Ethics Grand Rounds: Cross-Cultural Care in a Culture of Poverty
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Cultural Competence includes understanding and having empathy for the unique circumstances experienced in poverty. Presented in Providence Stevens County October 16 2015
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Ethics Grand Rounds: Cross-Cultural Care in a Culture of Poverty
- 1. Ethics Grand Rounds: Cross-Cultural Care in a Culture of Poverty Presented by Andrea Chatburn, DO, MA Medical Director for Ethics 10.16.2015
- 3. Objectives ⢠Define and identify social determinants of health (SDH) ⢠Apply the concept of social determinants of health to healthcare in the TriCounty area of Washington ⢠Demonstrate new responses to individual patient encounters from a capabilities approach to SHD
- 4. Providence Model for Ethics Clinical Integrity Beneficence Autonomy Justice & Non-Maleficence Kockler, N. Seeing Ethics Consultations for the First Time: Disclosure Models, Analytic Design, and Ethical Decision-Making. Š2014 âNicholas J. Kockler
- 5. Social Determinants of Health- Why Should We Care? WHO: âCircumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illnessâ Preda, A., K. Voigt. The Social Determinants of Health: Why Should We Care? The American Journal of Bioethics, pp. 25-36, 15(3):25-26, 2015.
- 7. By Madison Corney of CCA Baldi Middle School Mc on Avon
- 8. WHO 2010
- 10. Migrant Mother by Lange
- 11. USDA Food Desert Map http://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas.aspx
- 13. Goals of Medicine & Social Justice 1. Give every child the best start in life 2. Enable all people to maximize capabilities & have control over their lives 3. Create fair employment and good work for all 4. Create and develop healthy, sustainable communities 5. Strengthen the role and impact of disease prevention Preda, A., K. Voigt. The Social Determinants of Health: Why Should We Care? The American Journal of Bioethics, pp. 25-36, 15(3):25-26, 2015.
- 14. Common Policy Targets ⢠Health care coverage & access for all ⢠Behavior: â Smoking â Diet â Alcohol ⢠Distinguish between health inequalities that are unfair, unjust and those that are not Preda, A., K. Voigt. The Social Determinants of Health: Why Should We Care? The American Journal of Bioethics, pp. 25-36, 15(3):25-26, 2015.
- 15. Social Justice ď reduce health inequalities âIt is always implicit in the Social Determinants of Health literature that the logical social response to the identification of social determinants of ill health is to transform themâ -Marmot 2009
- 16. Ethics asks âhow ought we be when we are with one anotherâ ChrisPerriman
- 17. Mission As people of Providence, we reveal Godâs love for all, especially the poor and vulnerable, through our compassionate service. Vision Together, we answer the call of every person we serve: Know me, care for me, ease my way.ÂŽ
- 19. Reciprocity: Honesty & Fairness ⢠Honesty/fidelity and fairness in medicine look different for different patients ⢠Fairnessď fair to the patient in their own context
Editor's Notes
- Autonomy: fairness to the patient within their own context; Justice: accountability to the legitimate interests of others
- These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politicsâ
- Itâs everything outside the traditional health care system, beyond what we can control within our hospitals, clinics and referral centers.
- Itâs an INDEPENDENT partial cause of an individualâs health status.
- -The most dramatic figures cited in SDH literature relate to differences in life expectancy across different cultures, for example life expectancies of more than 80 years in Japan or Sweden contrasted against a life expectancy of less than 50 years in many African countries. -Within high-income countries like the US, there are discrepancies in life expectancies between different socioeconomic groups. This has been studied and highlighted in Glasgow, Scotland which had a male life expectancy ranging from 54 years in areas of poverty and 82 years in the most affluent areas.
- In some medical literature, the health care system itself is a social determinant of health, influenced by and influencing the effect of other social determinants
- The Farm Bureau used this picture taken in 1936 of a mother of 7 who worked as a pea picker in California, but it remains a symbol of rural poverty in America to this day Marmot et al 2008: The poor health of poor people, the social gradient in health within countries⌠[is] caused by the unequal distribution of power, income, goods, and services, globally and nationally⌠Together the structural determinants and conditions of daily life constitute the social determinants of health and cause much of the health inequity between and within countries⌠social factors can be seen as âthe causes of the causesâ
- According to the USDA, a food desert is defined âlow income, low access communitiesâ - communities that have a poverty rate of 20% or greater OR a median family income at or below 80% of the nearby communities AND at least 33% of the population or 500 people live >10 miles from the nearest grocery store. According to NE WA trends, the Tri-county area- Stevens, Ferry, Pend Orielle- poverty rate was just over 20% in 2011 and was at 17.6% in 2013.
- 5 policy recommendations from the Marmot Review on inequalities in the UK
- Term distinction: inequality = differences, variations and disparities in health of individuals and groups inequity = those health inequalities that are unfair/ unjust- in other words, âwhere people have little or not choice in living and working conditions, the resulting health differences are more likely to be considered unjust [compared to] those resulting from health risks which were voluntarily chosen (Whitehead 1991)