Importance of Culturally Appropriate Health Policies

• Bernard F. Richards

Explain the importance of culturally appropriate health policies.

Lederach (1995) defines culture as “the shared knowledge and schemes created by a set of people for perceiving, interpreting, expressing, and responding to the social realities around them” (p. 9). Damen (1987) notes that culture can be defined as “learned and shared human patterns or models for living day-to-day living patterns and include thoughts, styles of communicating, and ways of interacting”. This incorporates sociocultural factors such as race and ethnicity, nationality, language, gender, sexual orientation among others.

The WHO (2014) notes that “health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society. An explicit health policy can achieve several things: it defines a vision for the future which in turn helps to establish targets and points of reference for the short and medium term. It outlines priorities and the expected roles of different groups; and it builds consensus and informs people.” It is a truism that a community or society is a complex construct with individuals who can be hurt, who have varying needs and respond differently to any intervention initiative. This signals the need for health policies to be crafted in a culturally appropriate manner in order to impact individuals and his community.

Studies have shown that culturally-appropriate health policies produce valuable results and assist in driving the accuracy of diagnosis, improve the likelihood of acceptance and adherence to the recommendations made and could possibly prevent or minimize the inappropriate use of health care facilities like clinics, hospitals and diagnostic centers. Experts have concluded that a modifications in health care delivering systems that are culturally oriented will promote quality improvement and should be applied at all levels of planning and execution. It is also suggested that a culturally appropriate health policy will have the effect of assisting in the reduction of any racial, ethnic or social health disparities. In this regard, effective communication must be an important consideration. In order for any policy to effective they must be enunciated and disseminated in a clear, simple and precise manner. The Department of Health and Human Services (DHHS) (2010) notes that an operational plan moves a static prevention policy from being mere words written on a piece of paper into an effective and affective construct ready for action.

Cultural appropriate health policies speak to the affective and contemplate the ability of systems to deliver patient care to a population or society having diverse values, beliefs, and behaviors and eliminating any disparities in health care. Although policies that improve the quality of care have both direct and indirect cost they can be used to improve quality and improve behavior at the level of the individual. It is also known that a society where the population is healthy has a higher propensity to generate wealth and wellbeing.

Explain how one can develop a policy so that it gets the support of the community.

Public health agencies worldwide are engaged in formulating policies and developing strategies to promote health within populations. Population health begins at the community level where smaller sub-groups can be targeted and engaged. However, to effectively execute strategies, support from stakeholders, including the community, is pivotal. An important consideration then is how promote the view of the strategy being ‘our policy’ rather than that from an outside, disconnected entity.

Before formulating the policy, a thorough research of community dynamics is important.

Campbell (2010) explains that anthropology is vital to public health practice. Such research provides information which will fuel the understanding of a community’s cultural beliefs and ideology regarding health related issues and practices (pgs. 76-77). Knowledge of community beliefs and practices can better guide policy makers in formulating health interventions that will be more accepted and supported by community stakeholders.

According to Pittet (2001), a major factor contributing to change resistance and compliance is ignorance. People are more likely to accept something they have been involved in and can associate with. Stakeholders should be educated as to the health problem that exists in the community and why change is necessary. Involvement from these grass root stages will promote greater acceptance policy as community members will see that addressing the problem is the responsibility of individuals and the community as a whole.

Resistance is possible at any stage of the change process. Therefore, open and continuous communication should be fostered with the community. Rabinowitz (2014) purports that fostering community support for health policy is a continuous process. New information at every stage, from formulation to implementation, should be shared with the community. Additionally, community stakeholders should be actively involved in the specific health interventions governed by the policy. Additionally, publicly lauding the successes of the interventions will draw further support from even sectors that initially against the program.

Explain how you might engage the community to be part of the voice when developing a policy

Health policy comprises methods put in place by health agencies to promote a particular health outcome (Cherry & Trotter Betts, 2005). The health care system consists of a number of forces acting to impact the system for their interest. These forces include political entities as well as private and public sector groups that have the capacity to impact the health care system and influence the health policy-making process.

Policy specialists advocate that political interface occur when individuals participate in the decision making process and cooperate in actions to improve said process. Mention must be made of the numerous stakeholders who have an interest the outcome of a health care policy who employ different means of activism to shape the health system. Public policy is described as a governmental act which embodies a response to health needs.

According to Gregory, Hartz-Karp and Watson (2008), community engagement is a process whereby the community is involved in all stages of policy planning and formulation. With respect to health policies, community engagement implies fostering participation with community members in the development and execution of policies that will affect community health. Factors included comprise health service delivery, budgetary allocation, and wider issues affecting the health system. The community contributes meaningful and valuable input in any health related strategy. Therefore, effective collaboration with these stakeholders will serve as a major driving force behind any policy aimed at positively influencing health.

The process of community engagement requires strategic actions at several levels. These levels include information gathering, education, discussion and partnership. To effectively put in place policies to counteract sources of ill-health in a community, it is important to first uncover what health issues exist. Coulter (2009) explains that health needs assessment is a methodical technique by which the health issues affecting a population are uncovered. This facilitates consensus as to the priorities that exist which will gear the allocation of resources (p. 11). This is usually one of the first steps in health planning and community engagement and facilitates formulation and application of steps to counteract such inequalities.

Knowledge equips one with the necessary information to fuel informed action. Furthermore, active dialogue with community representatives will inevitably foster cooperation. Practical ways to secure the informed participation of the various groupings of a population being served is through small groups interactive talks, church promotion and school base interactions, spot meetings and though the development of literature and health education materials which reflect their level of health literacy and cultural norms. In developing a policy that gets the support of the community it is necessary to engage community representatives in the planning meetings whether as part of a swat or focus group or even formally as board members. This ensures ‘buy in’ by those they represent since they will have a voice at the formulation stage of the policy process.

Engagement should endeavor to uncover what will work in the best interest of the jurisdiction being targeted, aid in the achievement of the stated policy, assess what resources are needed, how those resources should be allocated and utilized in the implementation of the policy, fairness and equity and effectively how the policy reflect the values of society. When all these elements are factored in the process then the much anticipated shared value can be a reality.

It has also been noted by researchers that increasingly the population of society has become very diverse and experience huge disparities in health. As we grapple with the severe differences in race, gender, ethnicity, and negative experience in the socioeconomic status of the world community research shows that health policies affect the health behavior of individuals, their socioeconomic standing and their work environment. Health policies therefore must be carefully planned, implemented and evaluated. They must also be inclusive and seek the involvement of stakeholders.

The DHHS (2010) discloses that the U.S. health expenditure is by far more than for any other nation however, this has not demonstrated superior results. Analysts have suggested that one of the possible reasons for this unfavorable outcome might be a failure to actively involve the population in strategic planning and execution. It can be concluded that in order to develop a policy that gets the support of the community the overarching principle is a merging of the efforts of policy makers and the community individuals who must regard the policy as relevant to their needs and are able to see the benefits they offer.

References

Campbell, D. (2010). Anthropology’s contribution to public health policy development. MJM, 13(1), 76-83.

Cherry, B. & Trotter Betts, V. (2005). Health policy and politics: Get involved! In B. Cherry & S. Jacobs (Eds.) Contemporary nursing: Issues, trends & management (pp.211-233). St. Louis, MO: Elsevier Inc.

Coulter, A. (2009). Engaging communities for health improvement: A scoping study for the Health Foundation. Retrieved from http://www.health.org.uk/public/cms/75/76/313/597/Engaging communities for health improvement.pdf?realName=788l5U.pdf

Damen, L. (1987). Culture Learning: The fifth dimension on the language classroom. Reading, MA: Addison-Wesley.

Department of Health and Human Services (2010). Healthy People 2010: Understanding and Improving Health, 2^nd ed. Washington, D.C., U.S. Government Printing Office.

Gregory, J., Hartz-Karp, J. & Watson, R. (2008). Using deliberative techniques to engage the community in policy development. Australia and New Zealand Health Policy, 5(16), doi:10.1186/1743-8462-5-16

Lederach, J.P. (1995). Preparing for peace: Conflict transformation across cultures. Syracuse, NY: Syracuse University Press.

Pittet, D. (2001). Improving adherence to hand hygiene practice: A multidisciplinary approach. Emerg Infect Dis, 7(2), doi:10.3201/eid0702.700234.

Rabinowitz, P. (2014). Gaining public support for addressing community health and development issues. Retrieved from http://ctb.ku.edu/en/table-of-contents/assessment/getting-issues-on-the-public-agenda/gain-public-support/main.

World Health Organization (WHO). (2014). Health policy. Retrieved from http://www.who.int/topics/health_policy/en/