Personal Awareness of Cultural Bias in Social and Cultural Diversity

Cultural bias implies an emphasized distinction or preferential status that indicates a predilection for one culture, over another. It is often discriminative, and is characterized by an absence of integration in a group, in terms of social principles, codes of conduct, and beliefs. Cultural partisanship introduces the accepted behaviors of one group as superior, and more valued, than those of another lesser-respected cultural group. In my surroundings, most of the residents, and hence, patients are white, making us (Afro-Americans and Asians) minorities, feel different if not isolated. Such deferential factors are responsible for establishing where specific individuals live, and what opportunities are available to them, in the healthcare and educational context (Sue et al., 2009)

Question 2

The presence of cultural bias within the context of healthcare-related recommendations and decision-making gives rise to significant challenges. Well-documented inequalities in health status of different racial and ethnic communities, in addition to nationally-publicized research works on the topic disclose that services in mental health were not available, accessible, or delivered adequately to racial/ethnic minorities. Cultural bias also results in challenges relating to ethnic/racial minorities being delivered inferior quality healthcare in comparison to non-minorities, lesser care access, and lesser likelihood of receiving advanced, effective therapy. Intervention-, therapist-, and client- related factors potentially influences who will most likely profit from particular culturally-adapted healthcare interventions. For instance, cultural competency techniques will likely have greater significance when dealing with un-acculturated, rather than acculturated, clients from ethnic minority groups. We have observed a Greek caregiver having better proximity and easier rapport with a Greek patient leading to better deliverance and acceptance of services even if caregivers of other ethnicities (specifically, white) had better skills. Cultural/ethnic and individual differences must be regarded with respect to the nature of content and delivery style of intervention. Even after decades and generations of Africans living in America, we face discrimination and prejudice in public health and services quite commonly. Inequalities are present due to service inadequacies, and not any potential differences concerning access-connected factors (e.g., insurance status) or the requirement for services. The focus on race and ethnicity is in response to several centuries of inattentiveness towards, and ethnocentrism against, the significance of minority status and culture. Cultural ideals of spirituality and interdependence, and bias in ethnic minorities' psychotherapy, are usually overlooked in therapeutic approaches to clients hailing from ethnic minority communities. In an initiative for rape prevention that had numerous African-American participants, culture was found to affect treatment interventions involving girls, youngsters, and adult African-American patients who had integrated values of harmony, spirituality, oral tradition, collective responsibility, experiences, and holistic approach with racial socialization, communal/interpersonal orientation, discrimination and prejudice, witnessed often in the worldviews of African-Americans (Sue et al., 2009).

Question 3

A comparison of interaction with culturally-different individuals and with people belonging to the same culture reveals that several leading healthcare groups are, of late, demanding cultural competence and the presence of personnel who are culturally-competent, in the healthcare sector. Cultural competency demands arose from issues faced by ethnic minorities (African-Americans, Native Alaskans, American Indians, Hispanics, and Asian-Americans). Such concerns arose because of increasing cultural diversity in the U.S. population, necessitating transformations in the system of mental healthcare, for meeting the different requirements of a multicultural society (Sue et al., 2009).

Statistically significant disparities appear in different ethnic/racial communities' socioeconomic status. There is a greater tendency of not completing high school, as well as having a household income that was below, or at, the federal poverty level, among Hispanics and African-Americans than among Asian and White communities. Racial disparities were also witnessed in the area of self-rated well-being; 22% of Hispanics and 17.2% African-Americans reported poor to fair perceived health status, as against merely 14.4% White respondents and 12.5% Asians. However, concerning nativity status and primary language -- African-Americans and Whites are more likely to report the U.S. as their birthplace and their first language as English, than Asians and Hispanics (Johnson et al., 2004).

Question 4

I have experienced that disparities based on race were not completely explained by disparities in care source, health status, demographics, health literacy, or provider-patient communication, among different racial groups. The degree of probabilities was diminished for ethnic/racial minority communities compared to Whites in regard to cultural competence deficits and perceptions of bias in the health system; they were all, however, statistically significant in case of Asians, African-Americans, and Hispanics, when compared to whites. Moreover, language-linked bias perception continued to be statistically significant in analyses controlled for mother language or foreign birth, as well (Johnson et al., 2004).

Part 2

Question 1

Discrimination is perceived, but appears more to do with jealousy, or a feeling of disconnect with what different individuals see in other people, thus eliciting negative treatment and judgment. Subtle racism, here, denotes understated, common forms of bias (e.g., treating differently, ignoring, or ridiculing). The aim must be to create awareness and educate people regarding subtle racism, to abolish it from the world. The malice of racism must not be overlooked, irrespective of whether it is overt or understated, small or big. The issue has no place excuses -- one understands clearly when an individual is showing racist attitudes, as well as whether it was deliberate or unintentional. In many instances, however, people's ignorance about cultural customs is mistaken for subtle racist attitudes. Some individuals are totally unaware, and so can be excused -- all they need to do is: learn and get going. Sociological descriptions of racism are inclined to focus on contemporary life's dynamics and structures that foster hierarchies of disparity and discrimination. By doing so, sociologists typically fail to concentrate on the reason behind emergence of race-based hatred (as against how it manifests), and to explain the reason for its potentially volatile and instinctual nature. Combining psychoanalytic tools and ideas with sociological approaches helps provide an accessible, clear-cut, and stimulating synthesis of various theories, with the goal of exploring the complex nature of bias, marginalization, and racism in modern times (Clarke, 2003).

Question 2

1) Traditional racism is manifested through attitudes like White supremacy, racial segregation, and the inferiority of ethnic minorities. These obvious forms of race-based hatred are now intolerable in Western society. Consequently, society has replaced overt racism with another form of racism, in which racist attitudes are indirect and subtle (contemporary racism). The assumption in this modern form of racist behavior is that ethnic minority communities violate key values (e.g., self-sufficiency, compliance and self-control), and have illegitimate demands for economic or political power.

2) Just like racial bias, gender-based bias, too, has undergone a change since traditional sexism. Traditional gender bias endorsed age-old gender roles, stereotypes pertaining to lesser female ability, and differential conduct towards males and females. Modern sexism, on the other hand, is typified by resentment towards female demands, denial of prejudice, and absence of backing for policies aimed at helping women. In the course of this parallel development, sexism and racism have been interrelated for a long time (Fernandez et al., 2001).

Part 3

Question 1 (a)

The ethical codes of the National Association of Alcoholism and Drug Abuse Counselors (NAADAC) and the American Counseling Association (ACA) share many common elements. The central element, however, in the codes of both organizations, is proper client/patient treatment. ACA's ethical code has five major goals: 1) Clearly spelling out the ethical duties of counselors; 2) Supporting ACA's mission; 3) Instituting ethical conduct principles for guidance; 4) Serving the profession and clients; and 5) Processing ethical inquiries and complaints lodged against members. The code offers justice, integrity, and respect. Counseling entails strictly abiding by the values of honesty and precision. Just and fair treatment of every patient is extremely critical in the counseling profession. Counselors need to respect every client's worth and dignity. The NAADAC code, on the other hand, includes nine provisions addressing a broad range of responsibilities -- patient welfare, provider-patient relationships, non-discrimination, trustworthiness, duties and rights, adherence to law, dual relationships (patient non-exploitation), responsibility of care (guaranteeing a safe workplace setting) and prevention of harm. NAADAC and ACA members share several similar obligations. The most crucial of these common obligations is, perhaps, that counselors need to refrain from imposing personal values on their clients, and employ impartiality and integrity. In other words, counselor should demonstrate an unconditional respect for individual clients, their personal views, and their unique backgrounds (Roskoski, n.d).

Question 2

Owing to demographic changes and ethnic minorities' demand for being treated justly and enjoying equal opportunities to participate in every aspect of a multicultural society, focus is now on development of appropriate and adequate clinical facilities for these groups. Ethnicity and culture's role is a progressively common aspect considered by clinicians hailing from different theoretical orientations. Therapeutic models attending to minority issues, ethnicity, and culture have been developed, which work well for therapists possessing cultural sensitivity.

Treatment-related studies, however, have failed to keep pace with the abovementioned clinical developments. A majority of treatment-linked studies on children and adult patients cannot be generalized to ethnic minorities. The basic issue of generalizability firmly supports treatment studies and must be assessed from the initial stages of problem conceptualization, design, selection of sample, data collection, and measurement, and also in treatment formulation and delivery. Furthermore, scant efforts are currently carried out for developing and testing interventions that are culturally-informed. There is an evident need for ecological validity in treatment research.

Thus, two key aims are identified: providing a culturally-sensitive approach to research of treatment outcome as a source to enhance treatment research's ecological validity; and presenting a primary framework to develop culturally-sensitive treatment interventions contributing to strengthening treatment outcome research's ecological validity with Latinos. Though the focus is on a distinct ethnic group, Latinos or Hispanics, the problems raised, along with the proposed framework, are relevant in case of other cultural and ethnic groups as well (Bernal et al., 1995).

Question 3

In terms of communication style, cultures are categorized into low context and high context cultures, for comprehending the fundamental differences in their cultural issues and communication styles. Style of communication implies how individuals express themselves, along with 'typical' communication patterns. The communication style of high context cultural groups is shaped by close human relationships, strong standards of behavior, and well-organized social hierarchy. Internal connotation is often entrenched in information conveyed by individuals of this cultural category, and thus, not every aspect is explicitly declared in spoken or written communication. Listeners are required to uncover the implied meaning of a statement and grasp the unsaid using their background knowledge. In high-context messages or other forms of communication, much of information is internalized in individuals or is in a physical context; the messages transmitted, coded or explicit component holds very little information. Individuals in high-context societies tend to talk linearly one after the other, and hence, speakers are rarely interrupted. The nature of communication is low-key, indirect, distant, vague, and agreeable, and there is placement of greater confidence in nonverbal communication, as compared to verbal communication. On the other hand, meanings in low-context societies are explicit. Individuals anticipate an explanation if any aspect of the conversation is ambiguous, and expect all information to reside in the message transmitted, for making up for anything the context misses (external as well as internal). Communication style in low-context cultures is linear, direct, dramatic, open, precise, and founded on true motives or feelings, accompanied by a steady, and at times, non-stop application of words (Nishimura et al., 2008).

Question 4

Different rapport development tactics should be applied, on the basis of client culture. For physical therapists, cultural competency is vital for each of the five aspects of client/patient management: diagnosis, examination, prognosis, evaluation, and intervention. Building rapport, gathering and integrating client information, identifying personal concerns regarding function, and coming up with a care plan for individual patients, necessitates cultural competence. Physical therapists, faced with a broad range of functional limitations, disabilities, and impairments, are required to take care of patient needs within individual patients' context, as well as that of their community, their families, and the general cultural setting. An analysis of information on certain unique traits linked to different cultural groups can help physical therapists understand, and tailor provider-patient interactions as well as the rehab facility offered by them for creating the best possible care plan. Grasping the cultural concept is crucial to comprehend cultural competence (Leavitt, 2002).

Question 5

Bias in individual healthcare providers' actions and beliefs has garnered the greatest level of attention. Other instances when bias takes place in a clinical setting include: development of groundless assumptions into normative beliefs that members of treatment facilities or practitioner networks begin sharing; and authorities' and community members' distinct intolerance of mentally-ill people from minority groups and differential enforcement of conformity standards of tolerable behavior. Practice styles represent local rules that govern diagnosis and treatment. They indicate shared understandings regarding the way clinical decision-making must occur over the vast range of options available to healthcare providers. Practice styles ensue because, during informal interactions, individuals develop common perceptions of managing uncertainty. Further, organizational culture denotes shared and typically implicit understandings about objectives and procedures. Scholars have measured inter-organizational cultural difference dimensions: quality emphasis, care coordination, performance goals, conflict resolution, and communication (Snowden, 2003). Counselors who are culturally competent must focus on and strive to eliminate discriminatory practices, biases, and prejudices. They must be familiar with sociopolitical contexts when performing evaluations and offering interventions, and must be sensitive to issues like racism, sexism, oppression, and elitism. Culturally competent counselors must assume the responsibility of educating clients with regard to psychological intervention processes, like aims, expectations, orientation of counselor, and legal rights (Sue, 1992).