THE BRIDGETOWN PROTOCOL HEALTH AND ENVIRONMENT WORKING GROUP REPORT
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Back to Working Group ReportsPART III - WORKING GROUP REPORTS
Chairperson: Dr. Jewel CrawfordINTRODUCTION
PRIORITY AREAS
CURRENT PROGRAMS
RECOMMENDATIONS
BARRIERS
WAY FORWARDThe general standard of healthcare is directed toward the achievement of improved health, disease prevention, addressing injury, controlling threats to one’s life and influencing social conditions in order to ensure access to healthcare. These goals enable the general community to realize optimal health and quality of life as well as guide healthcare professionals in the provision of health programs and services most appropriate for the clients they serve.
The reality of the healthcare environment in which Afrikan and Afrikan Descendant communities seek care is one in which a significant portion of the members are faced with barriers hindering their accessibility to health services. Many of these communities’ needs do not conform to westernized systems of healthcare delivery which are based primarily on a bio-medical, mono cultural model. Due to this fact, members of Black communities are utilizing healthcare services less and receive critical diagnosis and treatment significantly later than other populations. This is caused by, in large part, the cultural, linguistic, racial, gender, class and age barriers embedded within these system.
There is growing evidence that the experience of racism is a determinant of health and can have a pervasive and devastating impact on the health and well being of Afrikans and Afrikan Descendants. One factor that has been strongly implicated in the exacerbation of this impact is the current inadequacy of services to provide culturally appropriate, anti-racist, inclusive healthcare to all individuals. Inclusive healthcare locates health within the context of socio-economic realities and the analysis of healthcare needs is based on a definition of health, which encompasses and incorporates the biological, socio-cultural and psychological, and environmental dimensions of clients’ lives. Inclusive healthcare recognizes that all of these factors have a direct impact on the state of health and well being of individuals, and further recognizes that gender, religious, cultural and class backgrounds strongly influence how one experiences illness, how and when one is diagnosed and, eventually, how one is treated by the healthcare system.
The discussion of racism in healthcare is a discussion of the value that the healthcare system and, ultimately society at large, places on the health of Afrikan and Afrikan Descendant communities.
For example:
1. HIV/AIDS/STD’s;
2. Cardiovascular and haematological diseases;
3. Malaria/dengue fever and water borne diseases;
4. Mental health/substance use/post traumatic slave disorder;
5. Cancer; Breast, prostate, cervical, colon, lung;
6. Lack of proper nutrition, education and health promotion activitiesAll of these factors have high prevalence rates in Afrikan and Afrikan Descendant communities. There is also a lack of access and validation of traditional and alternative medicine procedures that would be culturally appropriate and should be included in inclusive healthcare services.
Many studies in North American and European contexts have found that mainstream agencies have failed to provide accessible and equitable services. Institutional racism as well as specific discriminatory practices reflect the lack of commitment to enact the changes that would fulfil the needs of Afrikan communities. Afrikan community members, (where in the minority) cannot take for granted that their medical practitioners will respect their experience, speak their language, understand their culture, or that the medical advice they receive will be consistent with both their world view and their material resources.
Racial discrimination in the healthcare system, at the extreme, renders most of the perspectives and health concerns in regard to Afrikan community members marginal and pathological. The mono-cultural, westernized medical model of healthcare renders the dominant cultures’ perspectives as normal, neutral and universal – whether by accident, design, or as a by-product of systemic discrimination. Afrikan community members suffer within this system by virtue of their difference from what is presented to be the norm.
Any discussion of inclusive healthcare must look at the determinants of health or the social and economic factors, which influence ones health status.
· Racism;
· Education/literacy;
· Housing/safe shelter;
· Employment/socio-economic status;
· Poverty/poor nutrition;
· Healthy environmentIt has been shown that all of these components influence health status through knowledge, time and opportunities to pursue health.
1. HIV/AIDS/STDs
2. Cardiovascular and haematological diseases
3. Malaria/dengue fever and water borne diseases
4. Mental health/substance use/post-traumatic slave disorder
5. Cancer; Breast, prostate, cervical, colon, lung
6. Health and nutrition – education and health promotion activities
7. Over arching issues:
a. Infant mortality
b. Environmental justice
c. RacismBRIEF DESCRIPTION OF WORK BEING DONE
Many of the key issues described are of global and regional importance. For example, HIV/AIDS is both a health, political, and economic threat. These circumstances are magnified in poor and under-resourced countries. There are a number of initiatives tackling health issues that are unique to location and conditions. Some communities have developed models of care, treatment and support specific to the Black communities. To this end, there were a number of papers demonstrating different types of interventions in Afrika and North America.
We recommend the study of sources that provide information and examples of initiatives, such as these institutions in the U.S.A.:
· Centres for Disease Control
· National Academy of Sciences
· Stroke Institute of Medicine
· Center of Minority Health and Health Disparities
· National Institute of Health1. Develop a strategy for worldwide monitoring, screening, treatment, and programs.
2. Develop data collection, research and evaluation under the control of Afrikans and Afrikan Descendants.
3. Create community-based education, training and counselling.
4. Form political action networks at all levels of government to develop health policies and provide political advocacy at local, regional, national and international levels.
5. Develop communication strategies to include:
· media training, i.e. how we manage the media
· social marketing
· use of media as agents of change
· dissemination of information among our communities allowing for linguistic differences
6. Develop alternative and culturally sensitive modalities based on best practices. Lobby governments to support the promotion of traditional health practices in coordination with traditional healers.
7. Encourage the development of evidence-based and culturally sensitive alternative therapies and a university/practice-based network of researchers of Afrikans and Afrikan Descendants.
8. Develop strategic health plans which are area specific.
9. Develop a worldwide data base of all Afrikan and Afrikan Descent health care agencies.
10. Plan human resource development for health care professions. Include a youth program for professional training.1. Social stigma applied to ethnicity, language, disability etc.
2. Cultural attitudes towards illness and treatment related to such factors as:
A. Gender and age based differences in health seeking behaviours, treatment, and attitudes of both patient and health care provider.
B. Denial and lack of disclosure
C. Racial bias
3. Socio-economic status including:
A. Low levels of educational attainment and literacy
B. Poor housing conditions
C. High unemployment
D. Poverty
4. Geography as related to access and provision of remote vs. centralized services. This is especially salient for:
A. Rural populations
B. Urban, poor, disenfranchised populations
C. Transient and mobile populations
5. Language/dialect differences between client and providers
6. Lack of sustained political will at all levels of government
7. Lack of program evaluation and healthcare outcomes management
8. Absence of medical/scientific data and a critical mass of researchersSOLUTIONS
· Improve formal and informal education.
· Develop target-specific materials for the most vulnerable groups (for example: sexually active bi-sexual men and low literacy groups)
· Develop comprehensive community-based programs
· Develop network of specialized health care workers with emphasis on counselling and data collection.
· Organize comprehensive outreach programs.
· Develop a system of inclusive support structures, which is culturally appropriate and safe.
· Provide a global exchange of best practices relevant to Afrikan people.
· Utilize telemedicine and other related technologies.
· Establish a global network of university/community partnerships of researchers and health-related businesses.
· Develop strong advocacy skills and organize political action networks on all levels.
· Establish accountability measures for program implementation.
· Develop programs specific to the needs of the elderly (care, treatment and support which includes the caregiver)
· Develop research and programs for women.FUNDING STRATEGIES:
Create a plan for indigenous resource development and funding
Short term: 1-5 years
a. Full time resource development staff
b. Establish a not-for-profit health foundation to receive monies & disburse funds
c. Target existing funding agencies, for example, CDC, NIH, NIMH and CIHR (Canadian Institute of Health Research)
d. Form an association of paying members to support the Health Foundation
Long term
a. Seek support for structural adjustments, i.e. change the current structures to facilitate better access to services
b. Redirect existing funds from government and non-profit agencies
c. Access remedial (Reparations) and compensatory measures
d. Promote economic empowerment by developing industries based on nutriceuticals, i.e. herbs and other plant extracts.
e. Encourage Afrikan people to patronize Afrikan physicians and Afrikan-owned health businesses wherever possible
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World Conference Against Racism 2003. All Rights Reserved.