Leveraging Culture to Address Health Inequalities Examples from Native Communities: Workshop Summary (2013) / Chapter Skim
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Appendix A: Culture as a Social Determinant of Health
Appendix A: Culture as a Social Determinant of Health
Pages 59-76
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From page 59... ...
The extreme levels of poverty among Native American populations mean lower education attainment, economic adversity, social dysfunction, and little or no access to high-quality health care. Additionally, because the traditional biomedical approach focuses primarily on disease progression and treatment, traditional Indigenous healing practices and other cultural complexities often have not been taken into account in the design of programs to change health behaviors and improve health outcomes in Indigenous communities.
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From page 60... ...
In dealing with individuals in a mechanistic way -- that is, as a collection of parts working as a very complex machine -- science and medicine have made great strides in our understanding of human biology and the biology of disease. In practice, however, this viewpoint results in a piecemeal and symptomatic approach to disease and ill health.
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From page 61... ...
The Path to Healing: Report of the National Round Table on Aboriginal Health and Social Issues.
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From page 62... ...
The following are of particular importance when considering the health of Native American individuals, communities, and populations: • culture and cultural continuity, • access to services and supports, • colonization, • globalization, • migration, • poverty, • self-determination, and • territory.4 3 Brascoupé,S., and Waters, C., Cultural Safety: Exploring the Applicability of the Concept of Cultural Safety to Aboriginal Health and Community Wellness. Journal of Aboriginal Health.
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From page 63... ...
Culturally competent and culturally safe care will need to recognize that one of the main causes of ill health in Indigenous communities and nations has been the almost complete disregard for and denigration of cultural
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From page 64... ...
The Importance of Culture in Patient-Centered Care There is growing recognition of the need for culturally safe, patientcentered care in improving the health outcomes of minority populations, particularly Native American populations. The health status of Indigenous populations is well below the national average both in Canada and the United States.6 The experience of many Indigenous populations with the mainstream health care system has been negative, often due to cultural differences.
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From page 65... ...
. Currently, the dominant discourse on cultural awareness, cultural sensitivity, cultural competence, and cultural safety can be viewed as a continuum that measures the congruence of a person's culture and his or her experience in the health system.
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From page 66... ...
The provision of culturally safe care involves lifelong learning and continuous development and refinement of competence based on awareness of the cultures of their clients and sensitivity to how culture mediates determinants of health, as well as their clients' experience with and beliefs about the health care system. Cultural safety is the outcome of culturally competent care.
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From page 67... ...
This would be seen as a goal for all health systems and all clients but, for the most part, would be a continuous and iterative process to be striven toward and not necessarily an end result in and of itself. An overarching concept necessary for the creation of cultural safety in health services and systems is the willingness of health care professionals to develop, implement, and internalize the idea of cultural humility, which can be defined as follows: Cultural Humility incorporates a lifelong commitment to self-evaluation and critique, to redressing the power imbalances in the physician-patient dynamic, and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations.13 Cultural humility can be seen as the driving force in moving health and health care services further toward culturally safe care, and is based on a specific and ongoing commitment of service providers, administrators, policy developers, and decision makers.
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From page 68... ...
The responses of communities would then be more likely to be culturally-based -- and therefore more likely to be culturally competent and culturally safe -- even in instances where these responses include or utilize external service providers or structures. It is important to note that Native American populations differ significantly from other minority groups in their conceptions, relationships, and interactions with lands and territories as well as with the State or States currently occupying their lands or territories.
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From page 69... ...
Indeed, higher costs typically do not equal better care -- and sometimes they mean the opposite.16 Through shared colonial histories, Australia, Canada, New Zealand, and the United States share relatively similar levels of development, economic philosophies, and legislative regimes. Each of these countries also has similar experiences with respect to relations with Indigenous populations.
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From page 70... ...
, control of education, security and cultural facilities, as well as control of the policies and practice of health and social programs. Cultural continuity also involves traditional intergenerational connectedness, which is maintained through intact families and the engagement of elders, who pass traditions to subsequent generations.18 Land and Self-Determination It is important to note that Native American populations differ significantly from other minority groups in their conceptions, relationships, and interactions with lands and territories.
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From page 71... ...
Colonization and marginalization have resulted in some of the worst health outcomes in the world for Indigenous communities in Canada and the United States. Elders and Healers continue to practice and develop Indigenous healing traditions to this day, and continue to call for support for these traditions as part of any response to the dismal determinants of health and poor health outcomes in many Indigenous communities and nations.
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From page 72... ...
The ideas and assumptions that drive research in its current form must be examined and reframed to be more inclusive of Indigenous insights and perspectives if that research truly seeks to be reflective of, or useful to, Indigenous peoples, communities, and individuals. With respect to Indigenous definitions or understanding of research, it is important to note that Indigenous communities are not, for the most part, against the acquisition of knowledge or information that results from research.
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From page 73... ...
Unfortunately, many Indigenous communities have been the victims of research that was badly designed, failed to collect accurate information or understand information in context, and did not communicate its findings well. Indigenous peoples and communities have cooperated with -- and sometimes have been forced to engage with -- research they had little say in or control over and that was used to further misinformation and negative stereotypes.
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From page 74... ...
This res toration, sought by many Indigenous peoples, is based on a return to traditional spiritual values, Indigenous knowledge, and culture. • The focus should be on training current health care providers to be culturally competent in the short term while working toward the goal that all service providers share the cultural background of the clients they serve.
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From page 75... ...
. • Pursuit of equity in access to culturally competent health care and healing services must be an overarching goal of any strategy for the amelioration of negative health outcomes.
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From page 76... ...
Good research involving Indigenous peoples o onsiders the root causes of ill health and the requirements for c optimal health that are particular to the experiences and histo ries of Indigenous peoples; o espects the worldviews of Indigenous peoples on connected r ness, respect, balance, and the equal importance of physical, emotional, social, mental, and spiritual health; o rovides insight into key health issues, and offers the potential p to improve promotion, prevention, treatment, rehabilitation, and family and community support; and o ddresses particular issues within the context of the long-term a aspirations of Indigenous communities to be self-sustaining, healthy, and prosperous. • The importance of the relationship of Native Americans to their lands and territories cannot be overstated.
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