Equality and Equity among Patients with Different Cultural Backgrounds
Author: Charlotte Okyerebea Ansah, Bsc student, Bachelor of healthcare,Nursing, Novia UAS.
Supervisor: Anita Wikberg, RN, RM, PhD, Senior Lecturer, Novia UAS.
ABSTRACT
Culture involves a set of shared values and believes or a set of learned behaviour among persons of a particular population group giving them a sense of belonging and identity. The concept of equality and equity in health has sometimes been used interchangeably but remain two distinct concepts in all cultural backgrounds.
To advance equality and equity in health depends heavily on the ability of health professionals and institutions to come up with systems and processes to overcome barriers to participation, the opportunities that allow individuals to influence decision making process and deliver change. The main idea for this article is to discuss some of the various barriers to the participation in the health delivery system by minority and disadvantaged groups.
Efforts needs to be made to involve not only children and the young but the elderly in the decision-making process that affects their health. Again, disabilities associated with blindness, deafness and language greatly dampens effective communication. And such providing effective information and communication will assure inclusive environment imperative for achieving an equal and equitable health. In addition, efforts to eliminate discrimination among minority groups in the health delivery system also help increase health equity and equality among patients from different cultural backgrounds.
INTRODUCTION
Advancing a conversation on equality and equity among patients with different cultural background requires an understanding of culture in order to appreciate the influence of equality and equity. In the view of Lebron (2013) culture entails a set of shared values and believes or a set of learned behaviour among persons of a particular society giving them a sense of belonging and identity. In its broadest sense culture is considered as a huge spiritual intricates, material, intellectual and emotional characteristics of a distinctive society or social group. It essentially involves modes of life, the fundamental rights of the human beings, values systems, traditions and beliefs (UNESCO, 1982).
In the opinions of Brown et al. (2020) there is no one true concrete definition of culture. Anthropologists generally considers tradition, development of self, kinship, structure of social unit including class structure, marriage, families, rite of passage, systems of beliefs and rituals. It is imperative for all to give cognizance to the emerging global community with its continuous improvement in fastpace communication and travelling and its effects on redefining culture. Deducing from the ongoing conversation shows that culture is the heart of every society and constitute the existence of society in essence.
Dell’Osso (2016) asserted that in the health delivery systems there are issues when addressed properly would assure equity, efficiency and quality of care for all. He believes that patients who access healthcare facilities comes from a different races, ethnicities and cultures as well as medical professionals. However, cultural insensitivity and intolerance continue to be pervasive in healthcare facilities which is adversely affecting our healthcare facilities and its surrounding communities. When all health professionals come to understand and appreciate the impact of culture in shaping the way we behave and why we do what we do, then we can truly create the opportunity for equality and equity in our health delivery system.
EQUALITY OF HEALTH
In its simplest form the right to equality and non-discrimination in our healthcare facilities have higher probability of advancing social rights, including the right to health (MacNaughton, 2011). Health equality entails same treatment and availability of healthcare service including access to all persons. Some researchers who took to the capability-based definition of equality affirm that an equal society protects and promotes equality of valuable capabilities. In essence an equal society recognizes the diverse capabilities of individuals and remove discrimination and prejudice and tackles the barriers that limits what individuals can do and be (Burchardt & Vizard, 2007).
The capability approach to equality focuses on what truly matters to people, recognizes diversity in needs that some individuals may require more support in order to realize its set goals, recognizes the barriers, constraints, structures and processes that affects the realization of each capability, recognizes the diversity in individual goals and the importance of facilitating its realization. The fact remains that promoting equality and addressing inequalities are at the centre of NHS England, (Public Participation Team, 2016), and the author also recognizes that it should be at the centre of all health delivery systems. People with special capability may experience some form of discrimination when trying to access healthcare. In order to advance equality and promote good relations and compliance to equality duty, certain barriers to participation and actions including age, disability, gender reassignment, marriage and civil partnership, race, religion or belief, sex or gender, sexual orientation among others needs to be addressed (Public Participation Team, 2016)
EQUITY OF HEALTH
Equity in health is generally seen as absence of systematic disparities in health between social groups with diverse capabilities. It is a known fact that inequality in health systematically reduce opportunities for individuals with poor capabilities including poverty, gender, race, ethnicity or religion (Braveman & Gruskin, 2003). In other considerations health equity is the attainment of the highest level of health for all persons including assuring full and equal access to opportunities that enable them to have a healthy life (Institute for Diversity and Health Equity, 2020).
The concept of health equity cannot be appreciated without a clear understanding of the constitution of the World Health Organization and the Universal Declaration of Human Right which came to light in the 1940s and recognize health as a fundamental human right that cannot be separated from other human rights. The constitution of the WHO considers health as a state of complete physical, mental and social wellbeing and not merely absence of disease or infirmity (Commission on Social Determinants of Health Knowledge Networks, 2011) while the Universal Declaration of Human Rights articulates the rights and freedoms every human being is equally and inalienably entitled (Commission on Social Determinants of Health Knowledge Networks, 2011). The Universal Declaration of Human Rights Article 25 affirms that, ‘‘everyone has the right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control ’’ (Commission on Social Determinants of Health Knowledge Networks, 2011, p. 8).
Much of health equity conversations centres on healthcare disparity in order to ensure equity of care which essentially entails the provision of healthcare that is equal and consistent by geographic location, socio-economic status, gender, ethnicity and other patients’ characteristics (Institute for Diversity and Health Equity, 2020). Equity of care partners efforts to eliminate disparities in healthcare has resulted in three core goals including to increase collection and use of race, ethnicity and language preference data, to increase cultural competency training and to increase diversity in governance and leadership (Institute for Diversity in Health Management, 2015).
MAIN BODY
Many people often use the term health inequalities and health inequities interchangeably, even though the reality is that the terms are not synonymous. Health equity refers to the absence of systematic disparities in the distribution of resources and processes in health between social groups with diverse underlying social disadvantages and advantages (Braveman & Gruskin, 2003) It is evident from the ongoing discussion that an equitable health system shall surely be the vehicle to promote the realization of health equality.
In order to advance equality of health, certain barriers to participation and actions including age, disability, gender reassignment, marriage and civil partnership, race, religion or belief, sex or gender, sexual orientation among others needs to be interrogated to design appropriate systems that could permit progress on participation.
The conversation on participation in the health delivery system goes beyond the elderly and includes children and young people’s right to participate in matters affecting their health. Participation generally involves the process that allow individuals to influence the decision-making process and bring about change in their health matters (Royal College of Paediatrics and Child Health , 2010). United Nations Convention on the Rights of the Child (UNCRC) went further and clearly laid out the binding requirement for children and young people to participate in matters affecting their life and it is imperative on the part of health professionals and health institutions to be mindful of which could result in experiencing stigmatization, poor information, ineffective engagement and even poor health outcomes. Disabilities associated with blindness, deafness and language barrier could seriously dampen communication efforts.
Effective flow of information and communication are imperative to assuring equality and equity in health (Public Participation Team, 2016). Persons with blindness may not get access to face to face meetings, workshops, and virtual engagement which could heavily dampen access to information and communication. This could even extend to inaccessible electronically published information and printed information including access to printed health documents and manuals requiring the need for an alternative form of communication such as auditory.
Persons who cannot hear may have the benefits of visual documents but will still have challenges interacting with various health professionals especially where there are no developed writing skills. In the view of the Public Participation Team (2016) health professionals should endeavour to create an inclusive environment, which promotes effective participation for all that includes proper consideration for each peculiar environment, provision of alternative forms of communication and consideration of the time of event. Providing effective access to information will surely help improve persons with disabilities access to health services, assure social inclusion and promote informed choices. Consequently, such an inclusive environment with effective communication will encourage effective contributions from all stakeholders, helping to produce a workforce representative of its own community and reducing inequality (Public Participation Team, 2016).
People from minority race including black and minority ethnic groups faces poor health, low life expectancy and inaccessible healthcare as compared to the general population. In addition, they also face additional barriers including ethnicity, culture, language and faith, (National Health Services, 2009) which surely plays an important role in healthcare access. It is believed that such barriers could affect perception, availability, use and eventual outcome of health access and delivery (National Health Services, 2009). For instance, persons from specific communities or religious groups may sometimes prefer specific medical officers from same or similar religious affiliation. Here the engagement procedure including planning, communication, and delivery should enable the fulfilment of such wish. Health institutions must endeavour to monitor such demographics of their local population and compensate for them. In addition, generational cultural difference may require peculiar approach towards health delivery and medical professionals must be accommodating enough to adjust towards a more socially acceptable approach. Such cultural integration goes a long way to add positive benefits for people and the society involved.
CONCLUSION AND RECOMMENDATION
It is with my opinion that while equity and inequality are distinct concept by itself, inequality is truly indispensable in operationalizing and interpreting equity. Equity in health entails equal opportunity to access health resource distributions for all population groups. This will require that processes are set up to assure equal health outcomes for minority population groups as compared with majority population groups. Here is why the idea of effective participation of all individuals in the health delivery system and process is crucial for delivering equality and equity in health. In essence, equal participation is fundamental to the attainment of the concept of equal rights to health as enshrine in the constitution of the WHO and the Universal Declaration of Human Right, (Commission on Social Determinants of Health Knowledge Networks, 2011).
Now, since the notion of equal participation is grounded in the concept of fundamental human rights, which require non-discrimination and the duty of governments, regulatory authorities and medical institutions to take the appropriate steps to eliminate unacceptable discrimination in any form, encourage more researchers to develop interest in investigating how to possibly increase and improve participation of minority and disadvantage population groups in healthcare systems and processes. In this case researchers should investigate discrimination in participation opportunities to be healthy in lieu of belonging to certain disadvantage population group. This truly reflects the need to mitigate all source of discrimination and marginalization.
REFERENCES
- Braveman, P., & Gruskin, S. (2003). Defining Equity in Health. J Epidemiol Community Health, 254-258.
- Brown, N., Mcllwraith, T., & Gonzalez, L. T. (2020). Prespective: An Open Introduction to Cultural Anthropology. Arlington: American Anthropological Association. Retrieved from https://perspectives.americananthro.org/
- Burchardt, T., & Vizard, P. (2007). Definition of equality and framework for measurement: Final Recommendations of the Equalities Review Steering Group on Measurement. London: Centre for Analysis of Social Exclusion.
- Commission on Social Determinants of Health Knowledge Networks, Jennifer H. Lee & Rita Sadana. (2011). Improving Equity in Health by Addressing Social Determinants. Geneva: World Health Organization.
- Dell'Osso, D. (2016). Cultural Sensitivity in Healthcare: The New Modern Day Medicine. Senior Theses, 58. Retrieved from https://scholar.dominican.edu/senior-theses/58/
- Institute for Diversity and Health Equity. (2020). Health Equity Snapshot: A Toolkit for Action. Chicago: American Hospital Association.
- Institute for Diversity in Health Management. (2015). Equity of Care: A Toolkit for Eliminating Disparities. Chicago: American Hospital Association.
- Lebron, A. (2013). What is Culture? Merit Research Journal of Education Vol. 1(6), 126-132. Retrieved from https://www.meritresearchjournals.org/er/index.htm
- MacNaughton, G. (2011). Healthcare Systems and Equality Rights. The Equal Rights Review, Vol. Six , 61-82.
- National Health Services. (2009). Black and Minority Ethnic (BME): Positive Practice Guide . London: Department of Health.
- Public Participation Team. (2016). NHS England and Patient and Public Public Participation Equality and Health Inequalities - Full Analysis and Associated Resources. Leeds: NHS England.
- Royal College of Paediatrics and Child Health . (2010). Not just a phase: A Guide to the Participation of Children and Young People in Health Services. London: Royal College of Paediatrics and Child Health .
- Social Care Institute for Excellence. (2012). At a glance 61: Co-production and participation: Older people with high support needs. Egham: SCIE.
- UNESCO. (1982). World Conference on Cultural Policies. Mexico City: UNESCO. Retrieved from https://culturalrights.net/descargas/drets_culturals401.pdf
