Essentials of Cultural Competence in Pharmacy Practice: Chapter 5 Notes Chapter Author: Dr. Kristina A. Peterson African American Patients.

Essentials of Cultural Competence in Pharmacy Practice: Chapter 5 Notes

Chapter Author: Dr. Kristina A. Peterson

African American Patients

Learning Objectives1. Articulate the discrimination and

environmental racism faced by African Americans

2. Recognize the health disparities and socioeconomic barriers that may impact African American patients

3. Specify the health care disparities that may affect African American patients

4. Identify strategies for working with extended and fictive family members that may be present in the procurement of pharmacy care

IntroductionCensus figuresHistory of African Americans in the United

States. Jim Crow laws in the South, racial segregation,

and discrimination. The Civil Rights Movement. The legacy of slavery and racism.

LanguageUntil the mid 1960’s the terms Negro or

Colored were widely used to describe African Americans.

Those terms are now considered derogatory. Some also criticize the term African American,

preferring to refer to themselves as “Black” or “a person of color.”

Black or African American citizens are classified as a person having origins in any of the black racial groups of Africa.

Communication StylesGenerally, more dramatic and expressive in

their speech and language patterns than are members of the dominant culture.

Communication also tends to be more people oriented than topic or object oriented.

More outwardly affectionate as well as more direct and assertive during argumentation.

Some may engage in the use of African American vernacular English or what is commonly known as Ebonics.

Cultural inversionWays of dressing, speaking, and acting that

unify them as a collective while they subtly oppose dominant culture expectations of them.

Family Roles/OrganizationHigh value is placed on familial relationships and tends

to include extended family. Elders may play a key role in family and community

systems. Fictive kinship relationships are also common and

involve people who are called family even when no biological relationship exists.

Increase in the number of births to unmarried women. A significant increase in the number of female-headed

households, which are associated with high rates of poverty and economic instability.

More than 50% of black children live in households with only one parent – mostly their mother.

Nearly 44% of African American preschoolers live in households with less than $10,000 annual income.

Legal ConcernsLegal issues involving African American men

are a possible contributing factor to the increase in female-headed African American families.

1995 study by the Sentencing Project on drug-related crimes

These disparities could be related to racism and discrimination or to classism and higher rates of poverty among African Americans.

African American children in foster care

Socioeconomic IssuesAnnual median income for African American

householdsChildhood povertyExposure of African American children to

violence

Workforce IssuesThe unemployment rate for African Americans

nationwide The median weekly wage Jobs held by African AmericansHigh value on education as a way to achieve

personal and family goals. High school and college graduation rates

Healthcare PracticesNearly one third of African Americans do

not have a regular doctor. Many use the hospital emergency room as

their primary health care provider and only seek services when they are sick or hurt.

Close to 1.8 million African American children in the United States do not have health insurance.

Health DisparitiesInfant mortalityAIDSKidney disease, septicemia, diabetes,

stroke and heart diseaseHypertension

Infant MortalityAfrican American infant mortality rates

compared with that of the dominant culture. Black infant deaths in first year of life

compared with white infants Contributing factors of infant mortality.

AIDSAIDS is five times as deadly for young African

Americans age 25-44 as for their dominant culture counterparts.

Proportion of new HIV infections in the United States that are in African Americans

AIDS rate in black women compared with white women.

Other Health DisparitiesHigh death rates from kidney disease,

septicemia, and diabetes, stroke and heart disease, asthma, and prostate cancer.

Hypertension in African Americans. Overweight

NutritionHalf of all black neighborhoods lack access to a

full-service grocery store or supermarket. 32 percent increase in the consumption of

fresh fruits and vegetables when there is a supermarket located in a community.

50 percent of African American adults do not exercise on a regular basis.

Although some of the poor health statistics have been attributed to lifestyle – higher incidence of intravenous drug use, smoking, and obesity – there is another culprit in the inequities of medical treatment.

Environmental RacismThe lack of adequate medical care for poor and

lower middle class African Americans greatly increases the number of deaths by disease.

Effect of environmental racism on the health of African Americans.

71 percent of African American families live in counties that violate federal air pollution standards.

Folk Medicine & Home RemediesMany African American people will attempt to

alleviate medical conditions with home remedies or folk medicine.

An important factor to consider in practicing pharmacy.

Pharmacists should ask patients about any remedies they may be trying at home.

Reflection Questions1. How would you address environmental

racism if it were to occur in a pharmacy practice setting?

2. As a pharmacist, how will you work with African American patients to mitigate known health disparities and socioeconomic barriers?

3. How will you utilize the information contained in this chapter to inform your practice?