This presentation presents information about the national CLAS Standards, defines culture, and explores the intersections of culture and health. Medical mistrust and its impact on health seeking behaviors is also examined.

1. INTRODUCTION
TO CULTURE &
HEALTH
Cultural Health SeriesMay 26, 2016
Jean-Michel Brevelle
Sexual Minorities Program Manager
Infectious Disease Prevention and Health Services
Bureau

2. Learning Objectives
As a result of this workshop, participants will be
able to:
 Describe the National Standards for Culturally
and Linguistically Appropriate Services in
Health and Health Care (CLAS Standards);
 Identify factors that influence health-seeking
behaviors of culturally distinct groups;
 Apply principles of cultural respect in
interactions with clients.
2May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

3. A Brief Overview of CLAS
 Culturally and Linguistically Appropriate
Services
 First published in 2000 by the Office of
Minority Health (DHHS)
 Framework for healthcare organizations to
best serve increasingly diverse communities
 Included in Healthy People planning
 Updated and enhanced 2010 – 2013
 Inclusive of LGBT communities as of 2013
 Used by different accreditation boards (JCAHO,
AAAHC, etc.) 3May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

4. Who Uses Enhanced CLAS
Standards?
 Accreditation and Credentialing Agencies
 Community-Based Organizations
 Educators
 Governance and Leadership
 Health Care and Service Providers
 Health and Health Care Staff and
Administrators
 Patients/Consumers
 Public Health Workforce
 Purchasers (of health plans) 4May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

5. Enhanced CLAS Standards
 15 Standards
 Provide individuals and organizations with a
blueprint for successfully implementing and
maintaining culturally and linguistically
appropriate services.
 All 15 Standards are necessary to advance health
equity, improve quality, and help eliminate health
care disparities.
 Directed toward a broader audience than the
original Standards in order to address more fully
every point of contact throughout the health care
and health services continuum. 5May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

6. Enhanced CLAS Standards
Principal Standard and Three
Themes
1. Provide effective, equitable, understandable,
respectful, and quality care and services that are
responsive to diverse cultural health beliefs and
practices, preferred languages, health literacy, and
other communication needs.
Principal Standard
Governance, Leadership, and Workforce
Communication and Language Assistance
Engagement, Continuous Improvement, and
Accountability
6May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

7. Enhanced CLAS Standards
 Health
Beliefs/Practices
 What causes sickness
 What it means to be
“healthy”
 Who can treat someone
who is sick
 Languages
 Language other than English
 Hearing/Speech Impairments
 Regional or Group dialects
and/or vocabulary
7May 26, 2016
Infectious Disease Prevention and Health Services
Bureau
 Health Literacy
 How the body works
 Science vs culture
 Using medical services
 Taking medication
 Other
Communication
 Low literacy
 Disclosing/keeping secrets
 Withholding unpleasant
information
 Communicating with family

8. Cultural Health Practices
 The Enhanced National CLAS Standards
frame cultural health as a set of standards-
based practices intended to advance health
equity, improve quality, and help eliminate
health care disparities.
8May 26, 2016
Infectious Disease Prevention and Health Services
Bureau
NHAS Vision
The United States will become a place where new
HIV infections are rare, and when they do occur,
every person, regardless of age, gender,
race/ethnicity, sexual orientation, gender identity, or
socio-economic circumstance, will have unfettered
access to high quality, life-extending care, free from
stigma and discrimination.

9. Health Equity
Health equity is the attainment of the highest level of
health for all people. Currently, individuals across the
United States from various cultural backgrounds are
unable to attain their highest level of health for several
reasons, including the social determinants of health, or
those conditions in which individuals are born, grow, live,
work, and age, such as socioeconomic status, education
level, and the availability of health services. Though health
inequities are directly related to the existence of historical
and current discrimination and social injustice, one of the
most changeable factors is the lack of culturally and
linguistically appropriate services.National Standards for CLAS in Health and Health Care:
A Blueprint for Advancing and Sustaining CLAS Policy and Practice, pg. 14.
9May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

10. What is Culture?
What comes to mind when you
think of the word culture?
10May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

11. Defining Culture
The integrated pattern of thoughts,
communications, actions, customs, beliefs,
values, and institutions associated, wholly
or partially, with racial, ethnic, or linguistic
groups, as well as with religious, spiritual,
biological, geographical, or sociological
characteristics. Culture is dynamic in
nature, and individuals may identify with
multiple cultures over the course of their
lifetime.
Definition from the National Standards for CLAS in Health and Health Care: A Blueprint for Advancing and
Sustaining CLAS Policy and Practice. U.S. Department of Health and Human Services, Office of Minority Health,
2013.
11May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

12. Elements of Culture
 Age
 Cognitive ability/limitations
 Country of origin
 Degree of acculturation
 Educational level attained
 Environment and
surroundings
 Family and household
composition
 Gender identity
 Generation
 Health practices
 Linguistic characteristics
 Military affiliation
 Occupational groups
 Perceptions of family and
community
 Perceptions of health and
wellbeing
 Perceptions/beliefs about
diet and nutrition
 Physical ability/limitations
12May 26, 2016 Infectious Disease Prevention and Health Services
Bureau

13. Elements of Culture, cont’d
 Political beliefs
 Racial and ethnic groups
 Religious and spiritual
characteristics
 Residence (urban, rural,
suburban)
 Sex
 Sexual orientation
 Socioeconomic status Individuals do not experience their lives or their
health through a single lens of identity (e.g.,
solely race, gender, or religion); rather, many
elements inform their perceptions, beliefs,
customs, and reactions.
13May 26, 2016 Infectious Disease Prevention and Health Services
Bureau

14. Exploring Culture
Since culture refers to groups that share
characteristics or world views, people often
automatically think of culture in terms of ethnic
or racial groups.
Cultures can be based on shared
characteristics or experiences other than race
and ethnicity.
14May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

15. Exploring Culture
 Lesbian Culture
 Rave Culture
 Gay Culture
 Christian
Culture
 Drug Culture
 Goth Culture
 Senior Culture
Cultures not Based on Race or Ethnicity
 Bisexual
Culture
 Migrant Culture
 Suburban
Culture
 Women’s
Culture
 Hip Hop Culture
 Geek Culture
 Gamer Culture
 Muslim Culture
 Rural Culture
 Skater Culture
 Transgender
Culture
 Academic
Culture
 Gang Culture
 More?
15May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

16. Exploring Culture
 Which cultures exist within your organization?
 Which cultures exist among the clients you
serve?
 Which cultures exist within the community
where you work?
 How would you describe the cross-cultural
interactions that take place where you work?
16May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

17. Exploring Culture
Members of a cultural group may share a
number of common norms and values.
Can anyone offer an example?
Cultural Norms and Values
17May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

18. Exploring Culture
 Time, timeliness, and time consciousness
 Focus on relationships, family, and friends
 Valuing individual vs. group
 Valuing conflict vs. harmony
 Sense of self, space, and physical contact
with others
 Communication and language
Cultural Norms and Values
18May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

19. Exploring Culture
 Work habits and practices
 Health beliefs and practices
 Beliefs and attitudes about authority, control,
and fate
 Adherence to prescribed gender roles
 Mental processes and learning styles
 Anything else?
Cultural Norms and Values
19May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

20. Cultural History
 The Elements of Culture exist within a
continuum of time and place. For example:
 environment, generation, and occupational
groups (among others) are sensitive to time and
place.
 History is another factor that shapes cultures.
 A culture’s history is the collective memories and
experiences over time of its individual members.
20May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

21. Cultural Mistrust of Medical &
Governmental Systems
Basis for
mistrust
is real
Tuskegee
Syphilis
Study
Birth
Control
Pills Study
Forced
Sterilization
Forced
Sexual
Orientation
Change
Efforts
Radiation
Experiment
s on Poor
and
Incarcerate
d
Experiment
s on Poor
Children &
Children of
Color
21May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

22. Activity Time!22
Exploring Cultural Mistrust
of Healthcare and
Government
22May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

23. Legacies of Mistrust
 Read the information sheet that you have been
given.
 Discuss as a group the following:
 What did you know about this topic before reading?
 What are your initial responses to this information?
 How do you relate to this information? Does it match your
own experiences or expectations, or does it challenge
them?
 How might this history impact your clients’ expectations
around healthcare?
Small Group Work
23May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

24. Legacies of Mistrust
 What did you learn?
 What did you feel?
 What other questions did this raise for you?
24May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

25. Racism and Public Health
…more than 200 years’ worth of anecdotal
and documentary evidence on racism in
medicine and mental health cuts across
age, gender and different racial/ethnic
groups, leading to a high degree of
vigilance, mistrust and disdain towards the
medical establishment in general and
mental health in particular.
25May 26, 2016
Infectious Disease Prevention and Health Services
Bureau
Excerpted from Beyond Misdiagnosis, Misunderstanding and Mistrust: Relevance of the Historical
Perspective in the Medical and Mental Health Treatment of People of Color. Suite, D et al;
Journal of the National Medical Association, Vol. 99, No. 8, August 2007.

26. Cultural Safety
 Your cultural safety and that of your agency
have already been evaluated by your clients
 Peer-recommended
 History-sensitive approach to service design and delivery
 Waiting room cues — papers & magazines, LGBT “Safe
Space” stickers, posters, videos
 Inclusive language in intake assessments (e.g., partner,
spouse) and in your own speech
 Open-ended (e.g., “Tell me what brings you in today”) and
direct (e.g., “How are you protecting yourself from HIV”?)
questions
 Non-reactivity in your responses
26May 26, 2016
Infectious Disease Prevention and Health Services
Bureau

27. Cultural Respect
For the provider of health information or health
care, [cultural] elements influence beliefs and
belief systems surrounding health, healing,
wellness, illness, disease, and delivery of health
services. The concept of cultural respect has a
positive effect on patient care delivery by
enabling providers to deliver services that are
respectful of and responsive to the health
beliefs, practices and cultural and linguistic
needs of diverse patients.
27May 26, 2016
Infectious Disease Prevention and Health Services
Bureau
National Institutes of Health
Clear Communication. Office of Communications and Public Liaison

28. It’s That Time…
May 26, 2016
28
Infectious Disease Prevention and Health Services
Bureau