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African American Patients. Essentials of Cultural Competence in Pharmacy Practice: Chapter 5 Notes Chapter Author: Dr. Kristina A. Peterson. Learning Objectives. Articulate the discrimination and environmental racism faced by African Americans
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African American Patients Essentials of Cultural Competence in Pharmacy Practice: Chapter 5 Notes Chapter Author: Dr. Kristina A. Peterson
Learning Objectives • Articulate the discrimination and environmental racism faced by African Americans • Recognize the health disparities and socioeconomic barriers that may impact African American patients • Specify the health care disparities that may affect African American patients • Identify strategies for working with extended and fictive family members that may be present in the procurement of pharmacy care
Introduction • Census figures • History of African Americans in the United States. • Jim Crow laws in the South, racial segregation, and discrimination. • The Civil Rights Movement. • The legacy of slavery and racism.
Language • Until the mid 1960’s the terms Negro or Colored were widely used to describe African Americans. • Those terms are now considered derogatory. • Some also criticize the term African American, preferring to refer to themselves as “Black” or “a person of color.” • Black or African American citizens are classified as a person having origins in any of the black racial groups of Africa.
Communication Styles • Generally, more dramatic and expressive in their speech and language patterns than are members of the dominant culture. • Communication also tends to be more people oriented than topic or object oriented. • More outwardly affectionate as well as more direct and assertive during argumentation. • Some may engage in the use of African American vernacular English or what is commonly known as Ebonics. • Cultural inversion • Ways of dressing, speaking, and acting that unify them as a collective while they subtly oppose dominant culture expectations of them.
Family Roles/Organization • High value is placed on familial relationships and tends to include extended family. • Elders may play a key role in family and community systems. • Fictive kinship relationships are also common and involve people who are called family even when no biological relationship exists. • Increase in the number of births to unmarried women. • A significant increase in the number of female-headed households, which are associated with high rates of poverty and economic instability. • More than 50% of black children live in households with only one parent – mostly their mother. • Nearly 44% of African American preschoolers live in households with less than $10,000 annual income.
Legal Concerns • Legal issues involving African American men are a possible contributing factor to the increase in female-headed African American families. • 1995 study by the Sentencing Project on drug-related crimes • These disparities could be related to racism and discrimination or to classism and higher rates of poverty among African Americans. • African American children in foster care
Socioeconomic Issues • Annual median income for African American households • Childhood poverty • Exposure of African American children to violence
Workforce Issues • The unemployment rate for African Americans nationwide • The median weekly wage • Jobs held by African Americans • High value on education as a way to achieve personal and family goals. • High school and college graduation rates
Healthcare Practices • Nearly one third of African Americans do not have a regular doctor. • Many use the hospital emergency room as their primary health care provider and only seek services when they are sick or hurt. • Close to 1.8 million African American children in the United States do not have health insurance.
Health Disparities • Infant mortality • AIDS • Kidney disease, septicemia, diabetes, stroke and heart disease • Hypertension
Infant Mortality • African American infant mortality rates compared with that of the dominant culture. • Black infant deaths in first year of life compared with white infants • Contributing factors of infant mortality.
AIDS • AIDS is five times as deadly for young African Americans age 25-44 as for their dominant culture counterparts. • Proportion of new HIV infections in the United States that are in African Americans • AIDS rate in black women compared with white women.
Other Health Disparities • High death rates from kidney disease, septicemia, and diabetes, stroke and heart disease, asthma, and prostate cancer. • Hypertension in African Americans. • Overweight
Nutrition • Half of all black neighborhoods lack access to a full-service grocery store or supermarket. • 32 percent increase in the consumption of fresh fruits and vegetables when there is a supermarket located in a community. • 50 percent of African American adults do not exercise on a regular basis. • Although some of the poor health statistics have been attributed to lifestyle – higher incidence of intravenous drug use, smoking, and obesity – there is another culprit in the inequities of medical treatment.
Environmental Racism • The lack of adequate medical care for poor and lower middle class African Americans greatly increases the number of deaths by disease. • Effect of environmental racism on the health of African Americans. • 71 percent of African American families live in counties that violate federal air pollution standards.
Folk Medicine & Home Remedies • Many African American people will attempt to alleviate medical conditions with home remedies or folk medicine. • An important factor to consider in practicing pharmacy. • Pharmacists should ask patients about any remedies they may be trying at home.
Reflection Questions • How would you address environmental racism if it were to occur in a pharmacy practice setting? • As a pharmacist, how will you work with African American patients to mitigate known health disparities and socioeconomic barriers? • How will you utilize the information contained in this chapter to inform your practice?