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##  School Health Education in a Multicultural Society. ERIC Digest.             

The beliefs and behaviors that surround health are an integral part             of cultural expression. Yet, for many school children in America's              multicultural society, the academic concepts presented in the                   classroom are different from the child's everyday life                          experience (Laboratory of Comparative Human Cognition, 1986). Rather            than feeling proud of what their culture uniquely offers in                     promoting a healthy lifestyle, some children may feel isolated,                 marginalized, and ashamed of the way their culture explains and                 manages health and illness. School health education needs to build a            broad base of awareness, tolerance, and sensitivity to different                expressions of healthy behavior while maintaining scientific                    accuracy. This can only be accomplished through exposing children to            the health knowledge found in different cultures (Ben-David & Amit,             1999). "REMEMBER YOUR ROOTS..."(Edelman, 1992, p. 90)                     Appreciation of others' cultural beliefs begins with understanding              and loving one's own culture. Children must be encouraged to explore            and value what their subcultures teach about healthy behavior. This             exploration needs to take place in an environment of acceptance                 where no one culture is regarded more highly than another. Caucasian            children often express a sense of "rootlessness" about their                    Euro-American culture with comments like, "I don't have                         a 'culture'." Educators need to help all children to clarify their              cultural heritages and acknowledge that their cultures are pieces in            the mosaic of American life. DON'T CONFUSE "...THE SHADOW FOR THE             SUBSTANCE"(Edelman, 1992, p. 69)  Health behaviors may seem                 meaningless or superficial until explained within the context of                culture. Cultural knowledge involves searching for hidden meaning or            rationale for a behavior. Children need the opportunity to explore              how different cultures explain suffering, treatment of illness, and             promotion of health. For example, children of Chinese ethnicity may             be taught that health is about self-control and performing specific             health-promoting tasks (Anderson, 1998; Chen & Uttal, 1988). Thus,              unsatisfactory behavior may be framed as illness, a "social                     construction of disobedience as sickness" (Anderson, 1998, p.                   139). 
Cambodian and some other southeast Asian children commonly              learn that health is a state of equilibrium, which is achieved                  through releasing "bad winds" from the body by vigorous rubbing of              the skin with hot coins. Health is promoted through avoiding                    extremes; therefore, one is encouraged to laugh when a situation                becomes too sad. Cambodians' laughter at sad occasions is a health              promoting behavior, not a bizarre or inappropriate social                       response (Frye & McGill, 1993). 
Some Native American children may             be taught to regard a healthy lifestyle as part of their                        relationship to the natural world. For example, the Lakota cultural             tradition is rich with messages that health is about "being," about             respecting the earth, about learning from the wind and the                      coyotes (Kavanagh, Absalon, Beil, & Schliessmann, 1992). Teaching               children to respect and value multiple pathways to healthy living is            essential in order to establish shared values and beliefs about                 health. THE IMPORTANCE OF "...FELLOWSHIP OF HUMAN                             BEINGS..."(Edelman, 1992, p. 66)  When children are encouraged              to learn about and value differences in a systematic manner at all              levels of education, then they will be more likely to search for                common ground and to establish shared values. When they are                     encouraged to acknowledge and maintain their own belief systems as              precious, then they will be more willing to extend that privilege to            others (Edelman, 1992; Sadler, Nguyen, Doan, Au, & Thomas, 1998).               Health education curricula in a pluralistic society need to                     communicate shared values by incorporating valid health promotion               content from different cultures (Laboratory of Comparative, 1986;               Stycos, 1998). 
Some ways that the health educator can promote                 health in the context of shared values include: 
Stories: 
Every              culture has stories of how people get sick, get better, and stay                healthy. One exercise is for learners to identify and share stories             from their cultural heritages. Students work in small groups that               are mixed ethnically. They discuss their own ideas about causes of              illnesses and ways to stay healthy. Students then complete a                    take-home assignment in which they find a traditional story from                their culture that explains how people get sick, get better, and                stay healthy. The exercise helps them to understand the cultural                roots of healing. Quite often, students who say "I have no culture"             benefit the most from this exercise of exploring cultural messages.             They are challenged to look at mainstream folk ideas (e.g., not                 covering your head in the rain causes a cold) and to acknowledge                that these ideas are not necessarily believed by all to cause                   illness. This approach works with elementary through                            university-level students. 
Case studies: 
One way to help                    students think about promoting and managing health is to have them              interview the person in their families who takes care of health                 needs. Students ask a set of open-ended questions such as: what are             the most serious potential health problems for family members, what             are the best ways to deal with these problems, who decides what to              do, how do you keep from getting these problems. Cultural                       differences emerge as students share the cultural management of                 health promotion and illness in their homes. Note: A good way to                involve parents is to invite them to class to be interviewed or                 share stories. 
Themes: 
Different health-related themes are the              basis for learners' explanations of what their culture would say                about a specific issue. Examples of cross-cultural health themes                around which shared values can be develop include the                           following: 
Respecting boundaries. There is a great deal of                    cultural variance on what parts of the body can be touched, when                they can be touched, and what parts are considered clean. For                   example, an Asian American child may be highly offended if the head,            the sacred part of her body, is patted, whereas most other American             children would consider that a sign of affection. According to many             cultures, the bottom of the foot may be seen as more unclean than               the anus or the mouth. Sexual exploration can be discussed in the               context of who touches whom and under what conditions. 
Eating for             health. Every culture speaks to the shared value of the relationship            of food and health. Food is frequently the first treatment for                  illness and highly valued in preventing illness. Students learn to              value knowledge from other cultures by exploring how their own and              other cultures use food to promote health. For example, an Asian                student might bring examples of hot and cold foods to the class and             explain the theoretical premise behind hot-cold food balance as                 therapy. The use of food for different situations can be explored               across cultures--for example, foods to heal, foods to comfort during            illness, foods to prevent illness, foods to protect babies, foods               for pregnant mothers, and foods for the elderly who are sick. The               cultural variation becomes a fascinating experience for the learners            and a source of identity and pride for those sharing. 
Body image.             Cultural groups often vary in their definitions of an acceptable and            desirable body size.  Hispanic and African American men and women               are more accepting of larger sized persons, equating large size with            strength, power, and beauty. Caucasian Americans are more likely to             associate leanness--and even extreme thinness in women--with                    beauty.  Adolescent students can be challenged to examine their own             beliefs about a positive body image by bringing to class pictures or            drawings of people who conform to their standards for an agreeable              body image.  Students may then discuss in small groups how both mass            media and their own culture affect body image. 
Causes of illness.             Every culture describes underlying causes of illness--failure to                follow social codes, lack of self-control, inadequate nutrition,                lack of harmony with the natural world, poor immunity, germs, "bad              winds." That illness is a cause-effect event is a shared value among            many cultures but causes vary. Cambodian children may whisper that              the real cause of illness is revenge of the neak ta, the spirits of             the trees, who are offended if one speaks loudly or rudely.                     Cross-cultural sensitivity develops when students identify causes in            an open environment in which their opinions are respected and not               negated. BRING IT HOMEPeace Corps incorporates three                      goals--serve, learn and bring the message home. In a multi-cultural             society, health educators need to incorporate these goals to serve              the needs of all children, helping them to feel pride in what their             cultures have to say about being healthy. Educators need to find                common ground and identify shared values about health among                     America's many subcultures. Most of all, educators need to bring it             home--the message that every American culture has unique strengths,             knowledge's, and wisdom concerning health. REFERENCESAnderson,            E.N. (1998). Child-raising among Hong Kong fisherfolk: Variations on            Chinese themes. Bulletin of the Institute of Ethnology, 86,                     121-154. 
Barnlund, D. (1994). Communication in a global village.              In L. Salmovar and R. Porter (Ed), Intercultural Communication: A               Reader (pp. 26-35). Belmont, CA: Wadsworth Publishing                           Co. 
Ben-David, A. & Amit, D. (1999). Do we have to teach them to              be culturally sensitive? The Israeli experience. International                  Social Work, 42(3), 347-358. 
Chen, C. & Uttal, D. (1988). Cultural            values, parents' beliefs, and children's achievement in the United              States and China. Human Development, 31, 351-358. 
Edelman,                    M. (1992). The measure of our success: A letter to my children and              yours. Boston, Mass: Beacon Press. 
Frye, B. & McGill, D. (1993).              Cambodian refugee adolescents: Cultural factors and mental health               nursing. Journal of Child and Adolescent Psychiatric and Mental                 Health Nursing, 6(4), 24-31. 
Kavanagh, K., Absalon, K., Beil, W.,             Jr., & Schliessmann, L. (1992).  Connecting and becoming culturally             competent: A Lakota example. Advances in Nursing Science, 21(3),                9-31. 
Laboratory of Comparative Human Cognition. (1986).                      Contributions of cross-cultural research to educational practice.               American Psychologist, 41(10), 1049-1058. 
Sadler, G.R., Nguyen,               F., Doan, Q., Au, H., & Thomas, A.G. (1998). Strategies for reaching            Asian Americans with health information. American Journal of                    Preventive Medicine, 14(3), 224-228. 
Stycos, J. (1998). Population            knowledge and attitudes of Latin American adolescents: Impact of                gender, schooling and culture. Cross-Cultural Research, 32(4),                  378-399. 
RESOURCES FROM ERIC 
These Digests are available from               the ERIC database at                                                            www.accesseric.org/resources/resources.html: 
Meeting the                      Educational Needs of Southeast Asian Children. (1990). ED 328                   644. 
Blueprints for Indian Education: Languages and                           Cultures. (1994). ED 372 899. 
Valuing Diversity in the                        Multicultural Classroom. (1994). ED 378 846. 
Hispanic-American                Students and Learning Styles. (1996). ED 393 607. 
Selecting                   Culturally and Linguistically Appropriate Materials. (1999). ED 431             546. 
Arab American Students in Public Schools. (1999). ED 429                 144. 
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This project has been funded at least in part with               Federal funds from the U.S. Department of Education, Office of                  Educational Research and Improvement, under contract number                     ED-99-CO-0007. The content of this publication does not necessarily             reflect the views of or policies of the U.S. Department of Education            nor does mention of trade names, commercial products, or                        organizations imply endorsement by the U.S. Government.                      **Title:** School Health Education in a Multicultural Society. ERIC Digest.             **Document Type:** Information Analyses---ERIC Information Analysis Products (IAPs) (071); Information Analyses---ERIC Digests (Selected) in Full Text (073); **Available From:** ERIC Clearinghouse on Teaching and Teacher Education, American                  Association of Colleges for Teacher Education, 1307 New York Avenue,            N.W., Suite 300, Washington, DC 20005-4701. Tel: 202-293-2450 or                800-822-9229 (Toll Free); e-mail: [email protected]. For full text:               http://www.ericsp.org.                                                       **Descriptors:**  Comprehensive School Health Education, Consciousness Raising,                   Cultural Awareness, Cultural Differences,  Diversity (Student),                Elementary Secondary Education, Health Behavior,  Multicultural                 Education, Student Attitudes                                                 **Identifiers:** ERIC Digests,  Health Attitudes                                              
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