Abstract
This chapter provides an overview of the social determinants of health in global populations. It introduces a conceptual framework for culturally competent healthcare to demonstrate how social determinants impact health of vulnerable populations. The framework integrates the principles of cultural competence, human rights, social justice, and beneficence to address health inequities particularly in vulnerable populations. Culturally competent care strategies are conceptualized at the individual, organizational/institutional, and community/societal levels. Amelioration of health disparities requires transformation of care for individuals and populations through intersectoral and multilevel efforts in order to transform life conditions of people supportive of their health. The ten guidelines for culturally competent practices in nursing care are listed with corresponding examples of implementation for each guideline.
Of all the forms of inequality, injustice in health care is the most shocking and inhumane.
Martin Luther King, Jr. (1966)
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References
Adler N, Singh-Manoux A, Schwartz J et al (2008) Social status and health: a comparison of British civil servants in Whitehall-II with European- and African-Americans in CARDIA. Soc Sci Med 66:1034–1045
Agency for Healthcare Research and Quality Advancing Excellence in Health Care (2014) National healthcare quality and disparities report. USDHHS, Rockville
Babones S (2010) Income, education, and class gradients in health in global perspective. Health Sociol Rev 19(1):130–143
Baer RD, Bustillo M (1993) Susto and mal de ojo among Florida farmworkers. Emic and etic perspectives. Med Anthropol Q 7(1):90–100
Bambas A, Casas JA (2001) Assessing equity in health. Conceptual criteria. In: PAHO, equity and health: views from the Pan American Sanitary Bureau, Publication 8. Author, Washington DC, pp 12–21
Bask M (2011) Cumulative disadvantage and connections between welfare problems. Soc Indic Res 103:443–464
Benatar S (2013) Editorial: challenges of health disparities in South Africa. S Afr Med J 103(3):154–155. https://doi.org/10.7196/SAMJ.6622
Benatar S, Sullivan T, Brown A (2017) Why equity in health and in access to health care are elusive: insights from Canada and South Africa. Glob Public Health 4:1–25. https://doi.org/10.1080/17441692.2017.1407813
Bourdieu P (1977) Outline of a theory of practice. Cambridge Univ. Press, New York
Braverman P (2014) What are health disparities and health equity? We need to be clear. Public Health Rep 129(S2):5–8
Burris S, Kawachi I, Sarat A (2002) Integrating law and social epidemiology. J Law Med Ethics 30(4):510–521
Carnwell R, Carson A (2005) Understanding partnerships and collaboration. In: Canrwell R, Buchanan J (eds) Effective practice in health and social care. Open University Press, McGraw Hill, London, pp 1–19
CDC (2011, Jan 14) CDC health disparities and inequalities report—United States, 2011. MMWR 60(Suppl). https://www.cdc.gov/mmwr/pdf/other/su6001.pdf
CDC (2014a) Health, United States, 2013. http://www.cdc.gov/nchs/data/hus/hus13.pdf#018
CDC (2014b) Adult obesity facts. http://www.cdc.gov/obesity/data/adult.html
CDC (2014c) High blood pressure. http://www.cdc.gov/bloodpressure/facts.htm
CDC (2015) Prevalence of childhood obesity in the United States, 2011-2012. http://www.cdc.gov/obesity/data/childhood.html
Chauhan S, Aeri BT (2013) Prevalence of cardiovascular disease in India and its economic impact—a review. Int J Sci Res Publ 3(10):1–5
Coleman J (1990) The foundations of social theory. Harvard University Press, Cambridge
Corrigall R, Bhugra D (2013) The role of ethnicity and diagnosis in rates of adolescent psychiatric admission and compulsory detention: a longitudinal case-note study. J R Soc Med 106:190–195
Countrymeters (2017a) China population. (2017). http://www.countrymeters.info/en/China/
Countrymeters (2017b) India population. (2017). http://www.countrymeters.info/en/India/
Cross T, Bazron B, Dennis K et al (1989) Towards a culturally competent system of care, vol I. Georgetown University Child Development Center, CASSP Technical Assistance Center, Washington, DC
Diez-Roux AV (2004) The study of group-level factors in epidemiology: rethinking variables, study designs and analytical approaches. Epidemiol Rev 26(1):104–111
Drewnowski A, Specter S (2004) Poverty and obesity: the role of energy density and energy cost. Am J Clin Nutr 79:6–16
Edwards A (2014) Dynamics of economic well-being: poverty, 2009-2011. U.S. Department of Commerce, Economics and Statistics Administration, (Household Economics Studies: 70–137). http://www.census.gov/prod/2014pubs/p70-137.pdf
Fang JY, Piao S, Field CB, Pan Y, Guo QH, Zhou L, Peng C, Tao S (2003) Increasing net primary production in China from 1982 to 1999. Front Ecol Environ 1(6):293–297. https://doi.org/10.2307/3868089
Frohlich KL, Potvin L (2008) The inequality paradox: the population approach and vulnerable populations. Am J Public Health 98(2):216–220
Fullilove MT (2004) Root shock: how tearing up city neighborhoods hurts America and what we can do about it. One World/Ballantine Books, New York
Gong P, Liang S, Carlton EJ et al (2012) Urbanisation and health in China. Lancet 379(9818):843–852
Gupta R (2012) Regional variations in cardiovascular risk factors in India: India heart watch. World J Cardiol 4(4):112. https://doi.org/10.4330/wjc.v4.i4.112
Guthrie A, Fleck F (2017) Quality care is key to tackling Mexico’s diabetes emergency. Bull World Health Organ 95:393–394. https://doi.org/10.2471/BLT.17.020617
Henneman EA, Lee JL, Cohen JI (1995) Collaboration: a concept analysis. J Adv Nurs 21:103–109
Hessini L (2007) Abortion and Islam: policies and practice in the Middle East and North Africa. Reprod Health Matters 15(29):75–84
Ibnouf AH, van den Borne HW, Maarse JA (2007) Utilization of antenatal care services by Sudanese women in their reproductive age. Saudi Med J 28(5):737–743
Iceland J (2012) Poverty in America: a handbook. Berkeley: University of California Press
Institute for Research on Poverty, University of Wisconsin-Madison (2016) Who is poor? http://www.irp.wisc.edu/faqs/faq3.htm
International Council on Human Rights Policy (ICHRP) (2012) Article 25: Universal declaration of human rights. http://ichrp.org/en/article_25_udhr
Izek I (2016) Mexico City: disparities in healthcare. http://pulitzercenter.org/projects/neonatal-outcomes-developing-developed-world-without-breath
Jenkins R (2002) Pierre Bourdieu. Routledge, London
Jimenez-Sanchez S, Jimenez-Garcia R, Alonso-Blanco C et al (2013) Prevalence of migraine headaches in the Romany population in Spain: demographic, lifestyle and co-morbidity. J Transcult Nurs 24(1):6–13
Kaiser Family Foundation (2015) Key facts about the uninsured population. http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
Kakoli R, Chaudhuri A (2008) Influence of SES, wealth and financial empowerment on gender differences in health and healthcare utilization in later life: evidence from India. Soc Sci Med 66(9):1951–1962
Kalra A, Pokharel Y, Glusenkamp N et al (2016) Gender disparities in cardiovascular care access and delivery in India: insights from the American College of Cardiology’s Pinnacle India Quality Improvement Program (Piqip). J Am Coll Cardiol 67(13):1849. https://doi.org/10.1016/s0735-1097(16)31850-2
Kaufman JS (2008) Social epidemiology. In: Rothman KJ, Greenland S, Lash TL (eds) Modern epidemiology, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 532–548
Kishk NA (2002) Knowledge, attitudes and practices of women towards antenatal care: rural–urban comparison. J Egypt Public Health Assoc 77:479–498
Krieger N (2011) Epidemiology and the people’s health. Oxford University Press, New York
Kronfol NM (2012a) Access and barriers to healthcare delivery in Arab countries: a review. East Mediterr Health J 18(12):1239–1246. http://www.emro.who.int/emhj-volume-18-2012/issue-12/09.html
Kronfol NM (2012b) Delivery of health services in Arab countries: a review. East Mediterr Health J 18(12):1229–1238
Kronfol NM (2012c) Health services to groups with special needs in the Arab world: a review. East Mediterr Health J 18(12):1247–1253
Last F, Fowler D, Freer-Smith PH (1985) Effects of air pollutants on agricultural crops. Burlington Press, Cambridge
Lavizzo-Mourey R (2015) In it together—building a culture of health. http://www.rwjf.org/en/library/annual-reports/presidents-message-2015.html
Lee L (2004) The current state of public health in China. Annu Rev Public Health 25(1):327–339. https://doi.org/10.1146/annurev.publhealth.25.101802.123116
Lewis O (1966) La vida; a Puerto Rican family in the culture of poverty—San Juan and New York. Secker & Warburg, London
Leyva B, Allen JD, Tom LS et al (2014) Religion, fatalism, and cancer control: a qualitative study among Hispanic Catholics. Am J Health Behav 38(6):839–849. https://doi.org/10.5993/AJHB.38.66
Lin A, Harris D (2009) The colors of poverty: why racial and ethnic disparities persist (National Poverty Center, Poverty Brief # 16). http://npc.umich.edu/publications/policy_briefs/brief16/PolicyBrief16.pdf
Liu X, Sun H, Feike T et al (2016) Assessing the impact of air pollution on grain yield of winter wheat—a case study in the North China Plain. PLoS One 11:1–15. https://doi.org/10.1371/journal.pone.0162655
Marmot MG (2006) Status syndrome, a challenge to medicine. JAMA 295(11):1304–1307
Marmot MG, Bell R (2009) Action on health disparities in the US: Commission on Social Determinants of Health. JAMA 301(11):1169–1171
Marmot MG, Rose G, Shipley M et al (1978) Employment grade and coronary heart disease in British civil servants. J Epidemiol Community Health 32(4):244–249. https://doi.org/10.1136/jech.32.4.244
Marmot MG, Smith GD, Stansfeld S et al (1991) Health inequalities among British civil servants: the Whitehall II study. Lancet 337(8754):1387–1393. https://doi.org/10.1016/0140-6736(91)93068-K
McEwen B, Nasca C, Gray JD (2015) Stress effects on neuronal structure: hippocampus, amygdala and prefrontal cortex. Neuropsychopharmacology 41(1):3–23. https://doi.org/10.1038/npp.2015.171
Mendoza R (2011) Why do the poor pay more? Exploring the poverty penalty concept. J Int Dev 23(1):1–28
Mikkonen J, Raphael D (2010) Social determinants of health: the Canadian facts. York University School of Health Policy and Management, Toronto
Miranda ML, Messer LC, Kroger GL (2012) Associations between the quality of the residential environment and pregnancy outcomes among women in North Carolina. Environ Health Perspect 120(3):471–477
Mohan I, Gupta R, Misra A et al (2016) Disparities in prevalence of cardiometablic risk factors in rural, urban-poor and urban-middle class women in India. PLoS One 11(2):e0149437. https://doi.org/10.1371/journal.pone.0149437
Moy E, Barrett M, Ho K (2011) Potentially preventable hospitalizations—United States, 2004–2007. MMWR 60(Suppl):80–83
Murguia-Peniche T, Illescas-Zarate D, Chico-Barba G et al (2016) An ecological study of stillbirths in Mexico from 2000 to 2013. Bull World Health Organ 94:322–330A. https://doi.org/10.2471/BLT.15.154922
National Coalition on Black Civic Participation (2014) Black Women in the United States, 2014: progress and challenges 50 years after the war on poverty, 50 years after the civil rights act of 1964, 60 years after Brown v. Board of Education. ncbcp.org/news/releases/BWRReport.BlackWomeninU.S.2015.3.26.15FINAL.pdf
OECD (2014a) OECD health statistics 2014. How does the US compare? http://www.oecd.org/unitedstates/Briefing-Note-UNITED-STATES-2014.pdf
OECD (2014b) Education at a glance 2014: OECD indicators. https://doi.org/10.1787/eag-2014-en. Accessed 2 Apr 2017
Pacquiao DF (2016) Cultural competence in ethical decision-making. In: Andrews MM, Boyle JS (eds) Transcultural concepts in nursing care, 7th edn. Wolters Kluwer, Philadelphia, pp 447–464
Pan X, Li G, Gao T (2012) Dangerous breathing P.M 2.5: measuring the human health and economic impacts on China’s largest cities, Beijing, China. China Environmental Science Press. Guardian News and Media Limited
Population Reference Bureau (2012) India’s aging population. Today’s research on aging. http://www.prb.org/pdf12/TodaysResearchAging25.pdf
Poss J, Jezewski MA (2002) The role and meaning of susto in Mexican Americans’ explanatory model of type 2 diabetes. Med Anthropol Q 16(3):360–377
Powers M, Faden R (2008) Social justice: the moral foundations of public health and health policy. Oxford University Press, New York
Putnam RD (2000) Bowling alone: the collapse and revival of American community. Simon & Schuster, New York. ISBN: 0-7432-0304-6
Ramachandran A, Snehalatha C, Vijay V (2003) Explosion of type 2 diabetes in the Indian subcontinent. Int Diabet Monit 15:1–6
Rao N (2014) Women in India—longevity, health disparities and empowerment. https://globalhealthaging.org/2014/07/26/women-in-india-longevity-health-disparities-empowerment/
Raphael D (2004) Introduction to the social determinants of health. In: Raphael D (ed) Social determinants of health: Canadian perspectives. Scholars Press, Toronto, pp 2–19
Rawls J (1971) A theory of justice. Harvard University Press, Cambridge
Rohde RA, Muller RA (2015) Air pollution in China: mapping concentrations and sources. http://berkeleyearth.org/wp-content/uploads/2015/08/China-Air-Quality-Paper-July-2015.pdf
Romdhane HB, Grenier FR (2009) Social determinants of health in Tunisia: the case analysis of Ariana. Int J Equity Health 8:9. https://doi.org/10.1186/1475-9276-8-9. © World Health Organization
Sampson RJ, Raudenbush SW (1999) Systematic social observation of public spaces: a new look at disorder in urban neighborhoods. Am J Sociol 105(3):603
Seith D, Kalof C (2011) Who are America’s poor children? Examining health disparities by race and ethnicity. National Center for Children in Poverty, Columbia University
Sengupta R, Jena N (2009) The current trade paradigm and women’s health concerns in India: with special reference to the proposed EU-India Free Trade Agreement. SSRN Electron J. https://doi.org/10.2139/ssrn.1757785
Setse RW, Euler GL, Gonzalez-Feliciano AG et al (2011) Influenza vaccination coverage—United States, 2000–2010. MMWR 60(Suppl):38–41
Slaughter MJ, Swagel P (1997) Does globalization lower wages and export jobs? Econ Issues (11):1–13. IMF, Washington, DC
UN (1948) Universal Declaration of Human Rights. UN General Assembly, 10 Dec 1948
UNESCO (2015) Gender and EFA 2000-2015: achievements and challenges. Author, Paris
United Nations (2004) World urbanization prospects: the 2003 revision. UN publication sales no. E.04.Xlll.6.ISBN 92-1-141396-0. UN, New York
US Census (2016) Income and poverty in the US:2015. https://www.census.gov/library/publications/2016/demo/p60-256.html
USDA (2017) Poverty demographics. https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/poverty-demographics/
USDHHS (2010) Healthy people 2020. Author, Washington, DC
USDHHS (2015) Key features of the ACA. http://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca-by-year/index.html#
USDHHS, HRSA-MCHB (2013) Child Health USA, 2013. http://mchb.hrsa.gov/chusa13/perinatal-health-status-indicators/perinatal-health-status-indicators.html
USDHHS, Office of Minority Health (2001) National standards for culturally and linguistically appropriate services in health care: final report. http://www.omhrc.gov/clas/. Accessed 15 Apr 2004
USDHHS-OMH (2014) Diabetes and African Americans. http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlID=18
Washington DL, Bowles J, Saha S et al (2008) Transforming clinical practice to eliminate racial-ethnic disparities in healthcare. J Gen Intern Med 23(5):685–691
Whitehead M (1992) The concepts and principles of equity and health. Int J Health Serv 22:429–445
WHO (2015a) Health Impact Assessment (HIA). http://www.who.int/hia/evidence/doh/en/
WHO (2015b) Health in the post-2015 development agenda: need for a social determinants of health approach. http://www.who.int/social_determinants/advocacy/health-post-2015_sdh/e
WHO (2016) Measuring the adequacy of antenatal health care: a national cross-sectional study in Mexico. Bull WHO 94:452–461. https://doi.org/10.2471/BLT.15.168302
Wilkinson R, Pickett K (2010) The spirit level, why greater equality makes societies stronger. Penguin Books, New York
Williams DR, John DA, Oyserman D et al (2012) Research on discrimination and health: an exploratory study. Am J Public Health 102(5):973–978
Wilson W (1996) When work disappears: the world of the new urban poor. Alfred A. Knopf, Inc., New York
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Pacquiao, D. (2018). Conceptual Framework for Culturally Competent Care. In: Douglas, M., Pacquiao, D., Purnell, L. (eds) Global Applications of Culturally Competent Health Care: Guidelines for Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-69332-3_1
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