Culture, Diversity and Health LecturePresentation Transcript
Culture, Diversity and Health in Practice Ben Harris-Roxas @ben_hr on Twitter
Who am I?
I’ve worked as a social worker and public health researcher. I consult and also teach at UNSW, UWS and the University of Newcastle I’m sorry I can’t be there.
A broader conceptualisation of the causes of health and illness require us to look atculture, gender and socioeconomic status
• Historical understandings
Miasma model of disease
The view that health ismerely the absence of illness and disease
controlling theenvironmental causes of disease =dealing with most public health concerns or does it?
many of the early gains in public health were linked to improving the environmental factors that cause disease the environmental determinants of health You’ll learn more about these during the course
sanitationvoted the most important medicaladvance since 1840.
air, water andsoil quality and toxicity
disease vector control
waste managementImage: ŧĒđĠūŸ®
housing quality andovercrowdin g
But the global burdenof disease has shifted
Source: WHO Global Burden of Disease 2002
Much of this disease still has environmental causes Many of the new causes of disease seemed to be different in nature to traditional environmental health concernsUnder-considered factors that powerfully influence healthand health related behaviours
NSW Health (2006) Report of the NSW Chief Health Office, NSW Health: Sydney.http://www.health.nsw.gov.au/public-health/chorep/dia/dia_typehos.htm
The causes of the causes? Image: Supermietzi
Schroder S. (2007) We Can Do Better: Improving the health of the American people. NewEngland Journal of Medicine, 357, 1221-1228.
What determines health? (A fuzzy pie chart) Genetics Opportunities/ 10-25% Socioeconomic Status 20-30%Risk Factors 20-40% Health Environment Services & Place 15-30% 5-15%
Dahlgren G, Whitehead M. (1991) Policies and Strategies to Promote Social Equity in Health.Stockholm: Institute of Futures Studies.
The Social Determinants of Health• Stress• Early life• Social exclusion• Work• Unemployment• Social support• Addiction• Food• Transport• The social gradient in health
Health Statistics NSWhealthstats.nsw.gov.au/Indicator/ses_lomidhiavodth
Murphy M et al. (2006) TheWidening Gap in Mortality byEducational Level in theRussian Federation, 1980-2001. American Journal ofPublic Health, 96:1293–99.cited inMarmot M. (2007) AchievingHealth Equity: From rootcauses to fair outcomes.Lancet, 370:1153-1163.
Health Impact Assessment and Culture
A combination of procedures, methods and tools by which a policy, program or project may be assessed for its potential and often unanticipated effects on the health of the population and the distribution of these impacts within the population. Gothenburg Consensus PaperEuropean Centre for Health Policy (1999) Gothenburg Consensus Paper on Health ImpactAssessment: main concepts and suggested approach, WHO Europe: Brussels (adapted byMahoney & Morgan).
HIA is a developing approach that can help to identify and consider the potential - or actual - health impacts of a proposal on a population. Its primary output is a set of evidence-based recommendations geared to informing the decision making process. Taylor & QuigleyTaylor L, Quigley R. (2002) Health Impact Assessment: A review of reviews. London: NationalHealth Service, Health Development Agency.
Key Aspects of HIA• A prospective activity• Uses a combination of methods• Looks at intended and unintended impacts• Looks at the distribution of impacts• Results in evidence- informed recommendations
When is an HIA done?
Explicit Focus on the Distribution of Impacts1. Age2.Gender3.Socioeconomic status4.Location5.Ethnicity and culture6.Existing levels of health anddisability
Assessment Recommendations If you These will be If you make These will beimplement the the impacts these changes the gains proposal
Health Impact Assessment of theNorthern Territory Emergency Response
• HIA conducted by the Australian Indigenous Doctors’ Association• Partly funded by Fred Hollows Foundation• Guided by communities in Central Australia and the Top End• CHETRE was a supporting partner (HIA expertise and data collection)
Overview• HIA of the Australian Northern Territory Emergency Response• Detailed discussions with four affected communities (some very remote), a panel of experts and a series of stakeholder interviews• Took almost 2 years and a large part of this involved building community trust and agreement to recommendations, ethics approval from three panels• Rethinking dimensions of health
The Dance of Lifeby Professor Helen Milroy
Selected indicators of Physical Psychologi Social Social Spirituality Cultural Health cal Health Health Wellbeing Integrity• premature • anxiety and • number of new • Autonomy – • recognition and • Evidence of mortality depression houses built personal and respect for having taken• morbidity • Suicide • number of new collective Aboriginal back from• self-reported • Stress houses • Opportunities people, world government health • trans- allocated to for social views, agencies• behavioural generational Aboriginal inclusion knowledge, certain rights of risks to health ‑ trauma, community • Participation in values and self- alcohol and cumulative members social decision aspirations government other trauma • number of making and • Aboriginal • Steps taken to substance • freedom from houses social action world views secure misuse, poor stigma, shame, meeting • Discrimination incorporated Aboriginal title nutrition, discrimination national quality • Trust (in other into policy to traditional smoking, • freedom from standards people and in development lands obesity, institutionalised • number of governments and • Degree of• physical racism school places, and their implementation community inactivity, teachers services, e.g. • alienation and control of interpersonal • opportunities health, justice despair services violence use of for employment and housing) • Official cultural health care • number and facilities to help services ‑ location of preserve and preventive and health services enrich cultural curative • number, lives, including services (e.g. qualifications, recognition and immunisation, and location of promotion of ear health, and health Aboriginal health checks) workforce languages • number, location of
The HIA predicts that“ the intended health outcomes.. are unlikely to be fully achieved through the NTER measures. It predicts that it will leave a negative legacy on psychological and social wellbeing, on the spirituality and cultural integrity of the prescribed communities. However it may be possible to minimise or mitigate these negative impacts if the Australian and NT governments commit to and invest in taking the steps necessary to work in respectful partnerships with Aboriginal leaders and organisations.”
Successes: Did the HIA have an impact?• No formal change to NTER• But better understanding of issues amongst all involved• Kept issue of health impacts of NTER on agenda• Expanded the discussion of impacts beyond physical and social health to look at social wellbeing, spirituality and cultural integrity
Challenges: The New Plan for Compulsory Income Management e.g. Stronger Futures in Bankstown
Opportunities: Thinking Differently?NTER Intervention recognised SDOH butnot the critical forces driving thedistribution of SDOH and the valuesneeded to drive the solution:•Democracy•Justice and Equity•Fairness•Transparency•Health•Sustainability
The importance of gender
Mental Illness and Gender Adrianna Mendrek CIHR Institute of Gender And Healthhttp://www.youtube.com/watch?v=hI-6Va_T7bw (6 mins)
• What factors determine the differences between men and women in terms of mental illness? – Biological and genetic – Behavioural – Social and cultural
My own clinical experience withdifferential diagnosis and culture
The End of Gender? Johanna Blakley TED Talkhttp://www.youtube.com/watch?v=ZR4LdnFGzPk’ (8 mins)
• Is this credible?• What’s wrong with her argument?• What’s right?• What does it tell us about the social construction of gender?
The Asian Super HighwayWhat are the potential healthimpacts?What information could we useto assess these potentialimpacts?
These slides are available atwww.slideshare.net/benharrisroxasEmail: firstname.lastname@example.orgTwitter: @ben_hr