Fluent Essays

People of Appalachian Heritage.People of Arab Heritage.Please read chapter 8 and 9 of the class textbook . Once done answer the following questions;1. Give an overview of the Inhabited localities and topography of the Appalachian and Arab heritage.2. Discuss any similarities in the beliefs of the Appalachian and Arab heritages regarding the delivery of healthcare.3. How the religion or folks beliefs influence the delivery of healthcare in these two heritages. Instructions: You must cite or quote at least two evidence-based references (besides the class textbook) no older than 5 years old. .A minimum of 600 words excluding the first and references page is required. Dissertation Chapter- Discussion in APA style, double spaceHere I attached the chapter 8 & 9 chapter_8___9_culture_.docx Unformatted Attachment Preview Chapter 8 People of Appalachian Heritage Overview, Inhabited Localities, and Topography Overview Appalachia consists of that large geographic expanse in the eastern United States that is associated with the Appalachian mountain system, a 205,000-square-mile region that extends from the northeastern United States in southern New York to northern Mississippi. It in- cludes all of West Virginia and parts of Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. This very rural area is charac- terized by a rolling topography with very rugged ridges and hilltops, some extending over 4000 feet high, with remote valleys between them. The surrounding valleys are often 2000 feet or more in elevation and give one a sense of isolation, peacefulness, and separateness from the lower and more heavily traveled urban areas. This isolation and rough topography have contributed to the development of secluded communities in the hills and natural hollows or narrow valleys where people, over time, have developed a strong sense of independ- ence and family cohesiveness. These same isolated valleys and rugged mountains can present accessibil- ity issues for those who do not have access to private transportation because public transportation is not widely available, and even then only in the larger, more urbanized areas. Even though the Appalachian region includes sev- eral large cities, most people live in small settlements and in inaccessible hollows or “hollers” (Huttlinger, Schaller-Ayers, & Lawson, 2004a). The rugged location of many communities in Appalachia results in a population that is isolated from the mainstream of health-care services. In some areas, substandard sec- ondary and tertiary roads, as well as limited public bus, rail, and airport facilities, prevent easy access to the area (Fig. 8-1). Difficulty in accessing the area is partially responsible for continued geographic and social isolation. In addition, the rugged terrain and Kathleen W. Huttlinger secondary roads can delay ambulance response times and are deterrents to people who need emergency health care. This is one area in which telehealth inno- vations can and often do provide needed services (University of Virginia, 2009). Many of the approximately 24.8 million people who live in Appalachia can trace their family roots back 150 years or more, and it is common to find whole communities comprising extended, related fam- ilies (Appalachia Regional Commision (ARC), 2010). The cultural heritage of the region is rich and reflected by a distinctive music, art, and literature. Even though family roots are strong, many of the region’s younger residents have left the area to pursue job opportunities and college in the larger urban cities of the North, South, and West Coast. The remaining, older popu- lation reflects a group that often has less than a high school education, is frequently unemployed, may be on welfare and/or disability, and is regularly uninsured (20.4 percent) (ARC, 2010). In fact, 80 percent of the population over age 65 is higher in Appalachia (14.3 percent) than in the rest of the United States (12.4 percent). The lack of education has often been associated with nonparticipation in health promotion activities (ARC, 2010; Graduate Medical Education Consortium [GMEC], 2001). Completion of a high school degree and matriculation to college are well below average throughout central and southern Appalachia. For example, in central Appalachia, 25 percent of the residents have attended college, compared to 50 percent for the nation (ARC, 2010). Graduation rates from high school in the year 2000 vary widely from 60.7 to 91.4 percent, with the lowest number of graduates occurring in West Virginia, southwestern Virginia, eastern Kentucky, and northeastern Tennessee (ARC, 2010; Haaga, 2004). Heritage and Residence Appalachians generally identify themselves by family surname. At one time an individual’s country of origin— Germany, Scotland, Ireland, and so on—was also 137 138 Aggregate Data for Cultural-Specific Groups Figure 8-1 Before the construction of the New River Gorge bridge, many people were isolated from health care. (Courtesy of West Virginia Division of Tourism and Parks.) included as an identification, but this tradition has gen- erally disappeared, except for older adults who still deem this aspect an important part of their residence. Germans, Scots-Irish, Welsh, French, and British constitute the primary groups who settled the region between the 17th and 19th centuries. It is important to remember that simply taking up residence in Appalachia does not make one an “Appalachian,” since a significant value is held for those whose roots are well identified within the region. Historically, the population has been predomi- nantly white, although many maintain a strong family identity with the American Indian tribes that once pop- ulated the area (e.g., Cherokee, Choctaw) (Huttlinger, Schaller-Ayers, Kenney, & Ayers, 2004b). In addition, African Americans have been in Appalachia since the 1500s. Early Spanish and French explorers brought with them African slaves, and free persons of color were among the earliest settlers. While a plantation economy never developed in the region, many wealthy mountain people owned slaves who worked in stores and inns, log- ging, and mining, as well as on farms. After the Civil War, many freed African Americans bought land to farm and lived rural lifestyles very similar to those of their white neighbors (Watkins, 2011). African American Appalachians have endured the same kinds of racial problems that exist elsewhere. While they recognize their ties to the larger African American population, they also have a unique identifi- cation with the region. Celebration of family heritage through the collection of family memorabilia and atten- dance at family reunions strengthens their separate iden- tity as African American Appalachians (Watkins, 2011). Appalachians in general cannot be distinguished from other white cultural and ethnic groups by either dress or physical appearance. However, similarities in beliefs and practices, tempered by variant cultural characteristics (see Chapter 1), give them a unique and rich ethnic identity. Like many disenfranchised groups, the people of Appalachia have been described in stereotypically negative terms (e.g., “poor white trash”) that in no way represent the people or the culture as a whole. They have also been called “moun- taineers,” “hillbillies,” “rednecks,” and “Elizabethans.” During the past 60 years, the media have perpetuated the stereotypes with cartoon strips such as “Li’l Abner” and “Snuffy Smith,” television programs such as the Dukes of Hazzard, and stories of the feuding Hatfields and McCoys and the Whites and Garrards. Interestingly, these feuds were among wealthy families over salt deposits and land and families who had high political profiles. Failure of the courts to intervene and a propensity of Appalachians to handle things them- selves perpetuated the longevity of the feuds. However, in recent times, works by popular authors such as Sharon McCrumb, James Dickey, Lee Smith, and John Ehle reflect values for deep-seated work ethics, low cost of living, and a high quality of life that permeate their Appalachian daily lives. All told, Appalachians see themselves as loyal, caring, familyoriented, religious, hardy, independent, honest, patri- otic, and resourceful (Huttlinger et al., 2004a). Other groups in the region who may identify with Appalachian culture include American Indians, African Americans, and Melungeons, who are of mixed African American, American Indian, Middle Eastern, Mediterranean, and white ethnic descent (Costello, 2000; Kennedy, 1997). Although Melun- geon heritage is often denied, there is, of late, a resur- gence of identification of Melungeon ancestry. In fact, annual Melungeon get-togethers are now held once a year in Appalachia (Kennedy, 1997). With the increase in immigration to the United States since the 1970s, the Appalachian region is becoming more ethnically and culturally diverse, and it is now very common to observe other ethnic groups, including those of south- east Asian, Chinese, and Hispanic heritage. Reasons for Migration and Associated Economic Factors Approximately 300 years ago, people came to Appalachia to seek religious freedom, land for themselves, and control over social interactions with the outside world. Over the years, mining and timber resources have become depleted, farmland has eroded, and jobs have become scarce, which has resulted in an out-migration of people, especially those of working age, to larger urban areas of the North such as Cincin- nati, Cleveland, and Louisville; to the South in cities like Charlotte and Atlanta; and even to the Southwest to places like Nevada and California (ARC, 2010). This migration began after World War II and has re- mained constant ever since (Obermiller & Brown, 2002). Those who move to urban areas often feel alone and sometimes become depressed as they are separated from family and friends. Many families fear for their young family members and worry that they will succumb to crime, drug use, and the other perils of living in an urban environment. In spite of these concerns, many of those who have remained in urban settings have become bicultural, adapting to the culture of urban life while retaining, as much as possible, their traditional Appalachian culture. The limited opportunities for employment in Appalachia often require wage earners to leave their families to seek work elsewhere, returning home on weekends and holidays or vacations to maintain their close ties with kinfolk. Their migration pattern is regional, where individuals from one area primarily migrate to the same urban areas as their relatives and friends—a pattern that is common with many migrants. This practice helps decrease the occurrence of depression and feelings of isolation and provides a support network of family and friends that is so important for members of the Appalachian culture. Appalachian migration patterns reflect the eco- nomic conditions found in the area, as well as some of the cultural values of home, connection to the land, and importance of the family. Working-age individu- als move from Appalachia to make their living but often return to their home hills and hollows in Appalachia to retire. Because of these patterns, Appalachia has one of the highest existing aging pop- ulations (ARC, 2010; Haaga, 2004). The pattern of re- turning home to retire has given rise to challenges for health-care delivery. In fact, older people were once able to rely on home care services, but severe budget cuts in 1977 left home care health service unreliable and ineffective. A study by Carter (2005) indicated that Appalachian nursing homes served resident pop- ulations with higher activities of daily living (ADL) impairment levels, had a larger proportion of resi- dents whose stays were reimbursed by Medicaid, and had a lower proportion of residents who paid pri- vately for their care. Carter noted that the long-term care facilities located in Appalachia were more likely to be hospital-based, reflecting hospital swing-bed policies in rural areas, and were less likely to offer spe- cialty beds designated for the care of residents with Alzheimer’s disease. Although important differences in operational and organizational characteristics were found (potential indicators of the poor quality of nursing home care), findings suggested that these did not necessarily lead to higher deficiency citation rates in Appalachia. Rather, Carter’s findings indicated that facilities whose resident populations have higher levels of ADL impairment have a greater proportion of Medicaid- reimbursed stays, and a smaller proportion of privately paid days received more deficiencies than did otherwise similar facilities, holding other factors constant. Lastly, her findings indicated that after ad- justing for other factors, a clear pattern of fewer deficiencies emerged across the Appalachian region that cannot be fully unexplained by either urban-rural or quality of care differences in the region, suggesting most likely that other, unexplained but regionally distributed, factors are contributing to the number and types of deficiencies found in nursing home facilities. A recent perusal of local phone directories shows, as of 2011, many private and community-based home care services throughout the Appalachian region. In the past, older people and the chronically ill had to rely on options for short-term and expensive hospital care, nursing homes, or no care at all (Hurley & Turner, 2000), whereas now they appear to have other options. For generations, the region has been a symbol of poverty in a land of wealth and opportunity. During the 1960s, the Appalachian Regional Commission (ARC) appropriated funds for building roads to at- tract industry and provided loans for residents to start their own businesses. In many areas of Central Appalachia, the unemployment rate and the number of people living in poverty have remained consistently above the national average, while the per capita in- come has remained below the national average. Eight of the 13 states in Appalachia have an unemployment rate higher than the national average, and the national poverty rate of 12.6 percent is exceeded by 10 of the 13 states in Appalachia. During the recent recession, Appalachia lost a disproportionate number of jobs compared with some other states (ARC, 2010). The average per capita income rate in Appalachia is $20,434. Not one Appalachian state achieves the na- tional per capita income of $25,470. Of 410 counties in Appalachia, 77 are considered economically dis- tressed, 81 are at risk, and 222 are transitional (ARC, 2010). Even though the cost of living in much of the area is lower than that in many other parts of the United States, costs for transportation of food, basic living supplies, and transportation fuels rise, thus cre- ating hardships for an area that is already economi- cally stressed (ARC, 2010). Educational Status and Occupations Although many of the original immigrants to this area were highly educated when they arrived, limited access to more formal education resulted in the isolation of later generations with fewer educational opportuni- ties. Despite the value placed on education, a disparity in the number and placement of educational facilities exists throughout the region. Access to colleges and universities has improved, but there is still a lack of knowledge about life outside of Appalachia and the educational opportunities available. Examples of uni- versities and colleges in Appalachia include, but are not limited to, West Virginia University, Appalachian State, University of Virginia’s College at Wise, East Tennessee State, Shawnee State, and the University of North Alabama. A dichotomy between those who are poorly educated and those who are extremely well educated still exists today (Huttlinger et al., 2004a). People of Appalachian Heritage 139 140 Aggregate Data for Cultural-Specific Groups Because isolation results in a cultural lag, IQ scores of children from Appalachia are sometimes lower than those in the populations outside of Appalachia who have access to larger schools and live in urban settings. However, with television and the Internet now available throughout the area, this cultural lag has been slowly improving. In fact, U.S. representatives from many of the districts that lie in Appalachia made it a priority to have broad- band and Internet connections made accessible. Fac- tors such as improved mobility, access to better schools with qualified teachers, increased employ- ment opportunities in some regions, and greater use of technology are responsible for improving socioeco- nomic conditions and better performance on standard IQ tests (ARC, 2010). However, the mountainous ter- rain often limits those services that require “line of sight” and may include cell phone and advanced TV technologies. Although a value is placed on education, education beyond high school is often viewed as not as important as earning a living to help support the family. Many Appalachian parents, and especially those who belong to more conservative and secular religious sects, do not want their children influenced by mainstream middle-class American behaviors and actions. However, fewer children drop out of school today than in previous decades. One interesting fact is that several states in Appalachia have laws that grant permanent driving privileges only upon completion of high school, which has lowered dropout rates significantly. Parents who value higher education encourage their children to seek quality education at the best institutions possible. Despite this value, the graduation rate from college is, at best, 27 percent compared with 45 percent for non-Appalachian counterparts (ARC, 2010). Unfortunately, the highly educated, including health-care workers, who return to the area are often unable to secure financially lucrative employment and soon leave to seek employment elsewhere. Because educational levels of individuals within the Appalachian regions vary, it is essential for healthcare providers to assess the health literacy and basic under- standing of health and disease of individuals when pro- viding any kind of intervention. Educational materials and explanations must be presented at literacy levels that are consistent with patients’ understanding. If ma- terials are presented at a level that is not understandable to patients, providers may be seen as being “stuck-up,” “putting on airs,” or “not understanding them and their ways” (Huttlinger et al., 2004b) (see Chapter 1). Communication Dominant Language and Dialects The dominant language of the Appalachian region is English, with many words derived from 16thcentury Saxon and Gaelic. Because the Appalachian dialect tends to be very concrete, continued exposure is necessary to avoid misunderstandings. Negative interpre- tations of Appalachian behaviors by nonAppalachian health-care providers can be detrimental to positive and facilitative working relationships. Some of the more isolated groups in Appalachia speak an Elizabethan English, which has its own distinct vocabulary and syntax and can cause communi- cation difficulties for those who are not familiar with it. Some examples of variations in pronunciation for words are allus for “always” and fit for “fight.” Word meanings that may be different include poke or sack for “paper bag” and sass for “vegetables.” The Ap- palachian region is also noted for its use of strong preterits such as clum for “climbed,” drug for “dragged,” and swelled for “swollen.” Plural forms of monosyllabic words are formed like Chaucerian Eng- lish, which adds es to the word—for example, “post” becomes postes, “beast” becomes beastes, “nest” be- comes nestes, and “ghost” becomes ghostes. Many people, especially in the nonacademic environment, drop the g on words ending in ing. For example, “writing” becomes writin’, “reading” becomes readin’, and “spelling” becomes spellin’. In addition, vowels may be pronounced with a diphthong that can cause difficulty to one unfamiliar with this dialect—hence, poosh for “push,” boosh for “bush,” warsh for “wash,” hiegen for “hygiene,” deef for “deaf,” welks for “welts,” whar for “where,” hit for “it,” hurd for “heard,” and your’n for “your.” However, when the word is written, the meaning is apparent. Comparatives and superla- tives are formed by adding a final er or est, making the word “bad” become badder and “preaching” become preachin ... Purchase answer to see full attachment