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Population Health for Nurses

21.1 Race, Ethnicity, Culture, and Nationality

Population Health for Nurses21.1 Race, Ethnicity, Culture, and Nationality

Learning Outcomes

By the end of this section, you should be able to:

  • 21.1.1 Describe the racial and ethnic makeup of the United States.
  • 21.1.2 Explain the concept of diversity.
  • 21.1.3 Identify the groups utilized in diversity calculations.
  • 21.1.4 Discuss the ways in which race and ethnicity describe diversity.
  • 21.1.5 Differentiate between race, ethnicity, culture, and nationality.

Diversity in the the United States is not new. Before the country’s founding, Native Americans lived in what is now the United States, and settlers immigrated from England, France, Germany, the Netherlands, Poland, Scotland, and other European countries. At the start of the American Revolutionary War in 1775, “more than 250,000 Native Americans lived east of the Mississippi River. They formed more than 80 nations and spoke dozens of languages and dialects” (Museum of the American Revolution, n.d., para. 1).

The U.S. population continues to increase—by 2060 it is projected to number 417 million, and as the population grows, it is becoming increasingly more diverse (U.S. Census Bureau, n.d.). To meet the needs of this multicultural population, nurses must recognize and appreciate the differences in health care values, beliefs, and customs in a diverse society.

The Difference Between Race, Ethnicity, Culture, and Nationality

Race, ethnicity, culture, and nationality are distinct but interconnected concepts that influence how individuals identify and interact. Race is a form of social categorization often based on physical appearance, while ethnicity is tied to social and cultural affiliations (A. García, 2018; J. D. García, 2020). Culture is a broader concept that encompasses learned and shared patterns of behavior, and nationality pertains to one’s country of citizenship. These factors can influence human behaviors, beliefs, values, and interactions in a community (Smith & Bond, 2019).

Though these terms have distinct meanings, they are often used interchangeably. As discussed in Structural Racism and Systemic Inequities, race is a societal construct that is commonly defined by physical characteristics, such as bone structure, skin, hair, or eye color, as well as social factors and cultural backgrounds. However, race is not biologically predetermined, and different racial categories may not reflect shared genealogy. Unlike heritage or ancestry, race is assigned rather than inherent or chosen. It is a dynamic and evolving concept that is influenced by historical, societal, and political contexts (Jones & Bullock, 2019). The use of racial categories in demographic counts can be traced back to the 1790 U.S. Census.

Race: A Myth and an Illusion

Though racial categories have been used in the U.S. Census for hundreds of years, these categories are social constructions, rather than biological facts.

Read RACE: The Power of an Illusion, watch the video “The Myth of Race, Debunked,” and then respond to the following questions.

  1. How have racial definitions changed over time?
  2. How do demographic shifts and the sociopolitical climate influence the definition of racial categories?
  3. What, if anything, surprised you in this video?

Unlike race, the social and cultural groups one belongs to determine their ethnicity. Ethnicity is a fluid concept rooted in shared cultural traits such as language, religion, nationality, history, or other cultural factors that bind individuals into distinct social groups. Ethnicity is inherited and shared among a group. Like race, the definition of ethnicity evolves over time and can be broadly or narrowly constructed. While everyone is “born into” certain features of ethnicity, personal experiences and societal influences can reshape these characteristics (A. García, 2018; J. D. García, 2020).

Culture has no single definition and is both universal and personal. Definitions in the literature indicate that culture:

  • is learned, shared, and transmitted (McFarland, 2018);
  • involves patterned responses to behavior (Giger & Haddad, 2021);
  • is a historically transmitted pattern of meaning (Forbes & Mahan, 2017);
  • is a learning process (Spradley et al., 2016); and
  • distinguishes the members of one group of people from others (Hofstede, 2011).

Nationality denotes an individual’s country of citizenship. In the 19th century, nations were formed based on ethnic nationalism, which presumed a shared ethnic origin among their people. Examples include Britain, Germany, Italy, and Sweden. Table 21.1 compares the concepts of race, ethnicity, culture, and nationality.

Social and cultural factors play a significant role in shaping the dynamics of societies. These factors encompass a broad range of elements that influence human behaviors, beliefs, values, and interactions in a community (Smith & Bond, 2019).

Race Ethnicity Culture Nationality
Definition A social construct used to categorize or divide individuals based on physical traits, social factors, and cultural backgrounds; not biologically based Based on everyday ancestral, cultural, national, and social experiences Based on beliefs, values, norms, and practices that are learned and shared generation by generation Refers to the country of citizenship
Examples Black, White, Asian, etc. Albanian, Amish, Cherokee, English, Polish, Libyan, etc. American culture, Arab culture, British culture, etc. Afghan, Chinese, Cuban, Italian, French, etc.
Table 21.1 Comparison of Race, Ethnicity, Culture, and Nationality

The Racial and Ethnic Makeup of the United States

Over the last 100 years, the racial and ethnic makeup of the United States has changed dramatically. In fact, in just 10 years, the country has experienced a 276 percent growth in the population of people identifying as two or more races (Jones et al., 2021). While these changes may be due, in part, to a change in the way the the 2020 U.S. Census framed questions about racial and ethnic identification, both the change in the way the questions were asked and the responses suggest a shift in the way Americans think about their racial and ethnic identities toward the embrace of more nuanced multiethnic and multiracial identities. In 2021, the United States was more diverse than in 2010, with the Hispanic/Latino population growing the most, increasing by 2.5 percentage points to 18.9 percent. Conversely, the White, non-Hispanic/Latino population experienced the most significant decrease, dropping by 4.5 percentage points to 59.3 percent. As discussed in Demographic Trends and Societal Changes, the United States will become a majority-minority nation by mid-century because of a decreasing non-Hispanic White population and an increasing minority population (USAFacts, 2022) (Figure 21.2).

Two pie charts show racial demographics of the U S population in 2010 and 2021. In 2010, the percentages were: 63.8% white non-Hispanic, 16.4% Hispanic/Latino, 12.3% Black, 4.8% Asian non-Hispanic, 1.8% multi-racial non-Hispanic, 0.7% American Indian/Alaska Native non-Hispanic, and 0.2% Native Hawaiian or other Pacific Islander non-Hispanic. In 2021, the percentages were: 59.3% white non-Hispanic, 18.9% Hispanic/Latino, 12.6% Black, 5.9% Asian non-Hispanic, 2.3% multi-racial non-Hispanic, 0.7% American Indian/Alaska Native non-Hispanic, 0.25% Native Hawaiian or other Pacific Islander non-Hispanic.
Figure 21.2 Between 2010 and 2021, the Hispanic/Latino populations grew the most, increasing by 2.5 percentage points to 18.9 percent. The White, non-Hispanic/Latino population had the most significant decrease, dropping by 4.5 percentage points to 59.3 percent. (data source: U.S. Census; attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Diversity refers to the relative size and representation of different racial and ethnic groups—the heterogeneous rather than homogenous nature of the mix of these groups in a population. The U.S. Census uses the following groups in its diversity calculations (Jensen et al., 2021):

  • Hispanic/Latino
  • White alone, non-Hispanic/Latino
  • Black or African American alone, non-Hispanic/Latino
  • American Indian and Alaska Native alone, non-Hispanic/Latino
  • Asian alone, non-Hispanic/Latino
  • Native Hawaiian and other Pacific Islander alone, non-Hispanic/Latino
  • Some other race alone, non-Hispanic/Latino
  • Multiracial, non-Hispanic/Latino

The United States is a heterogeneous society, with people from various ethnicities, cultures, and religions coexisting. Belgium is a European example of a heterogenous society. Belgium is known for its linguistic diversity, with three official languages: Dutch (Flemish), French, and German. The country is divided into distinct regions, including Flanders, Wallonia, and the Brussels-Capital Region, each with its own language and cultural characteristics. In addition to these linguistic divisions, Belgium is home to immigrant communities from various countries, further contributing to its heterogeneous nature (Droixhe & Gsir, 2017). India is another example of a heterogenous society. According to the most recent Census of India data, from 2011, the country has 30 different native languages. The most spoken language, Hindi, is spoken by just 43.6 percent of the population. The next five most spoken languages are Bengali (8 percent), Marathi (6.9 percent), Telugu (6.7 percent), Tamil (5.7 percent), and Gujarati (4.6 percent) (Office of the Registrar General and Census Commissioner, India, 2011). In terms of religious diversity, while the country is more than 80 percent Hindu, it also has large Buddhist, Jain, and Muslim populations and the largest Sikh population in the world (Kramer, 2021). In 2012, the U.S. State Department estimated that there were more than 2,000 ethnic groups in India (U.S. Department of State, 2012).

In contrast, countries such as Japan and South Korea are primarily made up of one dominant culture, making them homogeneous societies. Japan is predominantly made up of people of Japanese ethnicity, though there are also minority groups such as Ainu, Ryukyuan, and Korean communities that contribute to the country’s cultural diversity. South Korea is also primarily comprised of people of Korean ethnicity, with other minority groups making up a smaller proportion of the population.

The coexistence of diverse religious, ethnic, or cultural groups in a society, all adhering to the same rules, is called multiculturalism (Longley, 2021). In contrast, in cultural pluralism, there is one dominant society in which all minority groups participate fully (Clayton, 2020). Pluralism refers to multiple cultures existing in the same place with their own unique traditions and regulations. There is typically a dominant culture in pluralism, whereas no single culture holds more importance than the others in multiculturalism.

The success of immigrants in their new countries is greatly influenced by their ability to assimilate, integrate, and/or adapt. The United States is often associated with multiculturalism because of the religious, ethnic, and cultural diversity of its population. However, as a pluralistic rather than truly multicultural society, the United States has a dominant culture and allows minority groups to maintain their unique identities in the larger society. This coexistence of a dominant culture and diverse minority groups can result in positive aspects, such as cultural enrichment, but it can also create challenges, including differential treatment and variations in societal rules (Ziólkowska-Weiss, 2020). Despite efforts to promote inclusivity and tolerance, disparities may persist due to deep-rooted structures and systemic issues (Solomon et al., 2019). These issues are discussed in more detail in Structural Racism and Systemic Inequities.

While race and ethnicity are commonly used terms to describe diversity, they do not necessarily describe a person’s cultural identity. A person can have multiple racial and ethnic backgrounds, and reducing culture to a broad categorical or dichotomous variable in a culturally pluralistic society can hide the individual differences that exist in groups of people. Therefore, it is essential to recognize the underlying intragroup variations and acknowledge the complexity of cultural identity in a diverse society (Singer, 2012; Singer et al., 2016). Culture is much more than a racial or ethnic category.


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