DiversityNursing Blog

Written by James McIntosh

www.medicalnewstoday.com 

Obesity is a serious public health problem in the US and can affect anyone regardless of age. In particular, childhood obesity prevalence remains high. As well as compromising a child's immediate health, obesity can also negatively influence long-term health dramatically. Unfortunately, some racial and ethnic groups are affected by obesity much more than others.

For example, the US Department of Health and Human Services Office of Minority Health (OMH) report that African-American women have the highest rates of being overweight or obese, compared with other racial or ethnic groups in the US.

Approximately 4 out of 5 African-African women were found to be overweight or obese and, in 2011, African-American women were 80% more likely to be obese than non-Hispanic white women.

Researchers have identified that disparities in obesity prevalence can be found just as readily among children as among adults. It is alarming that these disparities exist to begin with, but more so that they exist so early in life for so many.

In this Spotlight feature, we take a brief look at the prevalence of childhood obesity in the US and the disparities in childhood obesity prevalence that exist among different racial and ethnic groups. We will examine what factors may contribute to this disparity and what action can be taken to remedy the situation.

A growing problem

"Obesity is the terror within," states Dr. Richard Carmona, the former Surgeon General. "Unless we do something about it, the magnitude of the dilemma will dwarf 9-11 or any other terrorist attempt."

These are strong words, but they illustrate the scope of the obesity problem. According to the Centers for Disease Control and Prevention (CDC), in 2009-2010, over a third (35.7%) of adults in the US were obese.

On average, childhood obesity in the US has not changed significantly since 2003-2004, and overall, approximately 17% of all children and adolescents aged 2-19 years are obese - a total of 12.7 million.

There are a number of immediate health problems that childhood obesity can lead to, including:

• Respiratory problems, such as asthma and sleep apnea
• High blood pressure and cholesterol
• Fatty liver disease
• Increased risk of psychological and social problems, such as discrimination and low self-esteem
• Joint problems
• Type 2 diabetes.

In the long term, obese children are much more likely to grow up to be obese as adults than children with healthy weights. Not only that, but the obesity experienced by these children is likely to be more severe, leading to further and more extreme health problems.

Significant disparities exist in obesity prevalence between different racial and ethnic groups. The CDC report the following obesity prevalence percentages among different youth demographics:

• Hispanic youth - 22.4%
• Non-Hispanic black youth - 20.2%
• Non-Hispanic white youth - 14.1%
• Non-Hispanic Asian youth - 8.6%.

From these figures taken from 2011-2012, we can see that levels of obesity among Hispanic and non-Hispanic black children and adolescents are significantly above average.

When the parameters are extended to include overweight children as well, the disparity persists. Around 38.9% of Hispanic youth and 32.5% of non-Hispanic black youth are either overweight or obese, compared with 28.5% of non-Hispanic white youth.

In 2008, Dr. Sonia Caprio, from the Yale University School of Medicine, CN, and colleagues wrote an article published in Diabetes Care in which they examined the influence of race, ethnicity and culture on childhood obesity, and what their implications were for prevention and treatment.

"Obesity in children is associated with severe impairments in quality of life," state the authors. "Although differences by race may exist in some domains, the strong negative effect is seen across all racial/ethnic groups and dwarfs any potential racial/ethnic differences."

However, if there are specific factors contributing to these disparities that can be addressed, the numbers involved suggest that attention should be paid to them. The long-term health of thousands of children in the US is at stake.

Socioeconomic factors

"Rarely is obesity in children caused by a medical condition," write the National Association for the Advancement of Colored People (NAACP) in their childhood obesity advocacy manual. "It occurs when more calories are eaten than calories burned."

The NAACP outline a number of factors that contribute to increases in childhood obesity, including:

• The development of neighborhoods that hinder or prevent outdoor physical activity
• Failure to adequately educate and influence families about good nutrition
• Ignored need for access to healthy foods within communities
• Limited physical activity in schools
• Promotion of a processed food culture.

The CDC report that childhood obesity among preschoolers is more prevalent in those who come from lower-income families. It is likely that this ties in with the disparity with obesity prevalence among different racial and ethnic groups.

"There are major racial differences in wealth at a given level of income," write Caprio, et al. "Whereas whites in the bottom quintile of income had some accumulated resources, African-Americans in the same income quintile had 400 times less or essentially none."

Fast food and processed food is widely available, low cost and nutritionally poor. For these reasons, they are often associated with rising obesity prevalence among children. According to Caprio, et al., lower-cost foods comprise a greater proportion of the diet of lower-income individuals.

If adults need to work long hours in order to make enough money to support their families, they may have a limited amount of time in which to prepare meals, leading them to choose fast food and convenient processed food over more healthy home-cooked meals.

Living in high-poverty areas can also mean that children have limited access to suitable outdoor spaces for exercise. If the street is the only option available to children in which to play, they or their parents may prefer them to stay inside in a safer environment.

Hispanic youth and non-Hispanic black youth are more likely to come from lower-income families than non-Hispanic white youth. According to The State of Obesity, white families earn $2 for every $1 earned by Hispanic or non-Hispanic black families.

Over 38% of African-American children aged below 18 and 23% of Latino families live below the poverty line. This statistic suggests that the effects of living with a low income that increase the risk of obesity may be felt much more by African-American and Latino families and their children.

Not only do these socioeconomic factors increase the risk of obesity among these demographic groups but equally obesity can compromise a family's economic standing.

The NAACP point out that families with obese children spend more money on clothing and medical care. Additionally, as obese and overweight girls frequently start puberty at a younger-than-average age, there is a possibility that their risk of adolescent pregnancy is also higher.

Cultural factors

Alongside these socioeconomic factors, a number of additional factors exist that may be linked to an increased prevalence of childhood obesity among Hispanic and non-Hispanic black youth.

The NAACP give one such example, stating that one component of body image is how a person believes others view them or accept their weight:

"This also poses unique challenges in African-American communities because of cultural norms that accept, uplift and at times reward individuals who are considered 'big-boned,' 'P-H-A-T, fat,' or thick.'"

Cultural norms such as these may lead to parents remaining satisfied with the weight of their children or even wanting them to be heavier, even if they are at an unhealthy weight. Other sociological studies have also suggested that among Hispanic families, women may prefer a thin figure for themselves but a larger one for their children, according to Caprio, et al.

As well as being influenced by socioeconomic status, the type of foods eaten by children can be influenced by the cultural traditions of their families.

"Food is both an expression of cultural identity and a means of preserving family and community unity," write Caprio, et al. "While consumption of traditional food with family may lower the risk of obesity in some children (e.g., Asians), it may increase the risk of obesity in other children (e.g., African-Americans)."

As mentioned earlier, the promotion of a processed food culture may be a contributing factor to childhood obesity. As fast food companies target specific audiences, favoring cultural forms associated with a particular race or ethnicity could increase children's risk of being exposed to aggressive marketing.

Caprio, et al., report that exposure to food-related television advertising - most frequently fast food advertising - was found to be 60% among African-American children.

The amount of television that is watched may contribute as well; one study conducted by the Kaiser Family Foundation observed that African-American children watched television for longer periods than non-Hispanic white children.

A number of these cultural factors are associated with socioeconomic factors. African-American children may be more likely to watch television for longer, for example, if they live in areas where opportunities for playing safely outside are limited.

What can be done?

This subject area is far too detailed to do justice to in an article of this size, but these brief observations suggest that there should be ways in which the disparity in childhood obesity between racial and ethnic groups can be addressed.

Having more safe spaces to walk, exercise and play in low-income areas would give children a better opportunity to get the exercise need to burn the required number of calories each day. Improving the availability of and access to healthy food would give families more options when it came to maintaining a healthy, balanced diet.

The NAACP state that low-income neighborhoods have half as many supermarkets as the wealthiest neighborhoods, suggesting that for many low-income families, accessing healthy food can be a challenge.

These problems are ones that would need to be solved by local government and businesses that have influence over the planning and development of public living spaces. 

Caprio, et al. propose that a "socioecological" framework should be adopted to guide the prevention of childhood obesity. Such a framework would involve viewing children "in the context of their families, communities, and cultures, emphasizing the relationships among environmental, biological and behavioral determinants of health."

This approach would require large-scale collaboration, involving peer support, the establishment of supportive social norms and both the private and public sector working together.

"For health care providers to have a meaningful interaction about energy intake and energy expenditure with children/families, providers should have training in cultural competency in order to understand the specific barriers patients face and the influence of culture and society on health behaviors," the authors suggest.

In order for this disparity to be adequately addressed, a lot of work will need to be done. Not only might certain cultural norms need to be altered, but most importantly, environments will need to be provided in which children will have the opportunity to live as healthy lives as possible.

By Heather Stringer

By 2043, the U.S. is projected to become a majority-minority nation for the first time in its history, according to the U.S. Census Bureau. Both the Hispanic and Asian populations will more than double between 2012 and 2060, and the black population will increase by 50% during the same time period. These statistics illustrate that nurses will be caring for a progressively diverse patient population and the increasing urgency to build a diverse RN workforce. 

“Patients come with an expectation that the caregiver will understand all of their care needs,” Deidre Walton, RN/PHN, MSN, JD, president and CEO of the National Black Nurses Association based in Silver Spring, Md., said. “When you have a diverse workforce, you have people with knowledge and skills to meet the diverse needs of patients. The patient’s cultural identification, spiritual affiliation, language and gender can all affect the care they need, and it is very important that the nurse understands that.” 

Although Walton said the healthcare community is far from reflecting the demographics of the American population, she has hope as she looks into the future because diversity in the nursing workforce is being highlighted as a critical priority by more than minority nursing organizations. 

“I am excited because organizations such as the Robert Wood Johnson Foundation and AARP have a diversity agenda, and that makes me hopeful that there will be change,” she said.

Increasing diversity in the workforce, as illustrated on the following pages, will take individual and group efforts. 

Job titles of minority nurses

According to the 2008 National Sample Survey of Registered Nurses, the largest sample to date, minority nurses were more likely to hold staff nurse positions than white, non-Hispanic nurses.

Black nurses comprise 5.4% of the RN workforce, and 13.8% are in management positions, which is higher than any other ethnic group. Walton, however, said far more black nurses still are needed in leadership positions because this 13.8% is taken from a small pool of nurses. 

“Some organizations have very active programs to promote diversity in leadership, but the diversity gap in leadership continues,” Walton said. “There is a gap between how many minorities are recruited and how many are actually hired. These minorities in leadership roles are able to participate in making changes to improve the practice environment and outcomes, and this is very important.” 

Can patient ethnicity affect care?

According to a 2012 report from the Agency for Healthcare Research and Quality, racial and ethnic minorities face more barriers to care and receive poorer quality of care when they can get it. Findings from the report included:

Blacks received worse care than whites, and Hispanics received worse care than non-Hispanic whites for about 40% of quality measures.

American Indians and Alaska Natives received worse care than whites for one-third of quality measures.

Blacks had worse access to care than whites for one-third of measures, and American Indians and Alaska Natives had worse access to care than whites for about 40% of access measures.

Hispanics had worse access to care than non-Hispanic whites for about 70% of measures. 

Would a more diverse RN workforce correct some of these disparities? "Absolutely,” Walton said. “Diversity will improve patient-nurse communication, collaboration and clinical practice for patients of all backgrounds. If an African-American woman comes to the ED with abdominal pain, what is the likelihood that she will be diagnosed with a sexually transmitted disease as the cause of the pain rather than [staff] conducting other tests for a definitive diagnosis? When you have a culturally diverse RN workforce, they may not as easily dismiss symptoms and will advocate for a more intense work-up.” 

According to the 2008 National Sample Survey of Registered Nurses, only 0.3% of the RN workforce is American Indian or Alaska Native. This small percentage who are accepted into nursing school, earn their degree and enter the workforce often have overcome significant challenges, Bev Warne, RN, MSN, one of the founders of the Native American Nurses Association based in Phoenix, Ariz., said. “A survey in 2010 showed that 51% of Native American high school students graduate, so the drop-out rate is very high,” Warne said. “There are complex reasons for this. Studies show that many grow up in families that are poverty-stricken, so they suffer from poor nutrition and difficult family situations, and by the time they are in junior high they are already behind.” 

Warne believes the preparation to attain a formal education begins with good prenatal care, proper nutrition and support for parents. Even after Native Americans are accepted into nursing school, there are other challenges they may face.

“There are differences in values among Native people and Western people,” Warne said. “Generally Native Americans are raised in more of an extended family where there is an emphasis on inclusiveness. When they go into the college setting outside the reservation, they may confront Western values that promote individualism and competition, which is often the opposite of how they were raised. To be successful in this new setting, it is important for educators to get involved with students to discuss this new reality.”

It also can be difficult to transition to the Western medicine paradigm, Warne said. “In the Western hospital setting, caregivers tend to look more toward the physical aspects of illness, but from the Native perspective, they are accustomed to a holistic way of viewing a person.” 

Power to promote

Although it may seem difficult to make time to promote nursing to minorities within the community, here are a few simple strategies that are making a difference. 

Celia Besore, executive director and CEO, National Association of Hispanic Nurses: 
“I believe stories are really what lead people to consider nursing. The personal stories of nurses who were maybe the first to go to college in their families and now are very successful are the ones that inspire people. Our chapter members go into the community and do career fairs and visit schools, and that is when nurses can share their stories. There have been times when people have discouraged Hispanic students from going to nursing school because they think the students will not succeed, and our nurses can give them hope. We also tell young people that 30% of our members are student nurses, so they know they will not be alone.

“During these events, we also explain that now is a good time to be a minority in healthcare,” she continued. “We get calls from places that are desperately looking for Latino nurses. The word is starting to get out that it is an asset to understand the culture and language of minority patients, and hospitals want people with this experience.”

Mildred Crear, RN, MA, MPH, chairwoman for nursing and community education, Bay Area Black Nurses Association:
“Our chapter sponsors community health events like blood pressure drives, and this gives people in the community a chance to see us and ask what it takes to be a nurse. We share this information and then invite them to our meetings. We also do a lot of health fairs with churches and black sororities and fraternities where we do presentations about nursing, and this has been a really effective way of promoting the profession.”

Sharon Smith, RN, MSN, FNP-BC, president of the San Diego Black Nurses Association:
“I think it is critical to connect with people when they are young and try to mentor them. You can meet youth through church, in the community or through the events sponsored by your minority association. Our chapter visits high schools to recruit students, and we will go into the tough neighborhoods where it is harder for students to believe that they can do it. I share my own story that I grew up in North Carolina in one of the poorest counties, and I was told I would never finish high school. I told myself, ‘This is your thought, and not mine,’ and I went on to earn a BSN, a master’s degree and now I am pursuing a doctorate. You can do simple things like take them to work or communicate online, and this will show students the positives of a career in nursing.” 

It starts in the schools

Diversity in the nursing workforce is dependent upon a pipeline of diverse students who graduate from nursing school. This much-needed diversity among students, however, requires focus and resources, Julie Zerwic, RN, PhD, FAHA, FAAN, professor and executive associate dean at the University of Illinois at Chicago, College of Nursing, said. “Our school went through a period of time when there was no staff focused on watching diversity, so the number of underrepresented minorities in the program dropped,” she said. “If no one is paying close attention, you can lose momentum.” 

For example, the school recognized that a number of underrepresented minorities were not finishing their applications and would benefit from having a staff member available to receive phone calls and answer questions. The school also started offering application workshops. 

Although Zerwic hopes to see even more diversity among undergraduate nursing students, her institution has had significant success in recruiting graduate minority students. Zerwic credits a National Institutes of Health-funded program, the Bridges to the Doctorate Program, that helps the school to support potential minority doctoral students through mentoring, funding and coursework. 

Like the University of Illinois, diversity became a high priority in the School of Nursing at The University of Texas Health Science Center. “We knew that about 62% of the population in San Antonio was Hispanic, and to provide competent healthcare we needed to increase the number of Hispanic nursing students,” Hilda Mejia Abreu, PhD, MS, BA, associate dean for admissions and student services at UTHSC San Antonio, said. 

During the spring and fall, staff members travel throughout the U.S. to college fairs, schools, nursing association recruitment fairs and other activities to recruit minority students. The local Spanish-language channel also regularly features a 15-minute segment in which Mejia Abreu explains the college preparatory classes needed to apply for nursing school and how to finance an education. 

By comparison, below are the national diversity statistics for nursing schools:

Race/Ethnicity of Students Enrolled in Entry-Level 
Baccalaureate Nursing Programs in the U.S. in 2011
White, non-Hispanic: 72%
Black: 10.3%
Hispanic: 7%
Asian, Native Hawaiian or other Pacific Islander: 8.8%
American Indian or Alaskan Native: 0.5%

(Source: American Association of Colleges of Nursing) 

Overcoming the language barrier

For nurses who have arrived in the U.S. as adults and learned English as a second language, there typically are two distinct challenges they will face when communicating: being understood by Americans and understanding Americans, said Victoria Navarro, RN, MSN, MAS, president of the Philippine Nurses Association of America. 

“In the Philippines, we were colonized by Spain for about 400 years, so the Filipino language (Tagalog) that evolved has root words based in Spanish,” Navarro said. “We pronounce every syllable. In English, you have words with silent syllables or letters, so that in itself is something that we need to learn.” 

In addition to pronunciation, healthcare workers use jargon to communicate, and this is even more complicated when English is a second language. Navarro remembers when a physician told a Filipino nurse to get the “lytes.” The nurse turned off the lights, when in fact he had meant electrolytes. Other communication challenges Filipino nurses confront in the U.S. include:

In Tagalog, there are no long vowels, so it takes time and practice to learn to pronounce these sounds. 

There are no pronouns such as ‘he’ and ‘she’ in Tagalog, and there are no singular or plural verbs. It takes time to know when to say the proper pronoun or verb. Many people make mistakes initially.

Mental processing in the native language happens before responding in English. The literal translation from Tagalog to English could change the intent of the sentence.
In the Philippines, people have high respect for elders and do not speak unless they are asked something directly. For this reason, Filipino nurses may be considered passive by peers or patients. 

Navarro and Joseph Mojares, RN, BSN, president of the Philippine Nurses Association of Northern California, say proficiency can come with practice and time and made the following suggestions:

Do not be embarrassed to ask questions to clarify what others mean so you can learn the correct pronunciation and terminology.

Constantly immerse yourself in English-speaking environments and expose yourself to mainstream media at work and at home. 

Challenge yourself by taking classes in communication, leadership and public speaking so you can improve your English. 

Find mentors and preceptors who can encourage you and give you suggestions about how to present yourself and communicate. 

Tips for scholarship success

Jasmine Melendez, the scholarships and grants administrator at the Foundation of the National Student Nurses Association, has an insider’s view into the world of financial assistance. She has seen hundreds of scholarship applications, and said reviewers are looking for three things from applicants: financial need, high academic achievement and involvement in community health activities. 

“It is important to maintain a high GPA, but students who make time for some form of community service really set themselves apart,” Melendez said. 
Another way to stand out from the competition is to turn in well-crafted, accurate essays. “What I’ve been noticing is that students need to learn to write well,” she said. “When you convey a message, you want to make sure you convey it in a clear, concise manner with no spelling errors or grammar mistakes.” 

Here are other tips she suggests:

Get comfortable with the Internet because most scholarships are found on the Web. Websites that can help minority students find scholarships include: 
DiscoverNursing.com/Scholarships 
MinorityNurse.com/Find-Scholarships 
NursingSociety.org/Career/CareerAdvisor/Pages/Scholarships_opps.aspx 

Check with minority-owned businesses to see whether they offer scholarships, and ask the financial aid office at your school about scholarships and applications.

The hospital association in your state may have access to scholarship information.

Don’t make the mistake of thinking scholarship deadlines are only in the first part of the year. There are scholarships available every quarter of the year.

Don’t disqualify yourself by not applying. Apply for everything and let the committee say no. 

Source: Nurse.com

By Jane Gutierrez

When you think of a nurse, what’s the first image that comes to mind? Chances are, you think of a woman — and for good reason. The vast majority of professional nurses in the U.S. are white women. In fact, only about six percent of nurses are male and, Considering males make up approximately half of the population and minorities are 30 percent, there’s a major disparity in the profession.

That disparity is reflected in equal measure in nursing schools, both in the student population and faculty. Experts argue improving the diversity in nursing education will improve health care by creating a more culturally sensitive healthcare workforce with improved communication abilities, reduced biases and stereotypes and fewer inequities, as well as increasing the diversity of the nurse education faculty.

At a time when the healthcare system is faced with a nursing shortage caused at least partially by a shortage of nurse educators, some argue males and minorities represent an untapped resource for recruiting new educators. They believe that by creating new opportunities to attract traditionally underrepresented populations to the field, we can both solve the shortage and make a measurable improvement to our healthcare delivery system.

Why Diversity Is an Issue

While minorities have made great strides in other traditionally white-dominated fields and women have done the same in traditionally male fields, nursing is one area where diversity initiatives seem to have been ineffective.

In the case of men, much of the resistance to nursing as a profession comes from a cultural perception of nursing being a “female” profession. Men report while they enjoy the care giving aspects of the job, it’s difficult when others ask questions or make comments deriding their career choice. For example, male nurses report being asked why they didn’t choose to become doctors, with the implication that they did not earn adequate grades or were too lazy to become doctors. In addition, men report feeling left out of the profession, with most training and professional development materials referring to nurses as “she” and a female-centric approach to teaching and training.

In the case of minorities, including African-Americans and Latinos, studies attribute the disparity in the nursing profession largely to lower overall academic achievement in those groups. Given that admission to nursing school generally requires at least a moderate level of academic achievement — and earning a

degree in nursing education requires at least a bachelor’s degree and some experience — it’s no surprise that groups that aren’t as academically advanced are lacking in the nursing profession.

Fixing the Problem

Because improving diversity in the nursing profession is a key to solving the nurse shortage — and by extension, the nurse educator shortage — the healthcare field is looking for new ways to recruit, mentor and retain minority nurses, male nurses and educators.

One step is to recruit potential professionals earlier — in some cases, as early as high school. Throughout the country, in the field in exchange for high school credit, with the goal of encouraging them to maintain their academic performance and attend nursing school.

However, academic performance is only part of the equation. The cost of education is another barrier to many potential students, regardless of sex or ethnicity. The cost for a four-year BSN program can be over $100,000 in some cases, while a two-year program generally runs between $5,000 and $20,000. Factoring in the master’s and doctoral degrees required to become nurse educators, and the cost only goes up.

In response, many schools, as well as states and the federal government, have instituted financial assistance programs designed specifically for minorities and males. The Federal Nursing Workforce Diversity program allows minority students to borrow money for school, and have some or all of their loans repaid if they agree to work in specific, undeserved areas. For those who want to become nurse educators, the government’s Nurse Faculty Loan Program offers partial or full repayment of student loans for agreeing to teach for at least two years after graduation.

With the nursing shortage only expected to grow, thanks to increased access to healthcare, reaching out to minorities and males only makes sense. Not only will it solve a serious problem, it will ensure quality, effective health care for future generations.

About the Author: Jane Gutierrez is a nurse educator and a member of her employer’s diversity initiative committee. She visits with local high schools to encourage students to consider careers in health care

By Max Fisher

Ethnicity, like race, is a social construct, but it’s still a construct with significant implications for the world. How people perceive ethnicity, both their own and that of others, can be tough to measure, particularly given that it’s so subjective. So how do you study it?

When five economists and social scientists set out to measure ethnic diversity for alandmark 2002 paper for the Harvard Institute of Economic Research, they started by comparing data from an array of different sources: national censuses, Encyclopedia Brittanica, the CIA, Minority Rights Group International and a 1998 study called “Ethnic Groups Worldwide.” They looked for consistence and inconsistence in the reports to determine what data set would be most reliable and complete. Because data sources such as censuses or surveys are self-reported – in other words, people are classified how they ask to be classified – the ethnic group data reflects how people see themselves, not how they’re categorized by outsiders. Those results measured 650 ethnic groups in 190 countries.

One thing the Harvard Institute authors did with all that data was measure it for what they call ethnic fractionalization. Another word for it might be diversity. They gauged this by asking an elegantly simple question: If you called up two people at random in a particular country and ask them their ethnicity, what are the odds that they would give different answers? The higher the odds, the more ethnically “fractionalized” or diverse the country.

I’ve mapped out the results above. The greener countries are more ethnically diverse and the orange countries more homogenous. There are a few trends you can see right away: countries in Europe and Northeast Asia tend to be the most homogenous, sub-Saharan African nations the most diverse. The Americas are generally somewhere in the middle. And richer countries appear more likely to be homogenous.

This map is particularly interesting viewed alongside data we examined yesterday on racial tolerance, as measured by the frequency with which people in certain countries said they would not want a neighbor from a different racial group.

Before we go any further, though, a few important caveats, all of which appear in the original research paper as well. Well, all except for the report’s age. It’s now 11 years old. And given the scarcity of information from some countries, some of the data are very old, dating from as far back as the early 1990s or even late 1980s. Conceptions of ethnicity can change over time; the authors note that this happened in Somalia, where the same people started self-identifying differently after war broke out. And so can the actual national make-ups themselves, due to immigration, conflict, demographic trends and other factors. It’s entirely possible, then, that some of these diversity “scores” would look different with present-day data.

Another caveat is that people in different countries might have different bars for what constitutes a distinct ethnicity. These data, then, could be said to measure the perception of ethnic diversity more than the diversity itself; given that ethnicity is a social construct, though those two metrics are not necessarily as distinct as one might think. Finally, as the paper notes, “It would be wrong to interpret our ethnicity variable as reflecting racial characteristics alone.” Ethnicity might partially coincide with race, but they’re not the same thing.

Now for the data itself. Here are a few observations and conclusions, a number of which draw from the Harvard Institute paper:

• African countries are the most diverse. Uganda has by far the highest ethnic diversity rating, according to the data, followed by Liberia. In fact, the world’s 20 most diverse countries are all African. There are likely many factors for this, although one might be the continent’s colonial legacy. Some European overlords engineered ethnic distinctions to help them secure power, most famously the Hutu-Tutsi division in Rwanda, and they’ve stuck. European powers also carved Africa up into territories and possessions, along lines with little respect for the actual people who lived there. When Europeans left, the borders stayed (that’s part of the African Union’s mandate), forcing different groups into the same national boxes.

• Japan and the Koreas are the most homogenous. Racial politics can be complicated and nasty in these countries, where nationalism and ethnicity have at times gone hand-in-hand, from Hirohito’s Japan to Kim Il Sung’s North Korea. The lack of diversity perhaps informs these politics, although it’s tough to say which caused which.

• European countries are ethnically homogenous. This is, to me, one of the most interesting trends in the data. A number of now-global ideas about the nation-state, about national identity as tied to ethnicity and about nationalism itself originally came from Europe. For centuries, Europe’s borders shifted widely and frequently, only relatively recently settling into what we see today, in which most large ethnic groups have a country of their own. That developed, painfully, over a very long time. And while there are still some exceptions – Belgium has ethnic Walloons and Dutch, for example – in most of Europe, ethnicity and nationality are pretty close to the same thing.

• The Americas are often diverse. From the United States through Central America down to Brazil, the “new world” countries, maybe in part because of their histories of relatively open immigration (and, in some cases, intermingling between natives and new arrivals) tend to be pretty diverse. The exception is South America’s “southern cone,” where Argentines and Chileans, many of whom originally come from the same handful of Western European countries, tend to be more homogenous. I was surprised to see Canada rate as more diverse than the United States or even Mexico; it’s possible that the survey counted Quebecois as ethnically distinct, although I can’t say for sure.

• Wide variation in the Middle East. The range of diversity from Morocco to Iran is a reminder that this part of the world is much less monolithic than we sometimes think. North African countries include large Berber minorities, for example, as well as some sub-Saharan ethnic groups, particularly in Libya. The diversity of Jordan and Syria are reminders of their internal complexity. Iran, with large Azeri, Kurdish and Arab populations, is one of the region’s most diverse.

• Diversity and conflict. Internal conflicts appear on first blush to be more common in greener countries, which might make some intuitive sense given that groups with comparable “stakes” in their country’s economics and politics might be more willing or able to compete, perhaps violently, over those resources. But there’s enough data here to draw a lot of different conclusions. One thing to keep in mind is that ethnicity might not be static or predetermined. In other words, as in the case of Somalia, maybe worsening economic conditions or war make people more likely to further divide along ethnic fractions.

• Diversity correlates with latitude and low GDP per capita. The report notes, “our measures of linguistic and ethnic fractionalization are highly correlated with latitude and GDP per capita. Therefore it is quite difficult to disentangle the effect of these three variables on the quality of government.” As above, keep in mind that correlation and causation aren’t the same thing.

• Strong democracy correlates with ethnic homogeneity. This does not mean that one necessarily causes the other; the correlation might be caused by some other factor or factors. But here’s the paper’s suggestion for why diversity might make democracy tougher in some cases:

The democracy index is inversely related to ethnic fractionalization (when latitude is not controlled for). This result is consistent with theory and evidence presented in Aghion, Alesina and Trebbi (2002). The idea is that in more fragmented societies a group imposes restrictions on political liberty to impose control on the other groups. In more homogeneous societies, it is easier to rule more democratically since conflicts are less intense.

Here’s the money quote on the potential political implications of ethnicity:

In general, it does not matter for our purposes whether ethnic differences reflect physical attributes of groups (skin color, facial features) or long-lasting social conventions (language, marriage within the group, cultural norms) or simple social definition (self-identification, identification by outsiders). When people persistently identify with a particular group, they form potential interest groups that can be manipulated by political leaders, who often choose to mobilize some coalition of ethnic groups (“us”) to the exclusion of others (“them”). Politicians also sometimes can mobilize support by singling out some groups for persecution, where hatred of the minority group is complementary to some policy the politician wishes to pursue.

Source: Washington Post 

If you live a neighbourhood which is ethnically diverse, you're more likely to be healthier and less likely to experience racial discrimination, a new study has found.

Researchers at the University of Manchester say diversity is associated with higher social cohesion and a greater tolerance of each other's differences.

They also found that someone from an ethnic minority is less likely to report racial discrimination in an ethnically diverse neighbourhood.

And that a neighbourhood's high level of deprivation - rather than diversity - is linked with poor physical and mental health, low social cohesion and race discrimination.

The findings, based on analysis of census and survey data, will be presented tomorrow at a conference attended by the study researchers, policy makers and community organisations

Professor James Nazroo, director of the university's Centre on Dynamics of Ethnicity,said: "Our research and this conference is all about setting the record straight on those diverse neighbourhoods which are so widely stigmatised.

"So often we read in our newspapers and hear from our politicians that immigration and ethnic diversity adversely affect a neighbourhood, but careful research shows this to be wrong.

"In fact, the level of deprivation, not diversity, is the key factor that determines these quality of life factors for people in neighbourhoods.

"So our research demonstrates the disadvantages of living in deprived areas but the positives of living in ethnically diverse areas.

"It's deprivation which affects those Caribbean, Black African, Pakistani, and Bangladeshi people who are disproportionately represented in these neighbourhoods, as well as those white people who live alongside them."

Also according to the researchers, one in five (20%) people identified with an ethnic group other than White British in 2011 compared with 13% in 2001.

The ethnic minority populations of England and Wales lived in more mixed areas in 2011 and this mixing has accelerated over the past 10 years, says the study.

Traditional clusters of ethnic minority groups have grown but the rate of minority population growth is greatest outside these clusters with ethnic diversity spreading throughout the country.

Fellow researcher Dr Nissa Finney said: "Despite the clustering of ethnic minority people in some areas, the vast majority of ethnic minority people have a strong sense of belonging to Britain, feel part of Britain and feel that Britishness is compatible with other cultural or religious identities."

While colleague Dr Laia Becares said: "Increased diversity is beneficial for all ethnic groups so we say the policy agenda should develop strategies for inclusiveness rather than marginalising minority identities, religions and cultures.

"Policies aimed at reducing the stigmatisation of diverse neighbourhoods and promoting positive representations can only be a good thing."

The conference, entitled 'Diverse Neighbourhoods: Policy messages from The University of Manchester', will take place at Manchester Town Hall.

Source: UK Huffington Post

New learning institute builds on past success to diversify the dental profession

By Janet Edwards

At the age of 13, Esther Lopez, DDS, knew intimately her mother’s battle with cancer because she served as the primary translator between the patient, a native of Ecuador, and her doctors. Even at such a young age, Lopez vowed the excruciating experience would influence her life’s work. She didn’t know the term “public health” then, but that’s where she would later find fulfillment, through dentistry. In part, Lopez credits the now defunct, but still influential, Dental Pipeline program for helping her achieve that dream. A new project, the Dental Pipeline National Learning Institute, builds on the program that brought Lopez into dentistry.

Esther Lopez is a dentist in Oak Park, Ill. Through both private practice and volunteer public health efforts, she works with low-income and minority populations, groups that typically find dental services inaccessible, complex, and unwelcoming. In large part, Lopez credits a now-defunct minority recruitment program, the Dental Pipeline, for the opportunity to do such work, a longtime ambition that often seemed out of reach.

Lopez is one of a small number of minority dentists in the country—only 9 percent of practicing dentists are African American, Hispanic, or American Indian. While these underrepresented groups comprise nearly 30 percent of the general population, they account for just 13 percent of first-year dental students. Dental schools and their community partners seek to close that gap through a new program that adopts lessons learned from the Dental Pipeline.

Dental Pipeline National Learning Institute
The original Dental Pipeline launched with funding from The Robert Wood Johnson Foundation (RWJF) and The California Endowment. In all, 23 (out of 62) U.S. dental schools were involved in the decade-long program, which ended in 2011. Widely credited with transforming dental education, the Dental Pipeline resulted in better access to care for underserved populations, along with more student exposure to community-based services and higher enrollment among minority students.

A new program launched in fall 2012, the Dental Pipeline National Learning Institute (NLI), is intended to build on that success. Project partners are the American Dental Education Association and the University of the Pacific Arthur A. Dugoni School of Dentistry, in San Francisco, Calif. Support comes from an initial 18-month, $650,000 grant funded by RWJF.

Eleven schools were tapped as NLI participants. Each institution receives $12,000 to cover the cost of building a recruitment project or community-based education component. The program includes a three-day training course covering best practices, advocacy and leadership, and various mentoring opportunities.  

Paul Glassman, DDS, professor and director of Community Oral Health at University of the Pacific, is project director. The primary goal is to expose other dental schools to methodologies developed as part of the Dental Pipeline “so they wouldn’t be reinventing the wheel,” he says.   

Evidence of the Dental Pipeline’s success is found in the numbers, Glassman says. “Schools involved in the Pipeline managed to dramatically increase—double, triple, even quadruple—the number of underrepresented minority students entering their schools. [Enrollments of] other dental schools not involved in the program stayed static,” he says. 

The NLI is a one-year program. Participants are dental school faculty members who collaborate with a partner from a local organization, such as a minority-focused college or community health center. “We want some significant community partner involved because we’re really trying to emphasize the fact that in this very complex world that we live in, dental schools really can’t break through these barriers by themselves. The way to make progress in our current world is through partnerships and establishing networks,” Glassman says.  

Like its predecessor, the NLI is also designed to develop future leaders in the push to provide more diverse dental care in community-based health settings, Glassman says. Barriers to health care for low-income and minority individuals, which result in less dental care and more dental disease, are well documented, he adds.  

“Minority populations tend to have more dental disease than more affluent populations and majority populations. They tend to have more barriers to access to care, so they get care less regularly,” he says. Paying for dental care is a serious obstacle, along with language and cultural challenges. “They feel uncomfortable going into a dental office because they feel someone isn’t going to understand them,” he says.  

“We’re expecting people who go through this program to become future leaders in this area, so within their own school and their community, and maybe even regionally, they’re going to be someone steeped in this whole idea of the dental profession doing a better job of improving the health of underserved populations and keep the momentum going,” he says.

The Minority Enrollment Challenge  

While the Dental Pipeline made positive inroads toward recruiting minority dental students, the NLI is designed to keep the momentum going, says Kim D’Abreu, senior vice president for access, diversity, and inclusion for the ADEA.   

The effort continues to face several high priority challenges. A large pool of minority students who could succeed in dental school remains untapped, D’Abreu says, including 12,500 students of color who graduate with majors in the biological sciences each year. “A 2003 focus group study published in the Journal of Dental Education found that early and frequent exposure to dentistry and dentists in practice is essential for minority students to consider the profession. Dental schools need additional tools and strategies to attract a talented group of underrepresented minority students,” she says. 

The process by which dental schools evaluate student candidates is undergoing review, Glassman says.        

“Traditionally, admission is based on grade point average, extracurricular activities, and other sorts of measures that aren’t necessarily the measures that students from minorities have excelled in … because they were working while they were in school and facing other social challenges in their lives,” he says. While it makes it harder for them to get through the admission process, it doesn’t necessarily mean they are less qualified or passionate about a career in dentistry, he says. Schools are now adopting a whole file review approach, one less focused on the numbers, Glassman says.  

The whole file review, which takes into consideration a host of cognitive and non-cognitive variables, has already proven to be effective and is just one of other successful admissions strategies shared with NLI institutional participants, D’Abreu says.

Engaging Students in Community Health
Along with recruitment of minority students, another goal of the Dental Pipeline was to get students to spend more of their clinical time in community health settings, a mission that continues under the NLI program.  

“(In the Dental Pipeline) we increased the number of days from three to four to up to 50 days for senior dental students as part of the education program,” Glassman says. “The hope is that in doing so, these students become more comfortable with community sites, they understand more about that kind of delivery mechanism, become more comfortable with diverse populations, and are better able to serve those populations in the future.”  

Esther Lopez knows too well the importance of that exposure. Her father, a Cuban-born immigrant, abandoned the family of three children, including a brother and sister, following the death of her mother. But in the midst of her undergraduate work in biology at DePaul University—coursework Lopez had hoped would lead to medical school—her father returned, homeless and afflicted with health issues that eventually led to two strokes. He had no job and no insurance. Between studies, Lopez pleaded with pharmaceutical companies for free medicine, and again served as a translator with various health agencies and doctors. 

“We were able to get some assistance,” Lopez says. “Things were going as well as they could have, considering the fact that we didn’t have health insurance. I really wanted to stay in school so I tried as best I could to find resources to help us along the way.”  

By the time her father died in 2000, Lopez, exhausted, had given up on medical school, but she was more determined than ever to help resolve the challenges facing low-income and minority individuals seeking medical care. She completed her bachelor’s degree, and then enrolled in the master’s program in public health at the University of Illinois at Chicago (UIC). With her coursework finished, Lopez continues to work on her thesis.  

While attending UIC, she joined a research project involving people with periodontal disease and diabetes.   

“We were trying to determine what needs existed for people that had diabetes, and if they even knew there was a corollary between that and periodontal disease, specifically in the Latino community. I got engaged, really excited, and decided dentistry intrigued me,” Lopez says. 

With the help of the Dental Pipeline, she enrolled in UIC’s College of Dentistry. “Dental school is really, 
really expensive. The fact that we have programs like the Dental Pipeline for people like me is just amazing,” she says. Lopez received some tuition reimbursement from the program and worked as a research assistant in exchange for remaining tuition waivers.  

While in dental school, she joined a group of fellow students in establishing the first student-run dental clinic in the United States.   

Located on the north side of Chicago, the clinic still operates in Goldie’s Place, which serves as a place for homeless adults to get back on their feet. In 1997, a single dentist began providing services. In 2008, Lopez and others created the student component.  

“Goldie’s Place helps dental students become part of the change, which is what I really wanted to do,” says Lopez, who served for a time as clinic director after graduating 
from dental school.  

As a student, she often spoke with colleagues about the challenges of health care in low-income communities. “A lot of times someone who comes from privilege has blinders to different barriers that exist. I think it’s more impactful when you’re hearing from a colleague about things that make it hard for you to succeed,” she says.   

No matter a person’s race, ethnicity, or income level, dental needs will always be the same: a cavity is always a cavity, an extraction is an extraction, Lopez says. “But the way they perceive disease is always different,” she says, a concept that young dental students initially struggle with at Goldie’s Place. “It’s hard for them to understand, but it’s true. When you come from an underprivileged background, it’s not that you’re neglecting yourself; it’s just that it’s more important to feed your child. Or pay your rent.”  

Communicating correct information in a way that is easy for clients to understand is imperative, Lopez says. “It’s important to service them understanding their cultural needs.”  

Today, many of her classmates continue to work with grassroots organizations. One student has written a manual on how to establish a student-run dental clinic based on the Goldie’s Place model. “They’re addressing dental health issues not one person at a time, but communities at a time,” Lopez says. Other community-based health organizations in Chicago are beginning to incorporate the model for student clinicians, she says.  

“I’m proud of the fact that … I was able to do something like participate in the Goldie’s Place dental clinic. There are so many great things going on there. Every time I hear of some success on their part it makes me happy. If it weren’t for the Dental Pipeline I wouldn’t have been able to do that. It’s meant a lot, not just for me, but for community members that really needed it.”  

Lopez continues to volunteer at Goldie’s Place, and as part of a Chicago Community Oral Health Forum project to assess the dental health needs of adults and children. The Dental Pipeline gave Lopez the opportunity to both share her hard-won knowledge in the realm of public health and to establish a meaningful career addressing the issues, she says.  

“I’m really excited that programs like this exist because they give students like me a chance to fulfill their dreams,” Lopez says. “It really does make me feel a sense of responsibility, because there was an organization that backed me, to really give back to the community in a significant way.”

Source: Insight Into Diversity 

Is something similar to the Dental Pipeline National Learning Institute happening in your area to increase the number of minorities that go in to the Nursing profession as well as offer Nursing access to undeserved populations? Comment below!

CentraState Healthcare System located in Freehold, NJ is a nonprofit community health organization consisting of an acute-care hospital, an ambulatory campus, three-senior living communities, a family medicine residency program, and a charitable foundation. Over the years, CentraState has employed multiple family members from numerous families in NJ.

In this “Focus on Diversity” issue of our bimonthly eNewsletter, we are featuring 4 members of the Santos family who work at CentraState – 3 family members have worked at CentraState for over 24 years! Joe Santos is the spokesperson for the Santos family.

Pat Magrath from DiversityNursing.com recently had the opportunity to chat with Joe Santos, RN and Unit Manager at CentraState’s Manor Rehab Healthcare Center. Joe said “every day is a different day working in the Rehab Center. My patience is tested daily and I love it”.

Joe grew up in the Philippines and while living there, Joe’s father was diagnosed with cancer. Joe took care of his father. He loved taking care of him and discovered he had a passion for it. Joe was always interested in science and medicine, but medical school in the Philippines was too expensive, so he became a Mining Engineer. When Joe immigrated to the US in 1989, no one needed his mining engineer skills so he went to CentraState and applied for a job as an orderly. He was hired the next day.

Joe has worked at CentraState for 24 years. While working as an orderly, he went to school and became an LPN. CentraState encouraged him to further his education and paid his tuition fees to become an RN where he is now the Unit Manager at the Manor. Over the years, Joe has been appointed Acting Director of Nursing, not once, but twice. He was happy to help out, but he was not interested in the position on a permanent basis.

Many years ago, there was a pretty lady named Evangeline living in Joe’s apartment complex. She too grew up in the Philippines and was already an RN at CentraState. They met and soon married. Evangeline has also been at CentraState for 24 years! She worked in Orthopedics for 16 years, transferred to short-stay Surgery for 2 years and currently works at the CentraState Family Medicine Center. They have 2 daughters and are expecting their first grandchild. Perhaps like their parents, they’ll be working at CentraState too!

Joe’s brother, Teodoro started working at CentraState in 1989 -- the same year as Joe and Evangeline. His career started as a cook in the hospital and 9 years ago, he became the Senior Cook at the Manor where Joe works.

Joe’s niece, Charmaine, has worked as a Patient Care Technician in the 5 North Progressive Care Unit for 6 years.

Well there you have it… 4 members of the Santos family – Joe, Evangeline, Teodoro and Charmaine... all happily and productively working at CentraState.

I had to ask… What makes CentraState such a great place to work? Joe responded… When they all immigrated to the US, they lived close to the hospital which was much smaller at the time. The convenient location and the “one big happy family” feel at the hospital, gave the Santos family a terrific opportunity for employment. They grew in their careers among genuinely friendly and caring people.

As the years have gone by, CentraState has expanded and it still feels great to be working there with talented, caring staff and family. As Joe told me, “we live in the community, work in beautiful facilities, enjoy generous benefits, and appreciate the ability to continue to grow in our careers at CentraState where we have been supported and encouraged”.

Dolores N. Napolitano, Manager of Recruitment for CentraState Healthcare System stated “we value our employees and feel like they are our family members too. When individuals who are actually blood related family work here, it makes it even more special and unique.  CentraState is their hospital in more ways than one because they live in the community and work here as well. The Santos’ are one of many multi-generational families working at CentraState and we embrace the concept and actuality of it.  It is only a part of what we do to acknowledge and support the diverse staff we have and the community that we serve".

"We welcome you and your family to visit our website http://www.centrastate.com/Careers/Nursing-Career-Information and check out our job opportunities.”

By Shantelle Coe RN BSN - Diversity and Inclusion Consultant

Creating an environment that embraces diversity and equality not only attracts the most qualified nursing candidates, but an inclusive environment also helps to assure that the standards of nursing care include “cultural competency.”  Cultural differences can affect patient assessment, teaching and patient outcomes, as well as overall patient compliance.

Lack of cultural competence is oftentimes a barrier to effective communication amongst interdisciplinary teams, which can often trickle down to patients and their families.

With the increase in global mobility of people, the patient population has become more ethnically diverse, while the nursing forces remain virtually unchanged.  Nursing staff work with patients from different cultural backgrounds.  Consequently, one of the challenges facing nurses is the provision of care to culturally diverse patients.  Hospitals and healthcare agencies must accommodate these needs by initiating diversity management and leadership practices.

According to Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989); these are the 5 essential elements that contribute to an institutions ability to become more culturally competent:

• Valuing diversity

• Having the capacity for cultural self-assessment.

• Being conscious of the dynamics inherent when cultures interact.

• Having institutionalized cultural knowledge.

• Having developed adaptations of service delivery reflecting an understanding of  cultural diversity. 

A culturally competent organization incorporates these elements in the structures, policies and services it provides, and should be a part of its overall vision.

From all levels, the nursing workforce should reflect the diversity of the population that it serves.  A more diverse workforce will push for better care of underserved groups.  It’s important to note that that diversity, inclusion, and cultural awareness isn't just about race or ethnicity.  We must always keep in mind socioeconomic status, gender, and disability in our awareness.

Becoming more inclusive is a shared responsibility between nurses and healthcare agencies.  Becoming an “agent of change” within your facility can inspire awareness and affect attitudes and perceptions amongst your peers. 

Nurses and healthcare workers must not rely fully on the hospital and healthcare systems to institute an environment of cultural awareness.   

Nurses can increase their own cultural competencies by following a few guidelines:                                   

• Recognizing cultural differences and the diversity in our population.

• Building your own self-awareness and examining your own belief systems.

• Describing and making assessments based on facts and direct observation.

• Soliciting the advice of team members with experience in diverse backgrounds.

• Sharing your experiences honestly with other team members or staff to keep communication lines open.  Acknowledging any discomfort, hesitation, or concern.

• Practicing politically correct communication at all times –  avoid making assumptions or stereotypical remarks.

• Creating a universal rule to give your time and attention when communicating.

• Refraining from making a judgment based on a personal experience or limited interaction.

• Signing up for diversity and inclusions seminars.

• Becoming involved in your agencies diversity programs – find out what your resources are - most institutions have something in place.

By incorporating a few of these steps into your daily nursing practice, you are taking steps towards becoming culturally competent.

Inclusive nurses demonstrate that we are not only clinically proficient and culturally competent, but are the essence and spirit of the patients that we care for.

By Christina Orlovsky, senior writer, and Karen Siroky, RN, MSN, contributor

As the nation’s population becomes more diverse, so do the needs of the patient population that enters U.S. hospitals. As caregivers with direct contact with patients from a wide spectrum of races, ethnicities and religions, nurses need to be aware and respectful of the varying needs and beliefs of all of their patients.

In its position statement on cultural diversity in nursing practice, the American Nurses Association (ANA) states that: “Knowledge of cultural diversity is vital at all levels of nursing practice…nurses need to understand: how cultural groups understand life processes; how cultural groups define health and illness; what cultural groups do to maintain wellness; what cultural groups believe to be the causes of illness; how healers cure and care for members of cultural groups; and how the cultural background of the nurse influences the way in which care is delivered.”

Additionally, the Joint Commission requires that all patients have the right to care that is sensitive to, respectful of and responsive to their cultural and religious/spiritual beliefs and values. Assessment of patients includes cultural and religious practices in order to provide appropriate care to meet their special needs and to assist in determining their response to illness, treatment and participation in their health care.

There are a number of ways to comply with the requirements for providing culturally diverse care.

First, be self-aware; know how your views and behavior is affected by culture. Appreciate the dynamics of cultural differences to anticipate and respond to miscommunications. Seek understanding of your patients cultural and religious beliefs and values systems. Determine their degree of compliance with their religion/culture, and do not assume.

Furthermore, respond to patients’ special needs, which may include food preferences, visitors, gender of health care workers, medical care preferences, rituals, gender roles, eye contact and communication style, authority and decision making, alternative therapies, prayer practices and beliefs about organ or tissue donation.

Kathleen Hanson, Ph.D., MN, associate professor and interim executive associate dean for academic affairs at the University of Iowa, summarized the importance of learning cultural diversity in nursing education.

“Cultural competency is threaded throughout the nursing school curriculum. We teach every course with the idea that there’s content that may need to be explained for a diverse student group,” Hanson said. “In nursing, cultural competency has been around for a long time. I think that’s probably something that the nursing profession recognized maybe a bit before some other disciplines. We’ve always worked in public health, so we have always seen the diversity of America.”

Hanson concluded: “We need to be able to care for diverse populations because our country is growing increasingly diverse. Oftentimes persons who are in minority groups or who are underrepresented have different health care needs. It’s important for us to have a student population that is as equally diverse as our client; we need to prepare a workforce that not only knows how to work with diverse peoples, but also represents them.”