Transcript Document
We are What We Eat - Culture and Food
Janet Schwartz, MS. RD. LDN
June 27, 2012
"People all over the world are looking - this is human nature
- you want to find a better lifestyle for you and your children
and your family." - Lebanese immigrant, Detroit
• http://www.npr.org/templates/story/story
.php?storyId=5005952
Connections on a Personal Level
Own background
–What does it mean to you?
– When you were growing up and you caught a cold, what were you
told about why you caught cold, and how you should treat it ?
–What have you learned from encounters with other cultures ?
Geography map challenge
– www.lizardpoint.com for interactive map
www.eduplace.com/ss/maps
So, what is culture?
Think
about
–When an individual says, I am Italian American
–When we refer to the Greek culture
–When a student is from a family that follows Islam
Understanding other cultures and religions
Requires
that you understand you own cultural
beliefs and values.
How
do you know your own cultural norms?
Comparison of Some Common Values
American Values
Other Cultures’ Values
Personal control over the environment
Fate
Change
Tradition
Time dominates
Human interaction dominates
Human equality
Hierarchy/Rank/Status
Individualism/Privacy
Group Welfare
Self-help
Birthright inheritance
Competition
Cooperation
Future Oriented
Past oriented
Action/Goal oriented
‘Being’ orientation
Informality
Formality
Directness/Openness/Honesty
Indirectness/Ritual/ “face”
Practicality/Efficiency
Idealism/ Theory
Materialism
Spiritualism/Detachment
Culture determines
Cultural practices, attitudes, beliefs
–Chinese: filial piety is #1, teachers held in high regard
See the principal as able to accomplish anything
–Importance of education for children
–Status of guests in home, community, and country
Ideology and world view
–View of America in different countries
–Hmong driving test - When the Spirit Catches You , You Fall Down
–Given a photograph, North American students of European background paid
more attention to the object in the foreground of a scene, while students from
China spent more time studying the background and taking in the whole science.
Culture determines how you solve problems
Point A to Point B to Point C to Point D
Linear approach to nutrition and health intervention
Point A
Point D
Point C
Point C to Point B to Point C to Point A to Point D
Linear approach to health intervention
Culture determines how you perceive time
What is considered ‘on time.’
When does a party start?
When is an appointment?
When does a health fair begin?
Culture Determines
Behavioral
characteristics and social networks
–Importance of godparents, friends
When
and how to interact
–Health care professionals often seen as ‘outside’
–Family members have more influence
Who
is involved in addressing dietary concerns
–Samoans
–Mexicans
Culture determines
Cognitive
style or how to solve problems
Bring someone how for dinner without informing
Problems stay in the family
Prevention and self-treatments as concepts
Religious
beliefs and practices
Often provide direct advise on health
–Islam – no alcohol and drugs
–Seventh Day Adventists – same with vegetarianism
–Catholic – fast periods
–Lots more
Culture determines
Degree to which encourage or reject different emotions
–Korea: show love by doing small things
How we perform to expectations, role performance
–- Co-madres, godmothers, Godfathers, baby naming
–Role of elderly in the family and community
Language characteristics
–Tu vs Usted
–Words for relationships
No English word for the relationship bw the parents of the wife and parents of the
husband
“Only one person lives there.”
Health disparities are real
Hispanic
–Diabetes 2 X population.; Hypertension is higher
–Overweight and obesity are common in some Hispanic groups
Afro Americans (AA)
– The combined overweight and obesity rates for AA are higher than for European Americans
– In the US, 38% of African-American adults are hypertensive, compared to 29% of European
Americans.
– Diabetes among AA is substantially higher than among the majority population, and the
incidence of complications, including lower-limb amputations and end-stage renal disease is
double.
Eastern Europeans
–Diseases of the digestive system in men are more common in this population than in the majority
population.
Sub-Saharan Africans
– Lactose intolerance is common among Africans.
– Recent immigrants may be suffering from dental caries as a result of poor dental care in their
home country or increased consumption of processed foods in the United States.
Health is a cultural construct
Arises from beliefs about the nature of disease and the
human body
Cultural issues are actually central in the delivery of health
services.
Need to support a health care system (and educational
system) that responds appropriately to, and directly serves
the unique needs of populations whose cultures may be
different from the prevailing culture.
Culture defines
Kleinman, Eisenberg, and Good (1978)
the definition of health
what causes diseases
how health care information is received
how rights and protections are exercised
what is considered to be a health problem
how symptoms and concerns about the problem are
expressed
who should provide treatment for the problem
what type of treatment should be given
Kleinman’s Explanatory Model of Illness
Depending upon the situation, wording and number of question
used will vary.
What do you think has caused your problem?
Why do you think it started when it did?
What do you think your sickness does to you? How does it work?
How severe is your sickness? Will it have a short or long course?
What kinds of treatment do you think you should receive?
What re the most important results you hope to receive from this
treatment?
What are the chief problems your sickness has caused for you?
What do you fear most about your sickness?
Culture is Learned
Acculturation
– process in which we learn the beliefs, attitudes, and behaviors
of the culture
–occurs early in life and passed on through generations
–Cultures maintain institutions to acculturation children.
• Ethnocentrism
– acceptance of own value system and lifestyle as
appropriate
– failure to view alternative practices as alternatives
• Cultural relativism requires understanding
Cultural Pluralism vs. Cultural Mosaic
Cultural Pluralism
physical and spiritual
blending of all cultures
Cultural Mosaic
each cultural group stays
within itself and exists next
to other cultures
Cultural Changes
Acculturation
–
Bi- or multi- culturalism
–
adaptation to the new majority society
majority and minority cultures are seen as
complementing, not competing
Assimilation
–
cultural group sheds its ethnic identity and
fully merges into the majority culture
Culture and ethnicity
Culture
–
knowledge, traditions, beliefs and values that are
developed, learned, and shared by members of a society
–
passed down generation to generation
–
a communal group that views the world in the same way
Ethnicity
–
–
a way of living shared by a socially identifiable group
Ethnic groups may live in different cultures, adopt
elements of the dominant culture while maintaining
elements of their ethnicity.
Migration Policy Institute Accessed 12.5.11
http://www.migrationinformation.org/datahub/charts/final
.fb.shtml
Region of birth of all immigrants
(Center for Immigration Studies 2007)
60
50
40
30
20
10
0
Massachusetts 2009
Cultural influences….
what is a food and what is not a food
how food is prepared and by whom
who eats the food and with whom
how often and when foods are eaten
taste preferences
special meaning of food.
Core Foods are staple foods
Core foods
–
staple foods
–
usually maintained through assimilation
Secondary Core Foods
–
foods eaten frequently but less often than core foods
Peripheral Foods
–
foods eaten sporadically
Core Foods
Irish Americans
potatoes
Mexican Americans
tortillas, beans
Asian Americans
rice/noodles
Korean Americans
kimchi
Italian Americans
pasta, ‘gravy’
Greek Americans
lamb
Food as a Symbol
For immigrants, food is a strong
tie to identity
Symbolism in food crosses
cultural and religious groups
Pomegranates are eaten in the
Middle East and signify prosperity
Black eyed peas are eaten by
southerners to signify good
fortune in the new year
Celebrating New Year’s Eve
though Food Symbols
Americans, South black-eyed peas and collards: bring luck and money
Japanese
eat rice and long noodles for prosperity and long life
Swedes
creamy rice pudding in which a whole almond is
placed. It's lucky food for all and particularly good luck
for the one who gets the almonds
Spaniards
eat 12 grapes at the stroke of midnight, one for good
luck for each month of the year
Greeks
eat vasilopita, a cake baked with a coin insides. Extra
luck for the finder of the coin
Italians
toss old things out windows eat cotechino con lenticcie,
pork sausage served over lentils which symbolizes
abundance because the pig is rich in fat and money
because lentils are shaped like coins
Brazilians speak Portuguese, not Spanish
Food shows strong Portuguese and African influence
–Portuguese: dried salt cod, linguica (sausage) spicy meat stews
–African: okra, palm oil and peppercorns
Common foods: manioc, rice, black beans, corn, sweet potatoes, quinoa, grilled meats
Feijoda completa: cooked beans, smoked meats, sausages, rice, oranges, boiled greens,
not sauce, toasted cassava
Table manners are important
–Never eat with hands, forks and knives for pizza
–Use glass for beverages; do not drink from bottle or can
Gregarious, outgoing people, family oriented
–Opinionated and passionate; this is not anger
–Touch and maintain eye-contact
–Family and friends kiss for hello and kiss for goodbye; both cheeks
Maxixi
Passion Fruit
Codfish
Pasteis
Churrasco
Feijoada
Culture, ethnicity, and religion
Culture: knowledge, traditions,
beliefs and values that are
developed, learned, and shared by
members of a society; passed
down generation to generation
Ethnicity: a way of living shared by a socially
identifiable group
Ethnic groups may live in different cultures, adopt
elements of the dominant culture while maintaining
elements of their ethnicity.
Religion is separate from ethnicity; different ethnic
groups practice the same religion differently.
Latino Culture -Don’t offer a
tortilla to a Puerto Rican
Very family oriented – challenge to include family members to make
dietary behavior change; men may buy food
Diet traditionally includes lots of veggies and fruit, spices can replace
salt
Show pix of correct portion control – hands-on activities
Be aware of folk remedies – add on
diet to these remedies
May shun exercise – love dance
www.latinonutrition.org/
“No Come Nada”
The view that overweight babies are
healthier babies is culturally imbedded,
reinforced by friends, grandparents and
history.”
Child doesn’t eat anything = child doesn’t
eat as much as Mama would like him to –
that he doesn't eat as much as he did when
he was a hungry, rapidly growing, normal
infant.”
Richard Garcia, MD Health Affairs – Volume
23, Number 2, March/April 2004
Afro-American Culture
Very connected to church and fraternal and
sorority organizations; community
organizations VERY important – barber shops
and salons
Older members care deeply about younger
family members
Build on sisterhoods
Pray for disease – God gave the disease
Women spend money on hair and don’t want
to sweat
Need to own problem; not told this is your
problem
http://www.hsph.harvard.edu/sisterstogether/hair.pdf
Some foodways are developed from a
sense of cultural nostalgia
Corned beef
and cabbage
are not eaten in Ireland on
Saint Patrick’s Day
Fortune cookies are
found in China
not
Islam
6 million Muslims live in the U.S.
– Koran – sacred writings, words spoke by Allah to
Mohammed the prophet
– Five Pillars of Islam Faith, Prayer-5x/day, Almsgiving-sakat,
Fasting, Pilgrimage to Mecca-hadj
No priests, communicate directly to God
Mufti gives legal advice based on Koran
Imam leads prayer and delivers sermon
If can’t get to a mosque prayers are said on a prayer rug
facing Mecca
The concept of Halal in Islam
has very specific motives
To preserve the purity of religion.
To safeguard the Islamic mentality.
To preserve life and to safeguard property
To safeguard future generations.
To maintain self-respect and integrity.
Halal – permitted or lawful foods M
Haram – not permitted, unlawful
Food Laws of Islam
Eating
is considered worship
Swine,
animals and birds of
prey are forbidden
Improperly
slaughtered
animals are forbidden
Alcoholic beverages,
caffeine,
and intoxicating drugs are
forbidden
Eat with right
hand; left hand is
used for toileting
Islamic Feast and Fast Days
*Ramadan 9th month of the Islamic calendar
– > 15 yo must fast
– Exclusions can make up days later: sick, traveling, pregnancy, lactation,
menstruation, elders, insane, hard labor
– Dine with friends after sunset (gain weight)
*Eid al-Fitr
–
Maulud n’Nabi
–
Feast of Fast Breaking,end of Ramadan, give alms
Mohammed’s birthday
Eid al-Azha
–
Feast of Sacrifice Abrahams’ willingness to sacrifice his son, Ishmael
for God, distribute sacrificial sheep to friends, relatives, and needy
Definition of Cultural Competence
Culturally competent health teachers
consistently and systematically:
understand and respect their students’ and
parents’ values, beliefs, and expectations;
understand the disease-specific epidemiology
and treatment efficacy of different population
groups;
adapt the way they teach to each student’s
needs and expectations.
Cultural competence
is
a set of attitudes, skills, behaviors, and policies that
enable organizations and staff to work effectively in crosscultural situations.
reflects
the ability to acquire and use knowledge of the
health-related and educational beliefs, attitudes, practices,
and communication patterns of clients and their families to
improve services, strengthen programs, increase
community participation
can
close the gaps in health status among diverse
population groups
Cultural competence is a developmental process that evolves
over an extended period. Both individuals and organizations
are at various levels of awareness, knowledge and skills
along the cultural competence continuum
National Center for Cultural Competence at Georgetown
University
http://www11.georgetown.edu/research/gucchd/nccc/inde
x.html
Organizational Continuum of Cultural
Competence
Cultural Competency
Cultural Pre-competency
Cultural Blindness
Cultural Incapacity
Cultural Destructiveness
Georgetown University: A Guide to Infusing Cultural and Linguistic Competence in
Health Promotion Training
http://www11.georgetown.edu/research/gucchd/nccc/projects/sids/dvd/view_onli
ne/index.html
Campinha-Bacote Model of Cultural
Competency
Awareness: Am I aware of my biases and prejudices towards other
cultural groups, as well as racism and other "isms" in healthcare?
Skill: Do I have the skill of conducting a cultural assessment in a
sensitive manner?
Knowledge: Am I knowledgeable about the worldviews of
different cultural and ethnic groups, as well as knowledge in the
field of bio-cultural ecology?
Encounters: Do I seek out face-to-face and other types of
interactions with individuals who are different from myself?
Desire: Do I really "want to" become culturally competent?
Travel the world - Visit the local ethnic food
store
What foods are familiar ?
What foods are new to you?
–types of cheese and milk
–fruits and vegetables/canned or fresh
–cuts of meat or types of fish/poultry
What appears to be staple foods ?
What other services are offered ?
Cultural Soup Exercise
Think of your childhood and a soup your
mother/grandmother/aunt prepared.
If your father/grandfather/uncle prepared it, think about why.
Think of the ingredients.
Think of sayings about the soup.
Think of when and how it was served.
Think of who prepares it now.
Think of how you prepare it or why you don’t.
Online Resources
Unnatural Causes PBS
–http://www.unnaturalcauses.org/ short video clips available online
Framingham State College
–http://www.framingham.edu/dgce/opdce/ online course
Management Sciences for Health The Providers Guide to Quality
and Culture
–http://erc.msh.org/aapi/cc1.html
HRSS Celebrating Diversity
–http://www.mchlibrary.info/pubs/pdfs/CelebratingDiversity.pdf
Boston Healing Landscape Project
–http://www.bu.edu/bhlp/pages/country_index/index.htm
Nat’l Center for Cultural Competence at Georgetown University
–http://www11.georgetown.edu/research/gucchd/nccc/index.html
There is no substitute for listening
A deaf ear is followed by death and an ear
that listens is followed by blessings.
–
Samburu (Kenya) proverb
www.afriprov.org/index.php/welcome.html
So when you are listening to somebody,
completely, attentively, then you are
listening not only to the words but also to
the feeling of what is being conveyed to the
whole of it, not part of it.
–Jiddu Krishnamurti Indian theosophist (1895-198)6
Who in your school
environment would you select
to be your teacher?