I decided to do a little test. Given the discussion in class and the readings presented in week five about cultural humility and cultural competency, I thought it would be a good idea to look at all of the readings assigned thus far for the course and see where the authors' viewpoints may lie with respect to these views of health care provision.
It wasn't very difficult to see where Flemming would side given the title of the article being
"Enhancing the empowerment agenda in health promotion through reflective practice". Through his paper, he seeks to explore how "typology has been used to reflect on how empowerment of individuals can be affected by commonplace health promotion activity.." (Fleming, pg 316). He really focuses on the role of enabling patients and addressing power imbalances in the clinical as well as health promotion settings. He also acknowledges in his article that there is no real end point of social health, although it can seem to be clear-cut and linear on paper and in reports. If this wasn't enough to steer Flemming into the realm of cultural humility, he also addresses action towards reducing inequities as a surefire way to improve overall health status of people and populations.
Verdict: Cultural Humilitiarian
Frankish, Venstra and Moulton were a little more difficult to pin point. The article is written to be much more objective than the other articles in the class, and as the authors state in the conclusion, it is meant to provoke discussion as opposed to answer questions. There are some hints throughout the beginning of the article that power imbalances ought to be checked out, that health promotion is very intersectional, and that a large push ought to be made towards making populations less dependent on services provided
to them and more self-sufficient. With this being said, there are also rumblings of time frames and views of static definitions of health and population health promotion. My conclusion is based on the underlying theme of power imbalances and empowerment through self-reliance.
Verdict: Cultural Humilitarian
Raphael makes a clear point in the opening of his article about the importance of the role of individuals and communities in their own health; advocating for enabling the individual or population to take control of their own health and cultural attribution. His article points to an unsettling view of Canadian health promotion because of the link it has with liberal political economy. Raphael concludes with a critique of Canadian health promotion, and a call for more concern towards empowering communities and away from lifestyle and individual-centered health discourses. Although there is little direct opinions towards a cultural competency vs. humility approach, his view certainly does not condone authoritative, top-down health nor static and end point-driven definitions of health. I conclude that despite hard evidence towards cultural competency and/or humility, the strong opinions in Raphael's article point to a desire to level the playing field in health and improve equity amongst populations.
Verdict: Cultural Humilitarian
Although Labonte's article hold's one of my favourite takeaways due to it's simplicity ("People are excluded from [social] benefits, we are told, because they are poor. But people are poor because they lack these benefits" pg. 117), it does not provide enough information or insight into cultural provision of healthcare or health care practitioners to be concluded humilitarian or competency-favoured. The wide critique of social inequity and promotion of social justice could have Labonte leaning towards favouring cultural humility, however I am not comfortable with the amount of opinion and information given to put a label on this author or article.
Verdict: Undecided.
The Ottawa Charter for Health Promotion was an interesting declaration to consider in this viewpoint. The declaration itself is presented as a truth, in other words, an objective source on health promotion. Based on the principles and themes presented in the declaration, one can make a claim for the stance of this objective document and it's authors in regards to cultural humility or cultural competency. The Ottawa Charter focuses on the role of health promotion in enabling and empowering people. It seeks to level the power imbalances existent in the social environment and within healthcare. The Charter is congruent to a cultural humility perspective in this way because of the power it gives to the citizen, or patient, and the desire to enable that person to take control and power over ones' healthcare outcomes rather than relying on a healthcare practitioner for all health facets. The Charter also states it's stance on healthcare goals despite the complex societies and interactions between people, environments and health. The statement "health cannot be separated from other goals" (pg 3) indicates a static and finite nature to health itself, which notedly fits well with the view of cultural competency. The tipping point comes in The Commitment to Health Promotion where the emphasis is clearly put on enabling the patient and allowing them to communicate what health, support, culture, and community means to them.
Verdict: Cultural Humilitarian
Braveman and Gruskin aim to define equity in health. In doing so, they give an excellent argument towards to perpetuation of systematic disparities and underlying social advantage as a result of power imbalances and inequities in health. Braveman and Gruskin also make a point of the roles of social groups on health status. Though it is not discussed within the article, one can extrapolate that the authors would agree with the patient discussing what their social environment and culture means to them and means in regards to their health status. As mentioned throughout the article, health inequities put disadvantaged people at disadvantaged health levels. This is an article that has much in common with those articles directed towards provision of culturally-swayed services.
Verdict: Cultural Humilitarian
There is little disputing the fact that Deepa Narayana, author of
Empowerment, would not hold a view culturally congruent with cultural humility. The four elements contributing to empowerment reiterate this by calling for mutual respect (inclusion and participation) and bringing power imbalances into check between patient and practitioner (access to information as well as inclusion and participation).
Verdict: Cultural Humilitarian
Carol McWilliam, one of Western's own, emphasizes right away the importance of patient expertise and avoidance of paternalism in healthcare delivery. Patient-centered care, which McWilliam strongly advocates for, is celebrated for the role it plays in enabling patients and including them intheir own treatment decisions. What is pointed out later in the article in the table (pg 279), is that patient-centered healthcare does not always come from standards that are congruent to cultural humility; patient-centered clinical methods of interventions are still suspect to healthcare definitions that are narrow, static, finite and power-imbalanced. The empowering partnering approach, which in the title indicates a power balance and mutual respect, is the approach McWilliam calls for in healthcare and health promotion.
Verdict: Cultural Humilitarian
Seear, author of the course textbook
An Introduction to International Health, will only be considered with respect to his assigned works thus far. Chapters one, three and nineteen were similar in demonstrating what Seear's opinion towards cultural competency versus cultural humility would be. In both chapter three and nineteen, there was substantial evidence pointing to Seear's perspective on the role of power and social inequity and health. Where income, resource and nature's imbalances are pointed at as facets of health inequity, the author also acknowledges the complexity of culture and concepts such as social cohesion in chapter three. Seear has a clear regard that culture is ever changing and a concept that cannot be narrowly defined. In chapter nineteen, partnerships are discussed and power imbalances and respect are brought to play. Seear advocates for the role of mutual respect in effective and successful partnerships and seeks to address power imbalances to promote the health of all citizens.
Verdict: Cultural Humilitarian
Many articles and cups of tea later, I conclude that the articles presented in our course are likely to favour a cultural humility model of healthcare provision. This was my suspicion from the start, however it is reassuring to know that common themes are weaving throughout this course, supporting and building upon one-another in attempts to clarify the complexities of global health. Given the fact that the articles and authors presented thus far in the course are of great esteem and well accredited, I feel that there is hope in addressing the issues of power imbalances and of mutual respect between practitioners and patients in the arena of cultural healthcare. This is a particular victory to me because of the place cultural health, and more specifically indigenous health, has in my heart. It's a glimpse of hope I suppose, and thank goodness for that.
