Page 24 - Cultural Competence in Health Education

2 Cultural Competence in Health Education and Health Promotion

INTRODUCTION
On January 25, 2000, the U.S. surgeon general released Healthy People 2010, a docu-
ment designed to provide a road map for improving the health status of all Americans.
Healthy People 2010 has two primary goals: increasing the quality of and extending
the number of years of healthy life for individuals and eliminating health disparities
among Americans (U.S. Department of Health and Human Services, 2000). In order to
accomplish the second goal, we need to explore and embrace the shifting demograph-
ics of the U.S. population, the policies that have contributed to these changes, and the
challenges and opportunities these demographics and policies represent for health
educators.
The purpose of this chapter is to describe the demographic shifts that are affecting
the U.S. population and to explore their impact on preparing a culturally competent
health education workforce. These demographic shifts include the overall growth in
population and the increase in the proportion of Hispanics, or Latinos, in that popula-
tion; the increase in the number of foreign - born residents and related changes in immi-
gration policy; the increase in the number of residents who do not speak English at
home; the increase in the overall number of elderly and in the number of minority
elderly; the increase in the number of women in the workforce; the population trends
among lesbian, gay, bisexual, and transgender individuals; and the trends among peo-
ple with disabilities. This chapter will also provide a brief description of relevant cul-
tural characteristics for each of the major ethnic groups in the United States. These
descriptions are essential background for the discussions of the challenges and respon-
sibilities of health educators that follow in the remaining chapters of this book.

DEMOGRAPHIC SHIFTS
Population Growth
According to the U.S. Census Bureau the U.S. population passed the 300 million
mark in 2006. This demographic shift is not surprising given the trend of popula-
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tion increases observed between 2000 (282,216,952) and 2007 (301,621,157) (see
Table 1.1 ). Exponential population growth is expected to continue for the next few
decades, with an expected population increase from 296,507,061 residents in 2005 to
419,854,000 in 2050. Moreover, the Census Bureau projects that as the population
increases, the majority of the population will be concentrated in urban areas, continu-
ing a trend started in the late nineteenth century (see Figure 1.1 ).

Race and Ethnicity
A report by the Agency for Healthcare Research and Quality states that members of
underrepresented groups are expected to make up more than 40 percent of the U.S.
population by 2035 and 47 percent by 2050 (Brach & Fraser, 2000). The shifts in the
ethnic and racial distribution and the age distribution of the U.S. population denote an
urgent need for health educators to develop programs that are culturally appropriate

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