LEVERAGING CULTURE TO
ADDRESS HEALTH INEQUALITIES
Examples from Native Communities
Workshop Summary
Karen M. Anderson and Steve Olson, Rapporteurs
Roundtable on the Promotion of Health Equity and the
Elimination of Health Disparities
Board on Population Health and Public Health Practice
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This activity was supported by contracts between the National Academy of Sciences and Aetna Inc.; Kaiser Permanente; Health Resources and Services Administration; Kresge Foundation; Merck & Co., Inc.; National Institute on Minority Health and Health Disparities; and the Robert Wood Johnson Foundation. The views presented in this publication do not necessarily reflect the view of the organizations or agencies that provided support for this activity.
International Standard Book Number-13: 978-0-309-29256-6
International Standard Book Number-10: 0-309-29256-5
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Suggested citation: IOM (Institute of Medicine). 2013. Leveraging culture to address health inequalities: Examples from native communities: Workshop summary. Washington, DC: The National Academies Press.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
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The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.
PLANNING COMMITTEE ON LEVERAGING CULTURE TO ADDRESS HEALTH INEQUALITIES1
JENNIE R. JOE (Chair), College of Medicine, University of Arizona
EVE J. HIGGINBOTHAM, Emory School of Medicine
JOHN C. (JACK) LEWIN, Lewin and Associates
NEWELL McELWEE, Merck & Co., Inc.
MILDRED THOMPSON, PolicyLink
WILLIAM VEGA, University of California, Los Angeles
ANTONIA M. VILLARRUEL, University of Michigan
TERRI D. WRIGHT, American Public Health Association
______________
1Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
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ROUNDTABLE ON THE PROMOTION OF HEALTH EQUITY AND THE ELIMINATION OF HEALTH DISPARITIES1
WILLIAM VEGA (Chair), University of Southern California
MILDRED THOMPSON (Co-Chair), PolicyLink
PATRICIA BAKER, The Connecticut Health Foundation
GILLIAN BARCLAY, Aetna Foundation
ANNE C. BEAL, Patient-Centered Outcomes Research Institute
AMERICA BRACHO, Latino Health Access
IRENE DANKWA-MULLAN, National Institutes of Health
JAMILA DAVISON, ACM Medical Transition Care
ALLAN GOLDBERG, Merck & Co., Inc.
NADINE GRACIA, Department of Health and Human Services
TOM GRANATIR, American Board of Medical Specialties
EVE J. HIGGINBOTHAM, Emory School of Medicine
A. MELISSA HOUSTON, Health Resources and Services Administration
CARA V. JAMES, Centers for Medicare & Medicaid Services
JENNIE R. JOE, College of Medicine, University of Arizona
JAMES R. KIMMEY, Missouri Foundation for Health
ANNE C. KUBISCH, The Aspen Institute
JEFFREY LEVI, Trust for America’s Health
JOHN C. (JACK) LEWIN, Lewin and Associates
NEWELL McELWEE, Merck & Co., Inc.
PHYLLIS W. MEADOWS, Kresge Foundation
GARY NELSON, Healthcare Georgia Foundation
ELENA O. NIGHTINGALE, Institute of Medicine
DAVID PRYOR, NBC Universal
AMELIE G. RAMIREZ, University of Texas Health Science Center
JOHN RUFFIN, National Institutes of Health
MELISSA SIMON, Northwestern University, Feinberg School of Medicine
SAM SO, Stanford University
PATTIE TUCKER, Centers for Disease Control and Prevention
ANTONIA M. VILLARRUEL, University of Michigan
WINSTON F. WONG, Kaiser Permanente
TERRI D. WRIGHT, American Public Health Association
______________
1Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
IOM Staff
KAREN M. ANDERSON, Senior Program Officer
ANDRÉS GAVIRIA, Research Associate (until August 2013)
ALEJANDRA MARTIN, Research Associate (until July 2012)
DORIS ROMERO, Financial Associate
HOPE HARE, Administrative Assistant
ROSE MARIE MARTINEZ, Senior Director, Board on Population Health and Public Health Practice
Reviewers
This workshop summary has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:
Stacy Bohlen, National Indian Health Board
Loretta J. Fuddy, Hawaii Department of Health
Tom Granatir, American Board of Medical Specialties
Elena O. Nightingale, Institute of Medicine
David Pryor, NBC Universal
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Ned Calonge. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the authors and the institution.
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Contents
1 INTRODUCTION AND THEMES OF THE WORKSHOP
2 CULTURE AS A SOCIAL DETERMINANT OF HEALTH
The Broad Determinants of Health
Cultural Competence, Cultural Safety, and Cultural Humility
Recommendations in the Commissioned Paper
3 WHY CULTURE MATTERS IN ADDRESSING HEALTH INEQUITIES
Incorporating Traditional Values and Practices into Federal Policies
4 CULTURAL SENSITIVITY IN HEALTH CARE DELIVERY AND RESEARCH
A Mentoring Program for Native Students
Increasing the Number of Culturally Aware Clinicians and Researchers
Increasing the Number of Native Practitioners in Hawaii and the Pacific Islands
Weaving Culture into the Clinical Setting
5 DIABETES PREVENTION IN NATIVE COMMUNITIES
Diabetes Programs Among the Mississippi Band of Choctaw Indians
Diabetes Prevention and Management Among Pacific Islanders
6 CANCER PREVENTION AND TREATMENT IN NATIVE COMMUNITIES
A Cancer Patient Navigation Training Program in Hawaii
A Comprehensive Cancer Control Program in the Northwest
Cultural Issues in Cancer Prevention and Survivorship
ACA | Patient Protection and Affordable Care Act |
AI | American Indian |
AN | Alaska Native |
DHAT | dental health aide therapist |
FSM | Federated States of Micronesia |
IHS | Indian Health Service |
IOM | Institute of Medicine |
MRI | magnetic resonance imaging |
NCAI | National Congress of American Indians |
OHSU | Oregon Health and Science University |
SAMHSA |
Substance Abuse and Mental Health Services Administration |
SEARHC | SouthEast Alaska Regional Health Consortium |
UN | United Nations |
VA | Department of Veterans Affairs |