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Alternative Health Systems - Coggle Diagram
Alternative Health Systems
Arctic Health
Who & Where
Populations & Living conditions
Geog = polar circle
Small pops
Scattered settlements
Difficult transport
Pol = part of other countries
Alaska (US)
Northern Canada
Greenland (DK)
--> Pop = inuit, 'indians' (first nations, alaskan natives)
Northern Russia --> Siberian people
Northern Scandinavia (Norway, Sweden, Finland) --> Sami (Euro ancestry)
Living Conditions
Trad lifestyle based on hunting (sea mammals)
--> Rapidly changing living conditions towards western lifestyle
Small settlements
Crowded housing conditions
Low Y
Shorter life expectancy in indigenous pops (about 10 y less than in DK)
Greenland
World's largest island
Self-rule from DK (apart from foreign policy & defence)
Pop = 56k
89% inuit
Only coastal strip inhabited:
Nuuk (capital) = 30% of pop (16K)
16 towns = 55%
50 settlments = 15%
--> Used to be many more but in 60s moved into towns
Only 1 central hospital + 16 small hospitals (1-4 physicians)
What?
Tradi Health Patterns
High incidence of CIDs - High epidemic potential
Isolation = transport difficult + travels dependent on time of year
Receptive pops = not previously infected
Favourable conditions for transmission = narrow & tight houses + crowding
--> TB + STIs + HIV (linked high alcohol, low SES, low compliance)
Low incidence of 'western' life syle diseases (eg CVDs)
--> Changing pattern!! - Risk factors
High alcohol & smoking
High suicide
High fast food
:!!: ==> Epidem Trans
Causes of death / BoD
Cancer
CVD (Coronary heart disease + stroke)
Suicide
Accidents
Acute infections
TB
Other
--> Overweight & obesity
DM = from 1 case in 1910 to 10% 2000s
How to deliver?
Health systems & care delivery
Free (in Alaska pub progs for native pops)
Local healthcare stations
Secindary & tertiary centers at distances
Interventions
Improve access to care
Increase logistics = staff (by bringing in / educating more qualified healthcare practitioners)
Develop cooperative research efforts
Action oriented policy recommendations
Acknowledge & integrate Indigenous rights and knowledges
Expand health-oriented monitoring and assessment programs
Implement community-led, critical research
approaches that focus on partnerships, reciprocity, adherence to ethical guidelines, and funding community-based research
Eg
Suicide prevention!
Improve healthy eating behaviors
Better housing - less overcrowding
One health
Challenges
Covid-19
Susceptible pops
Ind risk factors for severe infections
Vulnerable health system w/ few res
Long distances - patient transport issues
Non-specialized stadd
Few ventilators (Nuuk only)
Limited supply of meds
--> Strategy = keep covid out
Logistics =
Limited facilities & staff
Language & cult barriers
Evacuation issues
Extreme distances
Health disparities b/w (non)-indigenous pops
Substantial burden of CIDs
Increase burden of western NCDs (CVD & DM)
Gene-envt interactions
High but changing rates of suicie
Migrant Health
Who & Where?
Ethnically diversifying world due to migration
1B migrants globally = 1 in 8 people.
281M international migrants (155M in 2000
--> 58% from non-Western countries (incl Turkey, Pakistan, Ex-Yugo, Iraq, Leb & Somalia)
82.4M forcibly displaced
48M
internally displaced
26.4M
refugees
(25%)
4.1M
asylum seekers
Other 'Migrants'
Labor migrants
(migrant workers) = 150M (very diverse grp BUT migrant workers' health under-researched, 36 pubs)
Family reunified children
Descendants
Internal migrants
Left-behind children & parental migration = detrimental to health of left-behind children (no evidence of any benefit)
Unaccompanied/separated children
New forms
(diverse phenomenon)
'Forced' migration
Econ mig
Re-migration
Circular mig
Reverse econ emigration
Envtl/climate refugees
...
Pros & Cons for registering ethnicity in health data
Against registration =
Discrimination (prejudice against specific grps)
Stigmatising
Risk of misuse
For registration =
Increased equity in health (more targetted approach to care)
Destimatising
--> Arguments may change over time
:flag-dk:
"new/recent immigration country” not like UK or France from colonial past, not as diverse
--> Increased in 70s from Morocco, Pakistan, Turkey to work
What?
Terminology & definitions
Western v Non-western (vary diverse range of countries lumped together)
Illegal VS Undocumented
Less devlpd VS Devlpg countries
Immigrants VS Natives
1st VS 2nd generation
Ethnic minorities
...
Migration as a social construct
we are all migrants
Cultural diversity = fact of modern life
Ethnicity
About cult id
A dynamic concept that changes over time
Everyone has an ethnic background (incl majorities)
:green_book: :flag-dk: exhibitions of ethnic communities (in DK exhibited in Tivoli, sometimes kids put in cages)
Today = :flag-gb: 600 languages spoken
Why migrant health?
--> Growing field (started in Minnesota in 80s)
”Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that none should be disadvantaged from achieving this potiential, if it can be avoided”
"Free & equal access"
"The right to health" (UNDHR article 25)
Requires gvts & pub authorities to put in place policies & action-plans which lead to available & accessible healthcare for all in shortest possible time
Determinants of health for migrants
Migration = as a key determinant of health & well-being.
--> Adds layer of complexity
Refugees and migrants remain among the most vulnerable members of society faced often with:
Xenophobia
discrimination;
poor living, housing, and working conditions; and
inadequate access to health services (despite frequent phy and MH pbs)
Ind characteristics & behaviors
Genetics
Gender & sexuality (personal behaviors)
Age
(Dis)ability
Ethnicity
SE env
Educ
Health literacy
Income & social status
employment & working conditions
Social support networks
Culture & Religion
Class
Health services
Phy env
Safe water & clean air
Healthy workplaces
Safe houses, communities & roads
Food & nutrition
Risk Factors
Pre-migration
MH
Genetics
Lack of res (access to food, educ, healthcare...)
Trans-migration
MH
Lack of access to healthcare / medication (eg HIV)
GBV & child violence
CIDs (TB, STIs...)
Post-migration
MH
Navigating a new system
Language barriers
Discrimination & racism
Life course perspective
Hist of parents (genes + sex)
Country of origin (ind, envtl & contextual exposures)
Factors leading to migration (war, nat disasters, pol repression, etc.)
Migration - Process of migration (ind, envtl & contextual exposures)
First gen - health status of immigrant
--> New home country (ind, envtl & contextual exposures)
Offspring (genes + sex)
Home country (ind, envtl & contextual exposures)
Health situation of descendants of migrants/ ethnic minority
Intersectionality Theory
= how overlapping / intersecting social ids (particularly minority ids) relate to systems & structures of oppression, domination or discri
:green_book: unaccompanied + girl + minor + no schooling
Refugee children Health Risks/ Challenges:
MH - Traumatic events
Separation from parents / siblings
Death of family
Witnessed violence
Subjected to violence
Increased risk of CIDs
germany (2015) = 73% of refugee children pos for Measles, Mumps & Rubella (MMR)
Vaccination status & needs
L-t TB
Covid
Vulnerability to NCDs
Cancers
DM
DBD = DM + PTSD; DM + Obesity
Stroke * CVDs
Using different comparison grps
Comparing to host pop = health inequa
Comparing across gens = role of env
Comparing migrants in diff countries = role of context
Comparing w/ country of origin = role of migration
Importance of Context
Cultural competence (KAS)
= ability to understand, communicate w/ & effevtively interact w/ people across cultures
Knowledge = of epi (disease) in various ethnic grps + awareness of diff effects of treatment in various ethnic grps
Attitudes = how cult shapes ind behavior & thinking + social contexts in which grps live + 1's own prejudices & tendency to stereotype
Skills = ability to transfer info in a way patient can understand + know when to seek external help w/ comms + adapt to new situations flexible & creatively
"Dangers of a single story" (Chimamanda)
Response (Health Needs (HN) & access to care)
Health Needs (HN)
Upon arrival (in EU?)
In Transition
Upon arrival
L-t
Access to care
1. Formal barriers
Delay in diagnosis & treatment
Increased morbidity & mortality
2. Informal barriers
a.
Ind factors =
Language
Discri
Marginalization
'Newness'
Educ / iliteracy
Caregivers mental pbs
Family at home
b.
System-related factors =
Healthcare pros attitudes
Interpreter services
Cultural competency
