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.

www.nap.edu



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R1
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

OCR for page R1
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 mem- bers 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 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2013. Leveraging culture to address health inequalities: Examples from native communities: Workshop summary. Wash- ington, DC: The National Academies Press.

OCR for page R1
“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

OCR for page R1
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences 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. www.national-academies.org

OCR for page R1
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 1  Institute of Medicine planning committees are solely responsible for organizing the work- shop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

OCR for page R1

OCR for page R1
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 1  Institute 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. vii

OCR for page R1
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 viii

OCR for page R1
Reviewers This workshop summary has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accor- dance 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 proce- dures and that all review comments were carefully considered. Responsibil- ity for the final content of this workshop summary rests entirely with the authors and the institution. ix

OCR for page R1

OCR for page R1
Contents ABBREVIATIONS AND ACRONYMS xiii 1 INTRODUCTION AND THEMES OF THE WORKSHOP 1 Organization of the Summary, 2 Key Themes, 3 2 CULTURE AS A SOCIAL DETERMINANT OF HEALTH 5 The Broad Determinants of Health, 5 Indigenous Cultures, 6 Cultural Competence, Cultural Safety, and Cultural Humility, 8 Cultural Continuity, 8 The Relationship to the Land, 9 Research, 9 Recommendations in the Commissioned Paper, 9 Discussion, 11 3 WHY CULTURE MATTERS IN ADDRESSING HEALTH INEQUITIES 13 The Legacy of Colonialism, 13 Incorporating Traditional Values and Practices into Federal Policies, 16 Discussion, 18 xi

OCR for page R1
xii CONTENTS 4 CULTURAL SENSITIVITY IN HEALTH CARE DELIVERY AND RESEARCH 21 A Mentoring Program for Native Students, 21 Increasing the Number of Culturally Aware Clinicians and Researchers, 25 Increasing the Number of Native Practitioners in Hawaii and the Pacific Islands, 28 Weaving Culture into the Clinical Setting, 29 Discussion, 30 5 DIABETES PREVENTION IN NATIVE COMMUNITIES 33 Diabetes Programs Among the Mississippi Band of Choctaw Indians, 33 Diabetes Prevention in Alaska, 35 Diabetes Prevention and Management Among Pacific Islanders, 36 Discussion, 40 6 CANCER PREVENTION AND TREATMENT IN NATIVE COMMUNITIES 43 A Cancer Patient Navigation Training Program in Hawaii, 44 A Comprehensive Cancer Control Program in the Northwest, 46 Cultural Issues in Cancer Prevention and Survivorship, 49 7 REFLECTIONS ON THE WORKSHOP 53 The Importance of Culture, 53 A Focus on Prevention, 54 The Power of Community, 54 Institutions and Training, 55 The Need for Change, 55 References 57 APPENDIXES A CULTURE AS A SOCIAL DETERMINANT OF HEALTH 59 B AGENDA 77 C SPEAKER BIOGRAPHIES 81

OCR for page R1
Abbreviations and Acronyms 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 xiii

OCR for page R1