Ruth DeSouza » Culture and health

Culture, religion and health

This page was named bookmark of the month for July by the Centre for Health Assets Australasia July newsletter (pdf)

Working effectively with diversity in health and social services

Health care professionals are becoming more concerned about how to provide care for diverse groups. In addition the health workforce is becoming increasingly diverse (see page about migrant nurses). My particular interest is in those who are religiously and culturally different, but some of the concerns below could also be relevant for people who are marginalised because of their sexuality, disability, mental illness, age socio-economic status and gender.

Access to Health and Determinants of health

Aging

Alcohol and drugs

Bibliographies and resources

Some useful bibliographies

Children

These are papers from the Australasian Conference on Child Abuse and Neglect (ACCAN) held this year that deal specifically with migrant and refugee children

Cultural competence

Cultural safety

In New Zealand, the term cultural safety is used to signify the "obligation of the professional to practice safely" and consists of both a conceptual framework for understanding power inequalities structuring the relationships between Tangata Whenua and mainly Pakeha health professionals and practical strategies that can be utilised. The Treaty of Waitangi is seen as pivotal to its application as a negotiation tool for resource allocation for Maori. Cultural safety education has been a compulsory part of nursing education for the last ten years. Little is known of how cultural safety education in nursing translates into safe care for migrants in New Zealand because the focus has been largely on the partnership between nurses and Maori.

Culture and health links

Culture-Health-Ireland

An email discussion group for researchers and practitioners interested in the field of culture and health care in Ireland The aim of this email discussion list is to bring together researchers and practitioners from a range of disciplines interested in the relationship between culture and health care in Ireland and abroad. The list is multi-disciplinary and multi-sectoral and includes a variety of institutions and sectors. Bibliographies and contact information

Disability

Some useful resources on disability:

Ethnicity data collection

Accurate data monitoring of the experiences of groups is critical for successful policy and programme intervention. Reliable ethnicity data are needed as New Zealand becomes more ethnically diverse and some groups are uncounted or undercounted. Maori have been frustrated by the inefficiencies, inconsistencies, and general lack of responsiveness of current health information systems. Maori models of health emphasise the importance of integrating information about health with the wider social and economic context. Current health information systems are fragmented, however, with different providers using different standards and IT systems that impede - rather than facilitate - the integration of health care. The ethnicity definition used by different agencies and providers is inconsistent, so the data produced is poor. Gaps in data collections hinder sound analysis, policy and strategy development, and decision-making. Data - anonymous or not - has enormous spiritual and cultural significance for Maori , so may require more attention and protection than generally given.

Faith Communities

There is a need to recognise the importance of faith as a marker of self-identity. Debate is rife about whether there should be faith centred health and social policy initiatives to improve health outcomes for faith communities, who have been shown to experience health inequalities (for example Muslims in the United Kingdom). While, there have been developments to address inequalities experienced by minority ethnic communities, some would argue that religious discrimination is equally significant and should not be denied..

Migrant News columns

Online journals

Refugee Health

There are 9.6 million refugees in the world and about 11 million displaced people in need of protection and help (UNHCR, 2003) and 1% of the people in the world are refugees or displaced persons. Over 80% of all refugees are in developing countries. Migrants make up less than 3% of the world’s population but the world’s migrant stock increased by 75 million between 1980 and 2000. Europe ’s migrant numbers rose by 11 million to 33 million between 1980 and 2000. The US foreign born population grew from 14 million to 35 million between 1980 and 2000. One in every 15 people in Europe and one in every 8 in the US was born overseas. In the developed world migration accounts for a greater share of population increase than natural growth ( La Guardia, 2005). , most recently, I have become interested in whether health care workers should we focus on war and trauma or the more mundane everyday aspects of resettlement? (Grønseth, 2006). Many argue that perceived social support from the migrant's ethnic community, pre-migration trauma, family status and gender are associated with mental health outcomes (Schweitzer, Melville, Steel & Lacherez, 2006) rather than trauma.Laban (2005) suggests that mental health workers should recognize the impact of post-migration living problems and consider focusing treatment on coping with these problems instead of traumas from the past (Laban, 2005).Summerfield suggests that there is little acknowledgment to the role of social action and empowerment in promoting mental health and that survivors first seek to regain a measure of dignity and control over their environment and then to reconstitute the cultural, social, and economic institutions and activities that make sense to them. Summerfield asks whether a relentless and intrusive insistence on talking about what has happened ie ventilation and catharsis always best. Or is the delivery of adequate nutrition and general health care, decent accommodation, language tuition, safety from xenophobic violence and training for jobs? Is it useful to have one’s experiences professionalised and pathologised?

Sexual health

Some useful resources on sexual health

he literature has many suggestions about how health providers can work effectively with culturally diverse populations. Health care services need to be both universal, treating people equally and particular by responding to people's different needs differently in order to be equitable (Fuller, 1997). Strategies need to range from individual, structural, universal and particular, culturally sensitive and anti-racist. Change strategies need to be directed both to the care given to the consumer as well as to the operation of health services, as care locked within a biomedical and assimilationist model of health care will continue to impact negatively on consumers.

Support workers or cultural mediators

The evolution of a new professional group known as Mental Health Support Workers (MHSW) in the last few years with little formal training or qualifications, has raised concerns within the mental health workforce. Three reasons for the development of their role have been firstly that support workers fill the gaps in community care, particularly in terms of work with clients with complex needs not met within the current mental health system (Davies, Harris, Roberts, Mannion, McCosker & Anderson, 1996). Secondly, they have a recovery philosophy and meet the social needs of consumers, which are largely ignored by clinical mental health services. Finally, reports identify a paucity of culturally safe services for Maori and Pacific people. There is a need for more trained mental health workers before culturally appropriate services can be provided by mainstream and kaupapa Maori mental health services (Ministry of Health, 1997, Te Puni Kokiri,1993). National objectives in this document recommend the education of consumers as providers, community support workers and Maori and Pacific Island workers, which has led to the development of the National Certificate in Mental Health (Mental Health Support Work). There is also a term called cultural mediation where a cultural mediator or support worker, "facilitates communication when misunderstandings or conflicts due to cultural and linguistic differences pose actual or potential barriers between people of different backgrounds and service providers" (Access Ireland)

Translation help

These have been collated by Frankie Luxmoore-Peake, Health Promotion Library Manager, Brighton and Hove City Primary Care Trust and I've added some more.

home   migration & culture   mental health   women's health   nursing   education   research   profile   contact

Copyright © 2003-2007 Ruth DeSouza. All rights reserved. Contact: ruth[at]wairua.com.