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- Socioeconomic
Status (SES) and Health: One of the most powerful
factors that influences health is socioeconomic status. “Disadvantaged
socioeconomic status shapes experience of an exposure to virtually
all known behavioral, environmental and psychosocial risk factors”.1
Given that many racial and ethnic groups are disproportionately
represented in disadvantaged SES populations,
it is critical to understand and work to address the impact
of SES. The combination and interaction of race and socioeconomic
factors should be measured, studied, and made a focus for intervention
and change.
- Asset
and Strengths-Based Assessment and Planning: Numerous models
for engaging communities in developing priorities and plans for
improving multicultural health take a strengths-based approach.
For example, the National Association of City and County Health
Officials, in collaboration with the CDC, has developed an exciting
tool called Mobilizing for Action through Planning and Partnerships
(MAPP, 2001). MAPP is a community-wide strategic planning tool
for improving community health. Facilitated by public health leadership,
this tool helps communities prioritize public health issues and
identify resources for addressing them.
- Empowering
Education: Because of the nature of the social
determinants of health and the role of potential risk and
protective
factors, development of education and interventions to improve
multicultural health may benefit from using an adaptation
of an empowerment education approach developed by Friere
(1970). Delineated
in this model, the purpose of education is human liberation;
that is, learners can be subjects and actors in their own
lives and
society.
Friere’s three-stage methodology includes
listening to understand the felt issues or themes of the
community; participatory
dialogue about the investigated issues using a problem-posing
methodology; and action on the positive changes that people
envision during
their dialogue. Many public health organizations and communities
use these principles and approaches to engaging communities
in addressing multicultural health issues. CBPR incorporates
many
of these principles.
- Role
of Information Technology and Informatics: Information
technology and system advances will enable more effective
capture of essential data to analyze, monitor, and evaluate
health conditions
and interventions. Electronic health records, telemedicine,
monitoring devices, Internet tools, and information systems
can make key cultural,
linguistic, and medical information available at the point
of decision or service; can increase access to cost-effective
language and
medical care; and can improve information dissemination.
The
IOM Report, Who will keep the public healthy? cites Yasnoff
et al,
2000 in defining informatics as "the systematic application
of information, computer science and technology to public health
practice and learning” and lists informatics
as one of the areas of critical importance for public health
education in the 21st century.2
- Change
Management: Implementation of changes
within organizations and communities will require more effective
change management.
Kotter (1995) proposes the following key ingredients to successful
change and transformation: shared vision; tension for change;
sense of urgency; powerful guiding coalition; quick wins; remove
obstacles;
empower recipients and champions; communication; and institutionalize
the change. There are many other models of change management
for organizations and communities.
Managing Complex Change, developed
by M.B. Lippitt (2002) is a useful framework that describes a
set
of elements necessary for successful change within organizations
and/or systems. Public health leaders, professionals, and faculty
will need to be able to apply these strategies to bring about
effective change at the individual, group, system, and community
levels to
address the challenging issues that affect multicultural health.
For a selected list of materials related to change management,
see Transformative Leadership and Change Management and
Resources to Inform Change Efforts in the Resources section.
- Cultural
Brokering: The concept of cultural brokering has evolved
and permeated many aspects of U.S. society, including health
care. A review of the literature reveals that during the 1960s researchers
began to use the concept of cultural brokers within the context
of health care delivery to diverse communities.
Wenger (1995)
defined cultural brokering as “a health care intervention through
which the professional increasingly uses cultural and health
science knowledge and skills to negotiate with the client and the health
care system for an effective, beneficial health care plan.” Jezewski
(1990) defined cultural brokering as the act of bridging, linking,
or mediating between groups or persons of different cultural
backgrounds for the purpose of reducing conflict or producing
change.
 The NCCC documents the uses of this model in effectively addressing
the health and mental health needs of culturally and
linguistically diverse populations. Bridging
the Cultural Divide in Health Care Settings: The Essential Role
of Cultural
Broker Programs (2004):
- Introduces
the legitimacy of cultural brokering
in health care delivery to underserved populations, who
are culturally
and linguistically
diverse;
- Promotes
cultural brokering as an essential approach to increase
access to care and
to eliminate racial and ethnic health disparities;
- Defines
the values, characteristics, and areas of awareness,
knowledge, and
skills required of a cultural broker; and
- Provides
guidance on establishing and sustaining a cultural
broker program for health care settings
that is tailored
to the needs
and preferences of the communities
served.
Emerging
evidence suggests that cultural brokering holds great promise
as a model for public health.
References
1 House
and Williams, 2000.
2 IOM, 2003, p. 62.
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