One Third of a Nation, released by the American Council on Education and the Education Commission of the States, warns that the U.S. must renew its commitment to the advancement of minority groups or the future prosperity of the country will be jeopardize. [1] The report suggests the nation is moving backward in its efforts to achieve full minority participation in American life, and gaps between minority and majority groups are widening. A lower standard of living and a compromised quality of life in America are predicted to result from these disparities. [2]
According to demographic projections, the student population in public schools soon will include one of four students from families living in poverty. As many as 15% will be immigrants who do not speak English. After the year 2000, one of three Americans will be nonwhite. [3] The U.S. census for 1988 reported that 10.1% of White, 31.6% of Blacks, and 26.8% of Hispanics in this country were below the poverty level. [4]
The Census Bureau also reported that, in 1989, Whites had a population growth of .70% compared to 1.41% for Blacks and 3.53% of net increased per 1,000 for all other ethnic groups. The Bureau predicted growth will continue at lower rates with other ethnic groups providing the greatest growth: Whites .29, Blacks .93, and other ethnic groups 2.18 increases per 1,000. Such data lead statisticians to conclude the U.S. rapidly is becoming a nation populated by a majority of minorities.
Economically, the gap continues to widen between affluent Whites and poor minority groups, especially Black and Hispanics. This income inequity also reflects the growth of inequality within minority groups themselves. [5] Massey and Eggers [5] research demonstrates that growing income inequality among Whites is less pronounced than among minorities, with Asian and Hispanic income inequalities being well below Blacks, but still greater than Whites. These data and demographics will profoundly affect the health and wellness behavior of the nation, specifically children.
Ethnically sensitive educators and administrators are calling for multicultural education to occur at all levels of education to address such issues and concerns. Multicultural education promotes the recognition, understanding, and acceptance of individual uniqueness, and cultural diversity within a pluralistic society. [6] Pluralism is a societal condition where diverse ethnic, religious, or social groups maintain their individuality while functioning effectively in the society at large. [6] Therefore, multicultural education incorporates ethnic and cultural differences, concerns, and issues.
Where are most education today in regard to multicultural education and more specifically health education? According to Hellison, [7] 'the multicultural literature is replete with humanistic adverbs and adjectives which describe equity in the classroom, but the action is often left out and missing.' Numerous journal articles cite the need for multicultural education, however, little meaningful action has occurred. White the literature has addressed the needs of special groups in controlled situations, it does not offer generic suggestions for health educators who daily face ethnic diversity. One-hour assemblies and occasional classes taught by an interested teacher, as well as limiting training to only a few teachers, does not address the increasing need.
Ethnic and minority groups in the U.S. grow up and live within unique social, cultural, and psychological context that shape their knowledge, attitudes, and beliefs, as well as their self-image, system of values, and lifestyle. [8] If health educators capitalize on this fact, they can exert a profound influence on ethnic and minority children's health behavior.
THE STATUS OF MULTICULTURAL
HEALTH EDUCATION
Innovative strategies for health education and prevention in health areas are available, however, such programs to date have focused primarily on White majority target groups. [8] For multicultural education, these programs do not fulfill cultural relevance and applicability for minority or ethnic groups. While attempts have been made to reach specific target groups, numerous ethnic differences remain unexamined.
The heterogeneous nature of ethnic and minority groups makes it difficult to compare their health attitudes and behaviors within their own groups, let alone to compare them to Whites. Researchers studying various cultures in this country agree that enormous attitude and behavioral diversities exist among and within cultures and subcultures. [9] Consequently, meaningful research data and programs are scant. It is important to consider ethnic nuances in developing research, planning, and implementing health promotion and education strategies.
Though health educators know family and religion are dynamic influences on health behavior, most intervention strategies fail to go beyond White norms. Additionally, no data address ethnic and cultural influences that enhance positive health behavior. [8]
School health educators continue to confront problems of lack of adequate classroom time to address major health issues, lack of administrative support, and lack of requirements or mandates for adequate health instruction. Thus, how can health educators address yet another issue such as multicultural education?
SUGGESTIONS FOR IMPROVEMENT
Change must begin with educators. Few classroom teachers received specific training in teaching about ethnic and minority issues, unless they graduated recently from a few select universities. That training probably would include only one course or coursework within a course or two. Therefore, while educators may be willing to incorporate multicultural issues in their teaching, they probably have not been trained to teach diverse populations. Solutions to this situation occur at several levels.
1) Administrative changes should occur in policy and educational requirements. Administrators should aggressively recruit and hire teachers with diverse ethnic backgrounds. Relevant and interesting in service programs should provide teachers with the basis of multicultural education and how to incorporate it routinely into daily lessons. In addition, curricula should be written to include diverse cultural issues in all content and topic areas. Health education administrators should pursue these changes.
2) Health educators should develop, re-examine, and renew their educational philosophies. They should perceive multicultural education as a necessary and global issue to be incorporated into all areas to teaching, not merely another topic to be added to the curriculum. [10] Educators also should examine their own prejudices and backgrounds before planning and teaching these lessons. Ethnocentricity - a universal pride in one's own ethnic or cultural group - is subtle and may prevent teachers from presenting unbiased and varied cultural and ethnic viewpoints. [11]
Ethnocentricity must be carefully guarded against in health areas because so many topic and content areas are controversial such as sexuality and family life, death and dying, and substance use. Saville-Troike [12] posed several questions for multicultural health education: Who or what causes illness or death (germ theory vs. supernaturally)? Who or what is responsible for curing? How are specific illnesses treated? To what extent to individuals use and accept modern medicine? What beliefs and practices are associated with menstruation, puberty, and childbirth? And, what are beliefs and practices for hygiene and first aid?
Swisher and Swisher [13] concluded that introducing multicultural concepts involves more than studying games, dances, and food. It is an attitude which communicates diversity is desirable and it is acceptable to be different. Airhihenbuwa and Pinerio [10] concluded that health is a global state with no boundaries. Therefore, curricula must be designed to understand the health of ethnic minorities and should consider the following: ethnic minorities in the U.S., decision-making in minority populations, minority role models, learning health practices from a minority member, facing myths and realities, and merging health practices.
3) Health education programs that stress communications must be sensitive to channels within which that communication most likely occurs. Therefore, community parental involvement is necessary if these programs are to succeed. Periodic evaluation by both teachers and administrators is necessary to determine such issues and the relevance of the material to the population, the amount of time spent daily or weekly on ethnic and cultural issues, and the differences it has on the child's attitudes, beliefs, and behavior.
4) Departments of health education in colleges and universities must include multicultural education throughout teacher preparation programs. One preservice course on multicultural education or, more specifically, health education may not adequately address the issues. Diversity should be inherent in every syllabus and course outline throughout the entire undergraduate program. Likewise, graduate health education programs should include multicultural issues in core courses. At the graduate level, a course could be offered on multicultural education to provide indepth in investigation into the area. One-credit workshops may be offered for teachers to upgrade their skills.
5) Finally, health education conferences at the local, state, regional, and national levels can recognize the growing demand for the examination and presentation of multicultural issues and grant more time to conference programs that address these issues.
CONCLUSION
Multicultural health education can influence health status, disease prevention, wellness maintenance, and compliance with medical protocols in ways yet to be seen. To accomplish this goal, health educators must look beyond knowledge currently available for minority cultures.
For the 1990s and beyond, multicultural health education must focus more closely on the individual and examine issues such as self-esteem, family structures, male and female roles, belief and value structures, and how they affect behavior and wellness all within the student's cultural and ethnic background. Hixon[14] concluded that if we ignore the value structure of students, we ignore that care of a child's identity at a time when a child is most vulnerable.
Santos[15] cautions that educators, in pursuit of the illusive goal of excellence, cannot be lulled into 'quick fix' solutions that attempt superficially to solve complex health behavior. For health educators, critical issues that continue to trouble our culturally pluralistic youth such as hunger, teen pregnancy, suicide, substance abuse, and child abuse must be considered simultaneously.
Conversely, health educators must not become overzealous in their multicultural mission. In stressing the importance of separate cultures and ethnic groups, the unity of being one nation must not be lost. Students need to understand that through individual differences we gel and contribute collectively to the nation's health practices and advances. Therefore, while we appreciate and respect individual needs and differences, a need remains to unite and be one regarding important health and environmental concerns.
Finally, research data are lacking on multicultural health education. Because beliefs, attitudes, and practices may differ from culture to culture and subgroup to subgroup, further study of cultures and subgroups is indicated. Ideas for future research are numerous: How can we involve those most needed to participate in program planning? Who will monitor successes and shortcomings of multicultural programs? How can new and experienced educators be trained to teach from a multicultural perspective? Who should initiate such programs at national, state, and local levels?
With the rapidly changing ethnic and cultural make-up of the nation, health educators cannot underestimate the meaning these differences bring to the classroom. Because substance abuse, pollution, overpopulation, and communicable diseases do not discriminate or limit themselves to a specific culture or ethnic group, neither can our educational focus be limited.[3]
Reference
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[2 .] Collison MN-K Neglect of minorities seen jeopardizing future prosperity. Chron High Educ. 1988;34(May 2):Al,A20.
[3 .] Grant CA. Race, class, gender, and schooling. Educ Digest. 1988;88:561-569.
[4 .] Statistical Abstract of the United States: 1990, 110th ed. Washington, DC: US Census Bureau; 1990.
[5 .] Massey DS, Eggers ML. The ecology of inequality: Minorities and the concentration of poverty, 1970-1981. Am J Soc. 1990;1995: 1153-1188.
[6 .] Weaver VP, Education that is multicultural and global. The Social Studies. 1988:(May/June):107-108.
[7 .] Hellison D, ed. Multicultural perspectives. JOPERD. 1986;54: 33-34.
[8 .] Orlandi MA. Community-based substance abuse prevention: A multicultural perspective. J Sch Health. 1986;56(9):394-401.
[9 .] Gebhard PH. Human sexual behavior: A summary statement. In: Marshall DS, Suggs RC, eds. Human Sexual Behavior. New York, NY: Basic Books; 1971.
[10.] Airhihenbuwa CO, Pineiro M. Cross-cultural health education: A pedagogical challenge. J Sch Health. 1988;58(6):240-242.
[11.] Garcia RL. Teaching in a Pluralistic Society. New York, NY: Harper & Row; 1982.
[12.] Saville-Troike M. A Guide to Culture in the Classroom. Rossyln, Wash: National Clearninghouse for Bilingual Education; 1979.
[13.] Swisher K. Swisher C. A multicultural physical education approach. JOPERD, 1986;57:35-39.
[14.] Hixon J. Community control: The values behind a call for change. In: Epps EG, ed. Cultural Pluralism. Berkeley, Calif: McCutchan; 1974.
[15.] Santos SL. Promoting intercultural understanding through multicultural teacher training. Action in Teacher Education. 1986;54: 19-25.
Markella L. Pahnos, PhD, Assistant Professor and Coordinator, Undergraduate Health Education, Hofstra University, Dept. of Health, Physical Education, and Recreation, Hempstead, NY 11566. This article submitted March 22, 1991, and revised and accepted for publication August 12, 1991.
