population for a statistical overview of the diversity of patient populations
About the Author
Dr. Rachel E. Spector has been a student of culturally diverse HEALTH and ILLNESS beliefs and practices for 35 years and has researched and taught courses on culture and HEALTH care for the same time span. Dr. Spector has had the opportunity to work in many different communities, including the American Indian and Hispanic communities in Boston, Massachusetts. Her studies have taken her to many places: most of the United States, Canada, and Mexico; several European countries, including Denmark, England, Finland, Iceland, Italy, France, Russia, Spain, and Switzerland; Israel and Pakistan; and Australia and New Zealand. She was fortunate enough to collect traditional amulets and remedies from many of these diverse communities and to meet practitioners of traditional HEALTH care in several places. She was instrumental in the creation and presentation of the exhibit “Immigrant HEALTH Traditions” at the Ellis Island Immigration Museum, May 1994 through January 1995. She and has exhibited HEALTH-related objects in several other settings. Recently, she served as a Colaboradora Honorifica (Honorary Collaborator) in the University of Alicante in Alicante, Spain, and Tamulipus, Mexico. In 2006, she was a Lady Davis Fellow in the Henrietta Zold-Hadassah Hebrew University School of Nursing in Jerusalem, Israel. This text was translated into Spanish by Maria Munoz and published in Madrid by Prentice Hall as Las Culturas de la SALUD in 2003. She is a Fellow in the American Academy of Nursing and a Scholar in Transcultural Nursing Society. The Massachusetts Association of Registered Nurses, the state organization of the American Nurses’ Association, honored her as a “Living Legend” in 2007. In 2008 she was recognized by the American Nurses’ Association for her work in Human Rights.
Excerpt. � Reprinted by permission. All rights reserved.
You don't need a masterpiece to get the idea.
– Pablo Picasso
In 1977 I wrote the first edition of Cultural Diversity in Health and Illness and have revised it several times since then; this is the sixth edition. The purpose of each edition has been to increase the reader's awareness of the dimensions and complexities involved in caring for people from diverse cultural backgrounds. I wished to share my personal experiences and thoughts concerning the introduction of cultural concepts into the education of health care professionals. The books represented my answers to the questions:
- "How does one effectively expose a student to cultural diversity?"
- "How does one examine health care issues and perceptions from a broad social viewpoint?"
As I had done in the classroom, I attempted to bring the reader into direct contact with the interaction between providers of care within the North American health care system and the consumers of health care. The staggering issues of health care delivery are explored and contrasted with the choices that people may make in attempting to deal with health care issues.
It is now imperative, according to the most recent policies of the Joint Commission of Hospital Accreditation and the Centers for Medicare & Medicaid Services, that all health care providers be culturally competent. In this context, cultural competence implies that within the delivery of care the health care provider understands and attends to the total context of the patient's situation; it is a complex combination of knowledge, attitudes, and skills. Yet,
- How do you really inspire people to hear the content?
- How do you motivate providers to see the worldview and lived experience of the patient? How do you assist providers to really bear witness to the living conditions and life ways of patients?
- How do you liberate providers from the burdens of prejudice, xenophobia, the "isms"—racism, ethnocentrism—and the "antis"?
It can be argued that the development of cultural competency does not occur in a short encounter with cultural diversity; but that it takes time to develop the skills, knowledge, and attitudes to safely and satisfactorily deliver CulturalCare.
Features
- Free Companion Web site at www.prenhall.com/spector with activities, fill-in-the-blanks, multiple choice questions, web links, and more.
- Online Course Management Systems. Also available are online companions for schools using course management systems. For more information about adopting an online course management system to accompany Cultural Diversity in Health and Illness, Sixth Edition please contact your Prentice Hall Health Sales Representative www.prenhall.com/mischtm/rep-locator-fr.html or go to the appropriate websites at cms.prenhall.com/webct/index.html or cms.prenhall.com/blackboard/index.html or cms.prenhall.com/coursecompass
- Health Traditions Imagery. This edition of the book uses symbolic images to create the linkages from chapter to chapter. The HEALTH (HEALTH, when written this way, is defined as the balance of the person, both within one's being-physical, mental, spiritual-and in the outside world-natural, familial and communal, metaphysical) images were selected to awaken you to the richness of a given heritage and the HEALTH/health beliefs, and practices inherent within both modern and traditional cultures.
- Guidelines for Developing Cultural Competency. A "map" that passes from broad and general dimensions of health and illness to specific images of traditional HEALTH beliefs and practices; at the personal level, the modern health care delivery level, and within traditional dimensions.
- Three developmental dimensions:
- Cultural Foundations—an overview of cultural heritage and history that serves to illustrate the underlying concepts inherent in the diversity within our society, and basic elements of health and illness.
- Domains of HEALTH—the worlds of the provider and patient as reflected in broad and general HEALTH and HEALING from a personal perspective to the perspectives of socialization into the allopathic philosophy and health care delivery system.
- Panoramas of HEALTH—the worlds of traditional HEALTH beliefs and practices among selected populations.
- Historical Perspectives. An overview of historic sociocultural, public health, and health policy events and medical milestones from 1900 to 2003.
OVERVIEW
Unit I focuses on the background knowledge one must recognize as the foundation for developing cultural competency.
- Chapter 1 explores the concept of cultural heritage and history and the roles they play in one's perception of health and illness. This exploration is first outlined in general terms: What is culture? How is it transmitted? What is ethnicity? What is religion? How do they affect a given person's health? What major sociocultural events occurred during the life trajectory of a given person that may influence their personal health beliefs and practices?
- Chapter 2 presents a discussion of the diversity—demographic, immigration, and poverty—that impacts on the delivery of and access to health care. The backgrounds of each of the U.S. Census Bureau's categories of the population, an overview of immigration, and an overview of issues relevant to poverty are presented.
- Chapter 3 reviews the provider's knowledge of his or her own perceptions, needs, and understanding of health and illness.
Unit II explores the domains of HEALTH, blends them with one's personal heritage, and contrasts them with allopathic philosophy.
- Chapter 4 introduces the concept of HEALTH and develops the concept in broad and general terms. The HEALTH Traditions Model is presented, as are natural methods of HEALTH restoration.
- Chapter 5 explores the concept of HEALING and the role that faith plays in the context of HEALING, or magico-religious, traditions. This is an increasingly important issue, which is evolving to a point where the health care provider must have some understanding of this phenomenon.
- Chapter 6 discusses family heritage and explores personal and familial HEALTH traditions. It includes an array of familial health beliefs and practices shared by people from many different heritages.
- Chapter 7 focuses on the allopathic health care delivery system and the health care provider culture.
Once the study of each of these components has been completed, Unit III moves on to explore selected population groups in more detail, to portray a panorama of traditional HEALTH and ILLNESS beliefs and practices, and present relevant health care issues.
These pages can neither do full justice to the richness of any one culture nor any one health-belief system. By presenting some of the beliefs and practices and suggesting background reading, however, the book can begin to inform and sensitize the reader to the needs of a given group of people. It can also serve as a model as to how to develop cultural knowledge in populations that are not included.
The Epilogue is devoted to an overall analysis of the book's contents and how best to apply this knowledge in health care delivery, health planning, and health education, for both the patient and the health care professional.
There is so much to be learned. Countless books and articles have now appeared that address these problems and issues. It is not easy to alter attitudes and beliefs or stereotypes and prejudices. Some social psychologists state that it is almost impossible to lose all of one's prejudices, yet alterations can be made. I believe the health care provider must develop the ability to deliver CulturalCare and a sensitivity to personal fundamental values regarding health and illness. With acceptance of one's own values comes the framework and courage to accept the existence of differing values. This process of realization and acceptance can enable the health care provider to be instrumental in meeting the needs of the consumer in a collaborative, safe, and professional manner.
The first edition of this book was the outcome of a promesa—a promise—once made. The promise was made to a group of Black and Hispanic students I taught in a medical sociology course in 1973. In this course, the students wound up being the teachers, and they taught me to see the world of health care delivery through the eyes of the health care consumer rather than through my own well-intentioned eyes. What I came to see I did not always like. I did not realize how much I did not know; I believed I knew a lot. I have held on to the promesa, and my experiences over the years have been incredible. I have met people and traveled. At all times I have held on to the idea and goal of attempting to help nurses and other providers be aware of and sensitive to the beliefs and needs of their patients.
I know that looking inside closed doors carries with it a risk. I know that people prefer to think that our society is a melting pot and that old beliefs and practices have vanished with an expected assimilation into mainstream North American life. Many people, however, have continued to carry on the traditional customs and culture from their native lands, and health and illness beliefs are deeply entwined within the cultural and social beliefs that people have. To understand health and illness beliefs and practices, it is necessary to see each person in his or her unique sociocultural world.
The shattering events of September 11, 2001, represent in many ways the clarion call for all of us to wake up and hear and listen to the voices of all people. Indeed, the events are symptomatic of Global Polarization in such conflicts as:
- Traditionalism vs. Modernism...
Most helpful customer reviews
0 of 0 people found the following review helpful.
Could have been better.
By T. Vidal
Too much opinion in this book.
73 of 83 people found the following review helpful.
Not a good resource for this important area of inquiry
By Monte Abbott
This review updated by author on March 21, 2006:
I recently (Spring 2005) used this text in an undergraduate health professions course titled "Diversity in Health and Illness". The author addresses a broad scope of cultures, issues and responses to cultural needs in health care. Although the book contains much that is useful, my students found it to be, on balance, confusing and disorganized.
I believe much of this response can be attributed to poor editing. We identified numerous spelling and grammar errors throughout. Poorly edited content is also evident in several chapters. Example: "...this chapter has introduced the dominant culture's perception of health and illness through countless lenses" (pp. 67). Similarly, "...countless letters are displayed attesting to the healing powers of this statue" (pp. 106). Isn't there a more accurate word to use in place of `countless'? More importantly, ethnic and race labels are not used consistently. "Hispanic" and "Latino" are used as though they are strictly interchangeable; ditto for "Black" and "African American." Term consistency would enhance clarity.
My concerns with the text are more fundamental and numerous but I will limit myself to a few examples:
USE OF SOURCE DATA AND REFERENCE MATERIALS
Although the text is heavily laden with descriptive statistics, comparative data is often not included, thus limiting interpretations. For example, the discussion of rising expenditures for unconventional therapies in the U.S. (pp. 96) includes expenditure estimates for 1990 and 1997. Without companion statistics for conventional therapy expenditures, readers are unable to asses the magnitude of the trend. Similarly, the description of the African American population as young (54.4% are under 18 - pp. 233) is not very enlightening in the absence of corresponding percentages for the white population and the overall American population. Figure 10-3 adds little additional information.
References for culture group descriptions are often either very old (1950's - 1970's), not the definitive works, or are not sufficiently academic (encyclopedias and web pages), and should be replaced with citations for newer research reported in more rigorous formats. Several important sections contain insufficient or no reference citations. The "Health/HEALTH Care Choices" section (pp. 85) contains numerous historical claims but only a single reference to the American Heritage Dictionary.
OUT OF DATE THEORIES
Some of the sociological and anthropological concepts presented do not represent current theoretical stances. I was especially interested in exploring citations for the "Cycle of Poverty" discussion in Chapter 2, as this blame-the-victim concept has fallen out of favor in sociological circles because it ignores structural realities that are beyond the control of individuals. This conflation of structural problems with cultural phenomena inadvertently creates a situation where the subtle racist beliefs we all learn through our socialization is reinforced in the classroom. Sadly, the only citation provided in this section, (Spector 1979, pp. 148-152), refers to an earlier edition of this book. Original references should be provided.
The Chapter 3 discussion of the sick role is limited to functionalist models presented by Talcott Parsons (1966) and Edward Suchman (1965). As our society ages we are experiencing increasing levels of chronic illness and more patients cannot expect to fully recover. More recent examinations of the illness experience would be appropriate.
CULTURAL MISUNDERSTANDINGS
The discussion of historical background for Native American cultures (pp. 186-188) is particularly dismal. While somewhat correct in broad outlines, the text reads like a less-than-distinguished freshman research paper, and includes various repeats. The discussion of traditional health beliefs and practices is limited to those of the Navajo and Hopi - important southwestern groups - but not representative of all Native Americans. Sources cited are limited to a few 1960's and 1970's references. Strains of the Noble Savage are also evident, particularly with reference to the discussion of "True Indian love" and domestic violence (pp. 200).
The role of voodoo in African American traditions is somewhat overstated (Chapter 10), and is presented as an explanation for present-day underutilization of the allopathic system (pp. 239). At the same time, more realistic explanations are omitted. Chief among those are the disproportionate poverty experienced by the community as well as recent and historical sources of distrust between the African Americans and the largely white medical establishment (e.g., antebellum forced medical experimentation, Tuskegee Experiment, Holmesburg Prison Experiments).
INTERPRETATIONS
My graduate degree is in anthropology, and although I expected some level of disconnect between my training and the nursing orientation of Spector, I found myself admonishing my students several times over to ignore specific passages and sections in this text as irrelevant or just plain wrong.
For example, in the section titled "Cultural Phenomena Affecting Health", in Chapter 1, subheadings include "Biological Variations" and "Social Organization". Confusion between biology and culture appears in other places as well, and was especially troublesome for my students with their limited previous exposure to the concept of culture.
The "Social Organization" subheading precedes a disjointed (but brief) discussion of childhood socialization, family organization, and barriers to health care access. Perhaps the first two could be combined in a section "Socialization". Regarding the barriers to health care access (e.g., unemployment, poverty and lack of health insurance), these could be better characterized as economic barriers rather than social barriers. Diminished economic resources are correlated to large extent with particular demographic groups, but one should avoid essentializing the availability of resources as a series of ethnic or cultural traits. Conceptualizing these issues as cultural phenomena obscures the contributions of racism, xenophobia, and unequal distribution of wealth to the problems of unequal access. Spector draws these categories from a previously published article, and the uncritical use of other people's published materials is apparent throughout the book.
Spector's background is nursing, and on balance, I am not sure that this provides one with the appropriate skills necessary to summarize the fundamentals of culture and cultural diversity. Theorising culture and society is (and should remain) the domain of anthropologists and sociologists (and perhaps psychologists). Like nursing and most other applied and academic fields of inquiry, understanding culture requires a great deal of specialized education.
On my initial reading I suspected a functionalist interpretation of the intersection between health care and culture, but on further examination this book is more like an online encyclopedia where everything (including the kitchen sink) is thrown in. What is missing is a critical evaluation of the usefulness and theoretical implications of others' data and interpretations. The result is conflicting content and a great deal of confusion.
A final example: Spector rejects the WHO health definition but does not suggest a better alternative. Instead she seems to think that health is indefinable: "I would define health as an undefined term" (pp. 50). I agree that students should maintain an open mind, but perhaps a series of limited definitions addressing a variety of situations would be more useful in the classroom. Social science practitioners and researchers struggle with variability in human behavior as a matter of course, but that struggle is mitigated through a realization that definitions are often necessary heuristic devices rather than complete summaries. Put simply, if we can't know a thing, aren't we just wasting our time?
I have reviewed a number of alternate texts over the past year and have found the problems discussed here to be present in several other texts. Perhaps the academic pursuit of cultural care is still in its nascent stage.
In any case, I have found "Culture in Rehabilitation: from Competency to Proficiency" edited by Royeen and Crabtree (Pearson 2006) to be a much better text for my class. The authors represent a variety of health professions and the text was reviewed by a similarly diverse panel of ten. Most of the contributions present robust bibliographies, rely on up-to-date social science research, and avoid the culture-as-checklist approach. I will review the text in detail sometime in May 2006.
14 of 15 people found the following review helpful.
limited information on specific cultures
By SmarterTHANyourAVGbear
There is some interesting information on health and illness in the first half of this book, but the cultural evaluations in the second half of the book are lacking depth. The book places too much emphasis on race and too little emphasis on ethnicity. If you are looking for a book on health and wellness this may be useful, but if you want to study cultural diversity, this may not work for you. The book is definitely missing many key cultures.
Example 1: In Chapter 12, the chapter on Hispanic populations, there is a table listing the 8 regions where people identify themselves as Hispanic and the corresponding percentages of the US Hispanic population made up by each of these groups. Only two of these cultures, Mexicans and Puerto Ricans, are discussed in any depth. This oversight excludes all of the Hispanics from Central America, South America, and other smaller Hispanic populations. It does make sense to review the Mexican Culture because that culture represents the largest portion of our Hispanic population in the US. However, Central Americans make up the 2nd largest % of the US Hispanic population, whereas the Puerto Ricans make up only 9.2% of the US Hispanic population. The arbitrary inclusion and exclusion of specific cultures may raise some concern.
Example 2: In Chapter 13, the chapter on White populations, there is a table listing only 7 of the countries where people identify themselves as white and the corresponding percentages of the US white population made up by each of these groups. There are many countries with substantial populations in the US that are absent from this break down. Furthermore, only two of the 7 selected white cultures, German and Polish, are discussed in any depth (3 cultures from the list that make up significantly larger percentages of the US population than the Polish are not detailed in the chapter.
Example 3: Chapter 10, the chapter on Asian Populations, talks exclusively about the Chinese with the exception of Box 10-1 which is an overview of Ayurveda (Hindu/East Indian medicine). At least, the author explains this oversimplification by stating that most Asian cultures derive their beliefs and practices from the Chinese and Ayurvedic health practices.
Example 4: Chapter 11 is about 'Black Populations' and there is no mention of the cultural divide between those African Americans who are recent (voluntary) immigrants and those whose families have been in the United States for hundreds of years. In fact, other than a few sentences giving population statistics there is no divide between people from various countries (Haiti vs. Nigeria or Jamaica vs. Ethiopia).
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