The neglect of racism as an ethical issue in health care

Race and racism has been increasingly implicated in known disparities in the health and health care of racial, ethnic and cultural minorities groups. Despite the obvious ethical implications of this observation, racism as an ethical issue per se has been relatively neglected in health care ethics discourse. In this paper consideration is given to addressing the following questions: What is it about racism and racial disparities in health and health care that these command our special moral scrutiny? Why has racism per se tended to be poorly addressed as an ethical issue in health care ethics discourse? And why, if at all, must racism be addressed as an ethical issue in addition to its positioning as a social, political, cultural and legal issue? It is suggested that unless racism is reframed and redressed as a pre-eminent ethical issue by health service providers, its otherwise preventable harmful consequences will remain difficult to identify, anticipate, prevent, manage, and remedy.

Trust in mono-ethnic and mixed-ethnic association in Penang

Investigation into trust has become a topical issue in current social science research. This is, in large part, a result of a perception that trust in institutions has declined markedly in the past two decades. This paper investigates trust in some of Penang's civil associations as a way of measuring the health of social capital in Penang. It focuses on issues of trust and diversity since both are critical issues in Malaysian society in general and civil associations in particular. We began our analysis expecting higher forms of trust among members in the mono-ethnic associations, based on the power of bonding. However, findings from this study tend to suggest that rather than leading to lesser trust and infectiveness, involvement in mixed-ethnic associations have in fact generated higher trust among their members. These findings reveal an interesting corrective to more pessimistic view on the relationship between trust and diversity. Data from this study also provide important insight into how bridging between different people in associations marked by diversity can accentuate trust over and above the levels found in associations were bonding between like types is the dominant characteristic. The data also indicate that for both, mono-ethnic and mixed-ethnic associations, it is the extent of members' involvements in their associations that form trust and not vice versa.

Health care provider and consumer understandings of cultural safety and cultural competency in health care : an Australian study

There is increasing recognition in Australia that racial and ethnic minority groups experience significant disparities in health and health care compared with the average population and that the Australian health care system needs to be more responsive to the health and care needs of these groups. The paper presents the findings of a year long study that explored what providers and recipients of health care know and understand about the nature and implications of providing culturally safe and competent health care to minority racial and ethnic groups in Victoria, Australia. Analysis of the data obtained from interviewing 145 participants recruited from over 17 different organizational sites revealed a paucity of knowledge and understanding of this issue and the need for a new approach to redress the status quo.

Assessing cultural and linquistic appropriateness of the Rose Angina questionnaire in three ethnic groups

Introduction. Meeting the needs of migrant groups in Europe requires cross-culturally valid questionnaires, a substantial challenge to researchers. The Rose Angina Questionnaire (RAQ) is an important measure of coronary heart disease prevalence. It consists of seven items that collectively yield a diagnosis of angina. It has been shown to perform inconsistently across some ethnic groups in Britain. This study aimed to assess the need for modifying the RAQ for cross-culturally valid use in the three main ethnic groups in Scotland.

Methods. Interviews were carried out with Pakistani Punjabi speakers (n=26), Chinese Cantonese speakers (n=29) and European-origin English speakers (n=25). Bilingual project workers interviewed participants and provided translation and commentary to the English-speaking researcher. Participants were asked about general and cardiovascular health beliefs and behaviours, and about attitudes to pain and chest pain. They were also asked to comment on their understanding of an existing version of the RAQ in their language.

Results. No dominant themes in the cultural construction of health, pain or cardiovascular knowledge emerged that may significantly influence RAQ response between language groups. Problems were encountered with the Punjabi and Cantonese translations of the RAQ. For example, the translation for “chest” was interpreted by some Pakistani and fewer Chinese women to mean “breasts”. “Walking uphill” was translated in Chinese as “walking the hill”, without stipulation of the direction, so that some Cantonese speakers interpreted the question as meaning walking downhill. In addition, many Chinese interpreted RAQ items to be referring to breathlessness rather than chest pain due to ambiguous wording.

Conclusion. Existing Punjabi and Cantonese versions of the RAQ should be modified before being used in multi-ethnic surveys. Current versions are unlikely to be yielding data that is comparable across groups. Other language versions also require similar investigation to study the cardiovascular health of Europe’s migrant groups.

Review of prevalence data in, and evaluation of methods for cross cultural adaptation of, UK surveys on tobacco and alcohol in ethnic minority groups

Objective To assess the adequacy of cross cultural adaptations of survey questions on self reported tobacco and alcohol consumption in the United Kingdom.

Design Assessment of consistency of data between studies identified through literature review. Studies evaluated with 12 guidelines developed from the research literature on achieving cross cultural comparability.

Results The literature review identified 18 key studies, five of them on national samples. Survey instruments were obtained for 15 of these. The comparison of prevalence data in national surveys showed some important discrepancies, greater for tobacco than for alcohol. For example, prevalence of cigarette smoking in Bangladeshi women was 6% in a national survey in 1994 and 1% in a national survey in 1999; in Chinese men it was 31% in a survey in 1993-4 and 17% in one in 1999; in African-Caribbean men it was 29% in a 1992 survey and 42% in one in 1993-4. The most guidelines met by any study was three, although one study partly met a fourth. Two studies met no guidelines. Only four studies consulted with ethnic minority communities in developing the questionnaire, none checked each language version with all others, and two stated the questionnaire had not been validated.

Conclusions Surveys have not followed best practice in relation to measurement of risk factors in cross cultural settings. There is inconsistency in the prevalence data on smoking provided by different major national UK studies. Users of such data should be aware of their limitations. Research is needed to help achieve linguistic equivalence of survey questions in cross cultural research.

Trust in mono-ethnic and mixed-ethnic associations in Penang

Investigation into trust has become a topical issue in current social science research. This is, in large part, a result of a perception that trust in institutions has declined markedly in the past two decades. This paper investigates trust in some of Penang’s civil associations as a way of measuring the health of social capital in Penang. It focuses on issues of trust and diversity since both are critical issues in Malaysian society in general and civil associations in particular. We began our analysis expecting higher forms of trust among members in the mono-ethnic associations, based on the power of bonding. However, findings from this study tend to suggest that rather than leading to lesser trust and infectiveness, involvement in mixed-ethnic associations have in fact generated higher trust among their members. These findings reveal an interesting corrective to more pessimistic view on the relationship between trust and diversity. Data from this study also provide important insight into how bridging between different people in associations marked by diversity can accentuate trust over and above the levels found in associations were bonding between like types is the dominant characteristic. The data also indicate that for both, mono-ethnic and mixed-ethnic associations, it is the extent of members’ involvements in their associations that form trust and not vice versa.

Indigenous peoples are not multicultural minorities : cultural diversity, heritage and indigenous human rights in Australia

This theoretically innovative anthology investigates the problematic linkages between conserving cultural heritage, maintaining cultural diversity, defining and establishing cultural citizenship, and enforcing human rights.

It is the first publication to address the notions of cultural diversity, cultural heritage and human rights in one volume. Heritage provides the basis of humanity’s rich cultural diversity. While there is a considerable literature dealing separately with cultural diversity, cultural heritage and human rights, this book is distinctive and has contemporary relevance in focusing on the intersection between the three concepts. Cultural Diversity, Heritage and Human Rights establishes a fresh approach that will interest students and practitioners alike and on which future work in the heritage field might proceed.

Sweet talking to ethnic customers : a field experiment on the links between entrepreneurial business planning, cultural sensitivity and sales growth

The purpose of this study was to test whether calculated inclusion of cultural sensitivity in a selected entrepreneurial business planning (EBP) process could increase sales growth in a test market and to explore the implications of a positive answer for the theory and practice of entrepreneurial business planning. Execution of a pretest-posttest control group experimental design measured and compared the implemented effectiveness of a planned entrepreneurial initiative based on cultural sensitivity. Though small in scale and limited in focus, the initiative qualified as an example of entrepreneurial business planning (EBP) and could be used to apply, test and extend aspects of the developing theory in this field of entrepreneurship research. Since the initiative was planned to overcome a culturally-defined impediment to business growth, it also offered opportunity to explore the specific importance of cultural variables in the context of EBP.

A planned sales-promotion was offered to a control group (receiving information in English) and a treatment group (who received the information in the language of ethnic origin). The sixty subjects had been chosen at random from a population of route-trade retailers of defined ethnic origins (Greek, Lebanese and Chinese) and randomly assigned to control and treatment groups. Monthly sales averages of the promoted product were measured before and after treatment. A Chi Square test was used to evaluate the relative proportion of the control and treatment groups who accepted the promotional offer. A two sample t-test procedure and complementary non-parametric Mann-Whitney test were performed to compare the mean sales-performance change of the two groups. Analysis showed that there was a significant increase in mean sales when the planned entrepreneurial initiative was communicated in the relevant language of origin.

The experimental results have specific practical relevance to revitalising the deteriorating route-trade segment of the Australian confectionery market through increasing the sales growth of wholesalers who are prepared to act entrepreneurially and include cultural sensitivity as an element in planning and implementation. By introducing cultural sensitivity as a necessary extension of a plan’s communications role, the results also have general theoretical implications for the developing paradigm of entrepreneurial business planning.

Motivators and barriers of ethnic groups to engage in arts performance

This paper aims to highlight the behavioural processes of ethnic minority group consumers in relation to arts performance in Australia. Our findings indicate that Chinese, Vietnamese, Italians and Greeks have varying perceptions, practice and experiential decision-making. The major barriers for ethnic audiences to attend arts events were cost and time; a lack of understanding of or exposure to some artforms; language difficulties. Motivating factors for ethnic audiences were events associated with their own ethnic backgrounds; socialising/meeting with friends/people, and familiarity with the art-form. Our research will be critical for future arts marketing and cultural research and contribute to socially inclusive communities where every resident can act as a contributor to build socio-economically strong cities and nations