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Increasing the cultural competence of health care providers serving Minnesota's diverse populations
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Common health equity issues for African-Americans populations
Cultural competence is the ability to recognize and understand the role culture plays in health care and to adapt care strategies to meet patient needs.
Get to know patients on an individual level. Each person’s preferences, practices, and health outcomes are shaped by many factors. Generalizations in this material may not apply to your patients.
Blacks are the third-largest racial group in Minnesota—at 5.8% of the population.
African Americans in Minnesota
Minnesota is home to more than 317,130 people who identify as African American. At 5.8 percent of the state’s population, African Americans are the third-largest racial group in Minnesota and have been part of the fabric of Minnesota since the 1800s. Descendants of enslaved Black people migrated out of the South between 1916 and 1970. This shifted the population from 90 percent of all African-Americans living in the rural South to 47 percent living in the urban North and West, including Minnesota.
African Americans are people who have origins in any of the Black racial groups of Africa.
In the U.S., the Black immigrant population has increased 71 percent since 2000. Now, roughly one in 10 Blacks living in the U.S. are foreign born, up from 3 percent in 1980. In 2014, 22 percent of Minnesota’s foreign-born residents were from Africa, compared to 5 percent nationally. The top countries of origin for foreign-born African American Minnesotans include:
African American, Black?
African American and Black are used interchangeably. African Americans are people who have origins in any of the Black racial groups of Africa. The term African American used to refer to early African immigrants and descendants of enslaved Black people. As the number of African and Caribbean Blacks immigrating to the U.S. has increased, so have the chances that someone who identifies as Black or African American is a first- or second-generation immigrant.
U.S.-born African Americans speak English. 64,537 Minnesotans speak African languages at home. Of these, 27,046 (42%) describe themselves as speaking English “less than very well.” The most common African languages spoken at home in Minnesota are Cushite, Amharic, Ibo, and Kru.
African Americans in Minnesota face several disparities in health outcomes and care delivery compared to the overall population. Some health issues are biologically tied to race; many are tied to social inequities, including poverty.
More data on disparities in health and health care for African Americans:
Social determinant disparities
Social determinants of health are economic and social conditions that influence the health of people and communities. African Americans often experience race or ethnicity discrimination, which may impact housing, employment, legal status, and suffering from violence and bullying. Dealing with discrimination is associated with higher reported stress and poorer reported health.
More data on social determinants for African Americans.
Many aspects of African-American culture today reflect the culture of the general U.S. population. Generational differences impact social practices. Extended family may be an important source of support. Some African Americans designate friends and loved ones, who are not directly related, as aunts, uncles, nephews and nieces, a practice stemming from individuals being separated from blood relatives during slavery.
In 2015, Black older adults were less likely to say their home and community-based services meet all their needs and goals than White older adults.
For poorer African Americans, financial constraints often mean consuming a diet based on inexpensive fast food restaurant offerings and processed foods that are high in carbohydrates, sweeteners, and salt. Often called the “American diet,” this way of eating contributes to obesity, heart disease, and other health conditions. More than 30 percent of Black Minnesotans are obese, compared to 27.5 percent of White Minnesotans. Black older adults were more likely to skip a meal sometimes or often due to financial worries.
Numerous studies have identified a pattern of implicit bias towards African Americans in care delivery. Perception of bias can result in patients being less engaged and less likely to follow through with treatment plans and medication prescriptions.
Approximately one in five of all adults in the U.S. experiences mental illness in a given year. African Americans use mental health services at about one-half the rate of Whites. Slavery, loss of cultural practices and languages, eras of second-class legal status and substandard public education, racism, and other barriers have resulted in historical trauma for African Americans, the effects of which continue today. Carried across generations, this trauma should be considered in mental health treatment. The effects of historical trauma are being studied.
End of life
Life expectancy for African Americans continues to be lower than life expectancy for Whites. A Black child born in 2014 has a life expectancy of 72.5 years (males) or 78.5 years (females), as compared to 76.7 and 81.4 years for a White child born in the same year. African Americans have higher rates of Alzheimer’s and other dementia than Whites—some estimates are as much as 40 percent higher.
As with discussing end of life issues with any patient, health care providers need to understand preferences based on personal and family views. African Americans were found to consistently prefer the use of life support. Only 8.3 percent of hospice patients are Black—less than half the representation of Black people in the general population.
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