We are What We Eat - Culture and Food

1. We are What We Eat - Culture and Food Janet Schwartz, MS. RD. LDN June 27, 2012

2. "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

3. 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 Connections on a Personal Level www.eduplace.com/ss/maps

4. 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 So, what is culture?

5. Requires that you understand you own cultural beliefs and values. How do you know your own cultural norms? Understanding other cultures and religions

6. Comparison of Some Common Values

7. 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

8. Point D 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 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?

9. 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

10. 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

11. 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 Culture determines • Language characteristics • TuvsUsted • 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.”

12. 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.

13. 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.

14. Culture definesKleinman, 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

15. 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? Kleinman’s Explanatory Model of IllnessDepending upon the situation, wording and number of question used will vary.

16. 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

17. 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

18. Cultural Changes • Acculturation • adaptation to the new majority society • Bi- or multi- culturalism • majority and minority cultures are seen as complementing, not competing • Assimilation • cultural group sheds its ethnic identity and fully merges into the majority culture

19. 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. Culture and ethnicity

20. Migration Policy Institute Accessed 12.5.11 http://www.migrationinformation.org/datahub/charts/final.fb.shtml

21. Region of birth of all immigrants(Center for Immigration Studies 2007)

22. Massachusetts 2009

23. 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.

24. 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

25. Core Foods • Irish Americans potatoes • Mexican Americans tortillas, beans • Asian Americans rice/noodles • Korean Americans kimchi • Italian Americans pasta, ‘gravy’ • Greek Americans lamb

26. 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

28. Celebrating New Year’s Eve though Food Symbols

29. 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 Brazilians speak Portuguese, not Spanish

30. Feijoada Maxixi Passion Fruit Codfish Pasteis Churrasco

31. 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.

32. 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 Latino Culture -Don’t offer a tortilla to a Puerto Rican • Be aware of folk remedies – add on diet to these remedies • May shun exercise – love dance www.latinonutrition.org/

33. “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

34. 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 Afro-American Culture http://www.hsph.harvard.edu/sisterstogether/hair.pdf

35. 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 not found in China

36. Islam6 million Muslims live in the U.S. • Koran – sacred writings, words spoke by Allah to Mohammed the prophet • Five Pillars of IslamFaith, 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

37. 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

38. 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

39. Islamic Feast and Fast Days • *Ramadan9th 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 • Feast of Fast Breaking,end of Ramadan, give alms • Mauludn’Nabi • 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

40. 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.

41. Cultural competence • is a set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural 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 • (Cross et al. 1989; Lavizzo-Mourney and Mackenzie 1996).

42. 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/index.html

43. Organizational Continuum of Cultural Competence Cultural Competency 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_online/index.html Cultural Pre-competency Cultural Blindness Cultural Incapacity Cultural Destructiveness

44. 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?

45. 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 ?

46. 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.

48. 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

49. 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 • 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. • JidduKrishnamurti Indian theosophist (1895-198)6 www.afriprov.org/index.php/welcome.html

50. Who in your school environment would you select to be your teacher?