7

Reflections on the Workshop

During the final session of the workshop, Michael Painter, senior program officer at the Robert Wood Johnson Foundation, invited participants to sum up the lessons they had drawn from the day’s presentations and discussions. This chapter summarizes those observations, with the name of the participant who made the comment in parentheses.

THE IMPORTANCE OF CULTURE

•   Healing is different than treatment. (Mildred Thompson, PolicyLink Center for Health and Place)

•   Wellness is more than the absence of disease. It has spiritual, emotional, and cultural dimensions that extend beyond health care into the community. (Thompson)

•   Cultural humility is a critical dimension of delivering culturally safe care. (Thompson)

•   Good health involves harmony, balance, and rhythm, not just the absence of disease. (Jack Lewin, JCL Health Innovation Strategies)

•   Health care by itself does not guarantee good health. Many other factors are involved. (Jennie R. Joe, University of Arizona)

•   More important than the newest technologies are transportation, nutrition, sanitation, and other basic services. (Lewin)

•   Given the rates of re-admission and nosocomial infections that occur in hospitals, the perspective common in Native communities that hospitals are a place where people go to die is not surprising. (Lewin)



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7 Reflections on the Workshop During the final session of the workshop, Michael Painter, senior pro- gram officer at the Robert Wood Johnson Foundation, invited participants to sum up the lessons they had drawn from the day’s presentations and discussions. This chapter summarizes those observations, with the name of the participant who made the comment in parentheses. The Importance of Culture • Healing is different than treatment. (Mildred Thompson, PolicyLink Center for Health and Place) • Wellness is more than the absence of disease. It has spiritual, emo- tional, and cultural dimensions that extend beyond health care into the community. (Thompson) • Cultural humility is a critical dimension of delivering culturally safe care. (Thompson) • Good health involves harmony, balance, and rhythm, not just the absence of disease. (Jack Lewin, JCL Health Innovation Strategies) • Health care by itself does not guarantee good health. Many other factors are involved. (Jennie R. Joe, University of Arizona) • More important than the newest technologies are transportation, nutrition, sanitation, and other basic services. (Lewin) • Given the rates of re-admission and nosocomial infections that occur in hospitals, the perspective common in Native communities that hospitals are a place where people go to die is not surprising. (Lewin) 53

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54 LEVERAGING CULTURE TO ADDRESS HEALTH INEQUALITIES • Equity is important because everyone does better when everyone is doing well. (Thompson) • Medicine is a compassionate and caring field, and the people who choose that profession are people who appreciate the importance of culture and can incorporate it into practice. (Arne Vainio, Fond du Lac Ojibwe Reservation) • Humor is an important part of wellness, and humor was a prominent feature of the Workshop on Leveraging Culture to Address Health Inequalities: Examples from Native Communities. (Thompson) A Focus on Prevention • Under the Patient Protection and Affordable Care Act (ACA), medical facilities are going to be doing much more early screening, prevention, and reaching out to communities, activities tradition- ally associated with public health. Yet, public health schools and medical schools are largely siloed from each other and have so far failed to engage in dialogue. (William Vega, University of Southern California) • Effort devoted to prevention will reduce the amount of effort devoted today to treating diabetes, cancer, and other diseases. (Thompson) • Prevention requires a holistic perspective that encompasses a per- son’s circumstances and multiple health-related conditions, rather than a piecemeal perspective. (Joe) The Power of Community • Native peoples have much to offer in the refashioning of health care. (Lewin) • Cultural traditions should reshape health care, not the other way around. (Lewin) • The power of Native communities resides partly in their ability to convene as communities and identify what needs to be done. (Ralph Forquera, Seattle Indian Health Board) • The power of community that is well known among Native peoples is being realized technologically through such means as Facebook. (Lewin) • The people being served by the health care system need to be involved in developing new payment and delivery models and oth- erwise shaping the future of health care. (Lewin)

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REFLECTIONS ON THE WORKSHOP 55 • Most scientific studies of U.S. populations still list American Indi- ans and Alaska Natives as “other.” Native peoples need to make their voices heard if they are to be treated fairly in research. (Roger Dale Walker, Oregon Health and Science University) • Seven out of 10 Indians now live off reservations, and better health for Native Americans has to encompass all members of these com- munities, not just the Native people who live on reservations. (Forquera) Institutions and Training • Institutions, professions, and groups of people all have their own cultures, which in turn have an effect on health. (Joe) • Native people need to think about how to get their message across at the highest levels, and health care reform offers an opportunity to do that. (Walker) • Health care training generally does not reflect cultural differences. A new emphasis on relationships and two-way exchanges is essen- tial to accommodate the effects of culture on health. (Joe) • Health care providers need to be trained to deliver care in a respect- ful way to patients, yet health care training itself can be inherently disrespectful to trainees. (Eve J. Higginbotham, Emory School of Medicine) The Need for Change • Paradoxically, during a time of radical change in science, health care, and government, people will need to change to preserve and protect the cultural traditions that contribute to good health. (Michael Painter, Robert Wood Johnson Foundation) • In an era of big data, improving the quality and outcomes of health care will be a major theme. (Lewin) • Technical changes, such as adopting technologies and instituting quality improvements, are straightforward compared with cultural changes. (Painter) • Given constrained federal funding for health care, creativity will be needed to improve equity in the U.S. health care system. (Lewin) • One reason it is important to preserve culture is that culture is a tool that can be leveraged to create change. (Painter) • Self-determination equals power, and power contributes substan- tially to health. (Thompson)

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56 LEVERAGING CULTURE TO ADDRESS HEALTH INEQUALITIES • As the novelist and poet Alice Walker has written, the most com- mon way that people lose power is by not realizing that they had any in the first place. (Painter) “This has been a great meeting,” said Painter in summing up the work- shop. “There was a lot of knowledge and creativity and innovation and wisdom here, and that’s a good thing, because our country and our nation face some incredibly complex and huge problems.”