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18 Cultural Competence in Health Education and Health Promotion

level (U.S. Census Bureau, 2007a), and 30 percent had no health insurance coverage
(OMH, 2007).
Presently, there are 561 federally recognized American Indian and Alaska Native
tribes, and more than 100 state - recognized tribes (OMH, 2007). Federally recog-
nized tribes receive health and educational assistance from the Indian Health Service
(IHS), a governmental agency. This agency operates a comprehensive health service deliv-
ery system for 1.8 million American Indians and Alaska Natives, who reside mainly in
reservations and rural communities. The IHS funds thirty - four urban Indian health
organizations that provide services including medical and dental services; community
services; alcohol and drug abuse prevention, education, and treatment services; mental
health services; nutrition education; and counseling (OMH, 2007). Nonetheless,
American Indians and Alaska Natives frequently are faced with issues such as cultural
barriers, geographical isolation, inadequate sewage disposal, and low incomes that
prevent them from receiving quality medical care.
American Indians and Alaska Natives are disproportionately affected by heart dis-
ease, cancer, unintentional injuries (accidents), diabetes, stroke, mental health issues,
suicide, obesity, substance abuse, sudden infant death syndrome (SIDS), teenage preg-
nancy, and liver disease (OMH, 2007).

CONCLUSION
It is clear that members of underrepresented groups still face a number of barriers to
obtaining optimal health. Health educators must work in conjunction with health care
professionals not only to improve the health status of these groups but also to attempt to
decrease the adverse health consequences for this population of the kinds of socioeco-
nomic factors discussed in this chapter and also of events like the Tuskegee syphilis
experiment (see Chapter Eight ). Health educators must be cognizant of the differences
existing between and among ethnic and racial groups in the United States. The following
chapters discuss many ways of reaching out to these diverse populations.

POINTS TO REMEMBER

Demographic shifts in the U.S. population involving race, ethnicity, age, and sexual
orientation make it imperative for health educators to learn how to deliver quality and
culturally appropriate health education and prevention programs. An accurate under-
standing of the needs of different ethnic and cultural groups will go a long way toward
achieving the goal of reaching diverse groups with prevention programs.

CASE STUDY

Almost all health promotion planning models require the collection of demographic
data for the populations to be served. Using U.S. Census Bureau data, create a

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