+

African Americans
Cultural Presentation NUR 300
Dr. Karen Roush

Dhondup Dolma
Ayo Oguntoye
Akem Agbere
Kwaku Baidoo
Jana Wilson

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Definition of African American?

African Holocaust 16th to 19th centuries The Middle

Passage

A New Ethnicity fusion of cultures including traditional

African, European, Native American

New Generation African Americans

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Institute of Medicine Report
(IOM)

Commissioned by Congress, 2002. Report showed

pervasive racial and ethnic disparities in health care.

Identified a national context of social and economic

inequality, as well as persistent discrimination based
on race or ethnicity.

Influence of bias, stereotyping, prejudice, and clinical

uncertainty on the part of health care providers.

Nursing Implication: nurses must be aware of cultural

and financial barriers to health care for racial and
ethnic minorities.

(Watts, 2003)

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Diversity Within the Black
Community

Prevailing assumptions regard the Black population as

a monolithic entity that is largely poor and
undereducated. Such stereotypes obscure the vast
heterogeneity that characterizes this population
(Baytops, Patton, & Day-Vines, 2003).

Nurses must remember this diversity and approach

their clients as individuals, whose norms and values
may not be what is expected.

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African American Culture

May be distrustful of government & social services

Knowledge of Tuskegee Experiment (Carteret, 2011)

U.S. Public Health Service conducted the Tuskegee Study of

Untreated Syphilis in the Negro Male, 1932

399 men with syphilis, no informed consent, 40 years

Lack of ethical standards, no treatments given, some men

died, wives contracted the disease, children born with
congenital syphilis

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African American Culture &
Society
Impact of poverty on education, self-esteem, quality of
life and lifestyle - across the lifespan

Strong sense of pride may not admit when they need

help

Seniors very respected age represents respect,

authority and wisdom

Lack of knowledge about available services and how

the system works

Politically overwhelmingly Democratic

Social problems: racial profiling, judicial system,

poverty, institutional racism, less access to health care

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African American Kinship

Strong family bonds, adaptable family roles

Social and emotional support, take care of their own

Older family members pass on social and cultural traditions

Broader concept of who is considered family- fictive kin

Grandparents may provide childcare

May use more authoritarian styles of discipline for children

Informal support network church, community collectivist

Nursing Implication:

Importance of family fictive or not

Spirituality used to process & reconcile death

Funeral services may be seen as homecomings going home

to the afterlife (Carteret, 2011)

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Fictive Kinship vs. Mainstream
American

Fictive Kinship networks: collective over the

individual, kinship and affiliation, extended families,
spirituality, connectedness, harmony with nature, and
holistic thinking

Mainstream American culture: individualism,

achievement, success, competition, material
accumulation, nuclear families, religion distinct from other
parts of culture, mastery over nature

Nursing Implication: African Americans in the middle class

are more likely to adopt values that come from both
African American and mainstream American cultural
perspectives

(Baytops et al., 2003)

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Religion & Philosophy

African Americans may have strong religious

affiliations, often Protestant

Many African Americans are Muslim today about 1/3

of Sunni mosque attendees are African American

150,000 African Americans in the U.S. practice Judaism

this number is growing

Nursing Implication:

Rather than a direct question about religion, ask a client

where they turn for support in times of need

Learn how a clients faith may affect their behavior and

ideas about health (Carteret, 2011)

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Miscegenation

Miscegenation marriage or sexual relations between

individuals of different races

The politics of hair and skin color stems back to slavery

and the practice of miscegenation, when slave masters
accorded preferential treatment and status to their bi-racial
offspring who usually had lighter skin and straighter hair
textures (Okazawa-Rey, Robinson, & Ward, 1987). Following
the demise of slavery, African Americans continued to assign
greater value to individuals who approximated a White
European aesthetic. Even today, many African American
youngsters endure teasing and ridicule because of their
appearance, especially individuals who lie at either extreme
along the skin color and hair texture continuum (Baytops et
al., 2003).

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In Conclusion

There is an underlying fabric of racism and bias in the

United States.

Nurses, and all health care providers, must work

actively to change this.

African Americans are a unique ethnicity, of mixed and

varied heritages. Approach clients as individuals, they
may not conform to generally held cultural ideas about
the group.

Be cautious of your own bias.

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References & More Info

Baytops, J.L., Patton, J.M., & Day-Vines, N.L.. (2003) Counseling African
American adolescents: the impact of race, culture, and middle class
status. Professional School Counseling, 7(1), 40-51.
http://isites.harvard.edu/fs/docs/icb.topic545403.files/Day%20Vines%20e
t%
20al.pdf

Carteret, M. (2011). Health care for African American patients/families.

Dimensions of Culture (posted under category African American Culture).
Retrieved from http://www.dimensionsofculture.com/2011/05/health-carefor-african-american-patientsfamilies/

Watts, R.J. (2003). Race consciousness and the health of African

Americans. Online Journal of Issues in Nursing, 8(1), Manuscript 3.

http
://www.gourmet.com/magazine/2000s/2009/03/politics-of-the-plate-the-pric
e-oftomatoes

http://www.ushistory.org/us/6g.asp

http://www.nj-ptc.org/training/materials/Rutgers/SSW_SchoolSocWkrs/Cult
uralImpact%

DISPARITY IN THE EDUCATIONAL SYSTEM:

Despite unprecedented efforts to improve minority

education in the past decade, ethnic disparities in
education still exist.

African Americans greatly out-number Caucasians in

special education classes, in-school suspension and
remedial classes. This same group of students are
nearly non-existent on the class rosters of advanced
level courses, in which Caucasians tend to dominate
(Franklin, Waukechon and Timmer, 1995)

+DISPARITY IN THE EDUCATIONAL SYSTEM CONTINUED:

Some of the reasons for these disparities include:

Schools that have predominantly black populations often

lack the necessary educational resources and qualified
teachers that can be easily found at predominantly
white schools and there is under-representation of
minority students in gifted programs (Tatum, 2005).

More black children live in poverty, which is linked to

array of problems, low birth weight, exposure to lead
poisoning, too much TV watching, too little reading at
home, less involvement by parents and frequent school
changing

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ECONOMIC ACTIVITY:

African American economic conditions continue to lag

behind mainstream populations, particularly European
Americans.

A disproportionate number of African-Americans are poor

and impoverished or one pay check away from poverty.

For many African-Americans, the last 25 years have been

a history of lost jobs and low wages (Darity and Mason,
1998)

A large wealth gap persists between African Americans

and other racial groups even at the same educational,
income and occupational levels.

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AFRICAN AMERICANS AND THE
POLITICAL SYSTEM:

For a large part of U.S. history, African-Americans

voters saw themselves as being disenfranchised either
directly or through political practices.

Even today, the average participation of AfricanAmerican voters is lower than other ethnic groups,
even though there is a great variety within these voting
patterns.

Most Africa- Americans still perceive much greater

constraints on their political freedom than other ethnic
group.

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AFRICAN AMERICANS AND
HEALTHCARE DELIVERY:

Despite improvement, differences persist in healthcare

quality among racial and ethnic minorities. People in
low income families experience poorer quality care.

According to the 2010 population census, blacks people

received poorer health care compared to the other
ethnic group in 41% of quality measures.

BARRIERS TO ACCESS QUALITY

HEALTH CARE:
Health Insurance Status:
In 2009, African Americans under age 65 were less likely
than the other ethnic group to have health insurance
(81% compared with 83%).
In 2009, the percentage of people ages 25-64 with health
insurance was about one-third lower for people with less
than a high school education than for people with at least
some college education (56% compared with 88%).

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SPECIFIC SOURCE OF ONGOING
CARE:

In 2009, the percentage of people with a specific

source of ongoing care was lower for African -America
than for other ethnic group (85% compared with 86%.

In 2009, the percentage of people with a specific

source of ongoing care was significantly lower for poor
and low-income people than for high-income people
(78% and 80%, respectively, compared with 92%)

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CONCLUSION:

Areas where disparities are worsening between African Americans

and other ethnic groups and between poor and high-income
populations:

Maternal deaths in black population.

Breast cancer diagnosed at advanced stage per 100,000 women age

40 and over in black population.

Children 0-40 pounds for whom a health provider gave advice about
using car safety seats in Asian population.

Adults age 50 and over who ever received a colonoscopy,

sigmoidoscopy, or proctoscopy in AI/AN population and in poor
population.

People with difficulty contacting their usual source of care over the
telephone in AI/AN population.

Poor adults who did not have problems seeing a specialist they needed
to see in the last year.

Poor people without a usual source of care who indicated a financial or

insurance reason for not having a source of care.

REFERENCES

Disparities in Healthcare Quality Among Racial and Ethnic

Groups: Selected Findings from the 2011 National Healthcare
Quality and Disparities Reports. Fact Sheet. AHRQ Publication
No. 12-0006-1-EF, September 2012. Agency for Healthcare
Research and Quality, Rockville, MD.
http://www.ahrq.gov/qual/nhqrdr11/nhqrdrminority11.htm

Franklin, C., Waukechon, J., Larney, P.S., Timmer, D.F.,

Pennekamp, M. (1995). Indian Magnet School: Culturally
relevant school programs for American Indian children and
families. Social Work in Education, 17 (3), 183-193

Tatum, A.W. (2005). Teaching reading to black adolescent

males: Closing the achievement gap. Portland, ME: Stenhouse
Publishers

HEALTH BELIEFS OF
AFRICAN AMERICANS
Akem Agbere

Culture of African
Americans

African Americans are the second largest

minority group in the United States

Compose more than 10 percent of the total U.S.

population

Sensitivity on Health

African Americans reflect cultural roots that

include elements of African healing
-Anatomical folklore
-West Indies Voodoo religion
-Fundamentalist Christianity
Directly or indirectly influence health care
behavior

Folk Beliefs

Connection between the human body and the

forces of nature
-Dates
-Zodiac signs
-Numbers

Folk Beliefs
(continued)

The Farmer's Almanac

Used by many African Americans and Whites in
the South
The phases of the moon
The position of the planets
The seasons of the year and natural phenomena

Folk Healers

Spiritual healers
Grannies, herbalists, and physicians
Supernatural healers
Folk healing methods
Hypnosis for hexed believed people

HEALTH PRACTICES

DHONDUP DOLMA

DEMOGRAPHICS
In 2012, the population of African Americans
was estimated at 44.5 million, making up 14.2%
of the total U.S. population.
The US Census Bureau projects that by the year
2060, there will be 77.4 million African
Americans making up 18.6 % of the total U.S.
population
Source:
http://www.cdc.gov/minorityhealth/populations/remp/black.html

Insurance Coverage
In 2012, 50.4 percent of African-Americans in
comparison to 74.4 percent of non-Hispanic
whites used private health insurance.

In 2012, 40.6 percent of African-Americans in

comparison to 29.3 percent of non-Hispanic
whites relied on Medicaid, public health
insurance.

Finally, 17.2 percent of African-Americans in

comparison to 10.4 percent of non-Hispanic
whites were uninsured.

African American Health

Practices
Distrust with American health care system therefore issue
of noncompliance

Less likely to use preventive health services

Delays seeking treatment for serious disease which
results in a poorer prognosis and fewer more expensive
treatment options

African Americans use emergency departments as a

major health care resource

They tend to rely on informal helping networks in the

community particularly those associated with church until
problem becomes crisis.

Health Risks
Hypertension morbidity and mortality rates are three to five times higher
than for whites.

Diabetes is 33 percent more prevalent than in whites.

African Americans have a higher rate of coronary heart disease than
whites.

Cancer remains a major health problem.

Greater risk for HIV and AIDS
Sickle cell anemia is a genetically inherited disorder found almost
exclusively in African Americans.

Lactose intolerance is common in African Americans

Adolescent pregnancy
LEADING CAUSE OF DEATH ARE HEART DISEASE, CANCER AND STROKE

Historical influence on health

practice
Health practices are influenced by history
Develop their own healing traditions using
readily available resources- herbs, stones, roots

HEALTH PRACTICES
African American church participation and health
care practices
Churches are central places in the lives of many
African Americans
Religious participation and religiousness are
related to improvement in quality of life indicators
Optimistic life orientation
Greater perceived social support
Improved life satisfaction
Higher resilience to stress
Lower levels of anxiety

AFRICAN HEALING- Healing

power is a gift from God
Grannies, herbalist and physician: They have the lowest
status because of the belief that anyone may learn a
healing trade

Spiritual healers: Higher in status. Profound religious

experience involve prayer, laying on of hands, and the
use of holy oil or holy water with supernatural powers.

Supernatural Healers: These are the healers of highest

status, generally called sorcerers, voodooists, or root
doctors. Believed to have been selected by God at birth.
The bones are linked to physical attributes or body
parts; the patient arranges the bones on the floor and
the healer interprets the arrangement.

Implications for Nursing

Behaviors/Interventions
Recognize the presence of many individual and
subgroup variations

Building a relationship based on trust crucial

Encourage family involvement by engaging
extended family system, particularly
grandmothers in providing support and health
teaching

Alternative modes of healing may include herbs,

and prayers

References
Carteret, M. (2011, January 1). Health Care for African American Patients/Families |
Dimensions of Culture. Retrieved October 19, 2014, from
http://www.dimensionsofculture.com/wp-content/uploads/2011/05/Cross-cultural-Ne
ws-African-American-Health2.
pdf

Arnold, E. & Boggs, K. (2011). Interpersonal relationships: Professional

communication skills for nurses (6th ed.). Philadelphia: W.B. Saunders Co

Aaron, K., Levine, D., & Burstin, H. (2003, January 1). African American Church
Participation and Health Care African American Church Participation and Health
Care Practices. Retrieved October 19, 2014, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494942/pdf/jgi_20936.pdf

Nutritional Practices
Disclaimer: the following may not
represent all African Americans. The
word African American refers to
black people in the U.S whose
sociocultural roots are rooted in the
North American experience. This is
different from new generation
Americans. Nurses beware.

Soul Food

http://www.itvs.org/films/soul-food-junkies

History of African
American Cuisine
The word soul food originated in the 60s.
Influenced by European, African , and native
American culture

Originated in the south (slavery era)

Consisted of:
Discarded meat
New kinds of greens
New recipes for native crops

Dietary value of Soul food

High starch
High fat content
High cholesterol
High calories

Potential health problems

High Blood pressure
Diabetes
Atherosclerosis
Stroke
Heart attack
Memory problems

Factors affecting
nutritional choices
Lifestyle
Environment
Living distance from suitable healthy choices

Culture

Positive
trends

Implications for Nursing

Intervention
Do not make assumptions based on group
affiliation

See the individual in every encounter

Explore nutritional alternatives with clients
Educate
Advocate
Be a role model

Group the Following into Healthy

or Unhealthy Choices
Watermelon vs Iced tea
Collard greens vs Mac n cheese
Peach cobbler vs fresh peaches
Candied yams vs steamed sweet potato
Brisket vs smoked turkey
Fried chicken vs baked chicken
Table salt vs sea salt
Sugar vs honey

Benefits of making
healthy choices
Watermelon: Excellent thirst quencher. Lower in
sugar

Collard greens: High in minerals, fiber, and

phytonutrients (linked to prevention of ovarian
and breast cancer)

Steamed sweet potato: Beta carotene, trace

elements. Anti diabetic food.

Black eyed peas: High in protein and fiber

Lifestyle/Social Patterns

https://www.youtube.com/watch?v=7U-et8qOXLs

Family Structure
Father and mother present
Mother as bread winner
Extended family

Theories
Poverty
Decline in black marriage
Rise in divorce rates
Fathers MIA Issue of serial fatherhood

Impact of Lifestyle
Hygiene
Physical fitness
Diet Regulation

Consequences of excessive TV watching?

African Americans account for 87% of total U.S retail

spending
Influenced by targeted advertising and TV programs
Highest consumer of health and beauty product

Potential Problems for

children
Lack of discipline
Apathy and antisocial behavior
Helplessness and frustration
Low self esteem

Strengths
Black women report highest increase in per
capita income

Strong religious orientation

Extended family
Motivation to work hard
Strength and athleticism
Big brother

Implications for Nursing

Intervention
Cultural awareness
Counseling
Advocacy