The Culture of American's Health Care System - A Labyrinth or a Maze?
Introduction
The R. W. Johnson Foundation (2014) recently stated that “current personal health issues, status, and needs within the United States healthcare system demonstrate a lag in health equity.” Based on this and other information The Foundation is announcing its “Culture of Health,” initiative to promote health, well-being, and equity. The Initiative is considering activities that “extend beyond the reach of medical care into sectors not traditionally associated with health.”
This blog strongly supports this thinking and related planning and development of problem-solving activities. Each blog that follows this introduction will identify knowledge, thinking, activities and resources currently influencing the health culture in the U.S, as well as influences to transform the “culture of health.”
A Transformational Process
To better understand and engage in a “transformational process,” it is important to know the different between two frequently misused and misunderstood words – “a transformative process” and “a change processes.” The latter is a process that seeks to address issues by rearranging the pieces of a process. Transformational thinking, however, suggests different approaches and methods discovering, uncovering and addressing said process and related matters.
To better engage in understanding these two processes a helpful strategy is visualizing a symbolic representation with which to then analyze thinking and practices. For this process, two symbols are useful to visualize and express each process.
The first process is presented as a labyrinth. As a current symbol, it represents the frequent fluctuations taking place around health and health care issues. As a historical symbol, it accounts for a path with twists and turn. The path, however, is intended to guide a participant toward a center point. When that point is reached an exit pathway becomes apparent. Only one enter and exit point exists.
Labyrinth and Maze are often confused in usage and with their respective definitions.
A maze is also a representative symbol for contemporary health culture in the United States. It presents an even more complex pathway because of its many branches, choices, and dead-ends; it contains several entrance and exit points designed for the original purpose of studying spatial awareness. (www.diffen.com)
Expressing a Transformative Process through Words
Just as symbols help clarify and redirect innovative thinking so too is an understanding and use of words that relate to creative thinking and activities around “culture and health.” Let’s take a look at each of these words for their usage, starting with “health.”
Health
The relevance of “Health,” and its +200 related words (collocates) rank by @www.wordandphrase.info. as #344 of 60,00 words listed by the sight. This site tracks word usage within English language publications found in academia, magazines, and newspapers.
This type of ongoing data collection of word usage enables future conversations, engagement, and written to develop activities and practices for a healthier community for all and to design and implement policies that achieve that goal. Three examples follow showing how, “health,” is presented in recent publications.
Research Publications around “Health”
Power. GA, et al., (2016) investigated the effects of vaccine information and actions by examining 10,715 regional media articles (10/12 -10/14) coverage of vaccines, sentiments regarding it, and measles outbreaks. The analysis is useful to obtain, “deeper understanding of media influences on vaccine choices,” for better public health options.” (www.vaccine.com, 11/3/16)
Leopold, C, et al., (2016) searched NY Times and WS Journal (198502015) for coverage and concerns about pharmaceutical costs in the U. S. The paper concludes that “a concerted effort is required to enable affordable and high-value innovations.”
In addition to the publication examples, specific information is available on a variety of health topics. One such resource is the Congressional Quarterly (www.cqrollcall.com) It tracks all types of health proposals proposed for legislation. At the local level, one can track newspapers who write about health issues and topics relevant to an area or community.
Culture
It is interesting that the website, www.wordandphrases.info, does not track the documentation for the word. “Culture,” however has a significant, historical role influencing current thinking around health.
That power stems from the founder of cultural anthropology, E. B. Taylor, (1870), who wrote, “culture is a complex whole which includes knowledge, belief, arts, morals, customs and any other capabilities and habits acquired by man as a member of society.” (www.britannica.com) This definition influenced Charles Darwin's thinking and the subsequent development of the theory of biological evolution.
A current definition of “culture,” offered by Paul James, (2015), states “the social domain that emphasizes the practices, discourse and material expressions which over time, express the continuities and discontinuities of social meaning of a life held in common.” (www.en.wikipedia.org)
The R. W. Johnson Foundation publication, “Culture and Health,” (2016) suggests that “the systematic neglect of culture in health and health care is the single biggest barrier to the advancement of the highest standard of health worldwide.” Their recommended definition for culture, “the shared, overt and covert understandings that constitute conventions and practices, and the ideas, symbols and concrete artifacts that sustain conventions and practices, and make them meaningful.”
Lacking a meaningful and operative definition of culture when considering both health and health care is to overlook many important variables that influence both health status and health practices for those seeking care. A number of women with whom I worked reminded me of this when discussing their diabetes mellitus (DM) as an act of “nature,” which was “their lot.” Because of this cultural influence passed on to them for several generations, it was hard to see improvement in the management of their disease.
These ladies showed me as a community health nurse that without understanding these cultural factors women would follow the health patterns and practices they had seen within their families. When asked if they wished to live their lives in this same fashion, their collective response was a resounding, NO.” It was at this point that we could begin to talk about caring for their health within their cultural context.
Conclusion
A greater recognition of the significant relationship between one’s cultural influences and health practices is an important first step toward redirecting the resources of the American health care system toward healthier communities. This transformational process takes time on the part of health care practitioners to re-visualize and rethink the effects and outcomes of past practices, as well as to broaden the understanding and importance of words spoken within the cultural context of the patient.
Subsequent blogs will address listening, engaging and connection strategies and activities that play a part in the transformational process taking place within the American healthcare system
Continue the Conversation via my Blog
1. Within your practice as either a health practitioner or a patient, what are your observations about the influence culture brings when services are being either provided or received? Do you notice a cultural difference between or among the provider staff?
2. Are these differences important to you? How do you try to understand these differences as a health practitioner, patient, or employee?
3. Does the community have any significance role in addressing the costs of these evidence-based practices?
4. How would you like to see the health status for all American's improve and become more cost-effective - more disease treatment or more broad-based health strategies developed?
Post your responses to the blog site: www.hcchslec.com/the-culture-of-a...yrinth-or-a maze.
I look forward to your hearing from you.