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Workshop D-8: Scanning the community: identifyinng and targeting health disparities in ethnic communitiesAdapting Health Promotion Programs to the Needs of Israeli-ArabsArab-Israelis are Israel’s largest minority group, constituting approximately 20% of the population of the State of Israel. Since the establishment of the State of Israel in 1948, the Arab population has been undergoing rapid modernization. One result of this process has been a decrease in the differences between the health of the Jewish and Arab populations. The health of the Arab population has improved notably, in part thanks to an improvement in socio-economic status and a gradual transition from traditional to modern medicine. Some specific improvements in the health of the Arab population have been: a decline in mortality from infectious diseases, a decline in the infant mortality rate and an increase in life expectancy. Moreover, Israel’s National Health Insurance Law, adopted in 1995, led to significant improvements in access to care for the Arab population. Still, the Arab minority remains significantly disadvantaged in terms of health status and access to certain types of health care services. One key problem is that health care services and health promotion efforts are not always responsive to the unique health, social and cultural characteristics of Israel's Arabs. In Israel, the Ministry of Health, health plans, hospitals, and the voluntary sector carry out scores of health promotion programs. Some are limited to specific sub-populations, while others seek to reach the general population. Several programs directed to the general population have included special efforts to ensure cultural and social appropriateness, so that the programs do meet the unique needs of Israel’s Arab population in an effective manner. However, there is a widespread perception that in many cases, major nationwide health promotion efforts have not done enough in this regard, and therefore, the programs’ potential impacts in the Arab sector have not been realized. The overall goal of the study is to provide the information needed to make health care and health promotion programs more culturally appropriate to the cultural and social needs of Israel's Arab population. The study endeavors will be focused on ways to:
The study, which is in the early stages of implementation, is innovative in that it examines cultural appropriateness across a wide range of programs. Accordingly, our goals for the workshop are to get input from participants regarding the study methodology, the interpretation of preliminary findings, and strategies for addressing the problems identified. The lead researcher is Shuruk Isma'il, an Arab-Israeli whose work in social and cultural appropriateness includes involvement in the Center's evaluation of “Refuah Shlema” – a special project to increase the effectiveness of primary health care services for the Ethiopian population. She works closely with Dr. Bruce Rosen, the Director of the Brookdale Institute's Smokler Center for Health Policy Research. The initiative includes consultation with researchers from other divisions within the Institute, as well as universities and research institutes in Israel and overseas.
Addressing Health Disparities in the Hispanic/Latino and Russian-Speaking Communities: Partnerships with Family Planning Clinics and Community-Based Organizations in Washington StateIndividuals from culturally and linguistically diverse communities face a range of barriers in accessing family planning and reproductive health (FP/RH) care and other health services. Navigating the health care system in the U.S. is challenging for most patients, but is particularly daunting for individuals with limited English proficiency (LEP). Routine tasks such as scheduling and confirming appointments, communicating with front office staff and completing patient registration forms may be insurmountable for individuals with LEP. Language problems during provision of clinical care may further heighten these initial challenges. Working with professional interpreters may facilitate communication between patients and providers, but may not help patients and providers understand the cultural context for health care. Finally, other more common service access problems may also play a role in service delivery to LEPs, including lack of transportation, insurance, and childcare services. The Center for Health Training (CHT) explored these barriers to FP/RH care for individuals with LEP over a two-year period through a Service Delivery Improvement research grant from the DHHS Office of Population Affairs. Four study sites in two distinct LEP communities in Washington State participated in this project. In Vancouver, WA the project focused on religious refugees from the former Soviet Union and in Yakima, WA, the work centered on monolingual Hispanic/Latino farm workers and immigrants. Two sites in each community included a Title X-funded family planning clinic and a community-based organization (CBO). The first year of the project focused on assessing access and service issues from community and agency member perspectives. This culminated in CHT and local agencies devising program innovations to address LEP FP/RH service provision in each community. During the second year, project participants successfully implemented these plans and CHT is evaluating their impact. Each community presented unique challenges. In Vancouver, the FP clinic did not routinely collect information on client languages and refugee status so it could not monitor service provision to the LEP in question. In Yakima, the partnering agencies had conflicting perspectives on the community and organizational cultures and had to learn to collaborate. One other general challenge was learning to navigate the fine line between micromanagement and undersupplied guidance to allow for a truly collaborative process and genuine relationship to develop between partnering agencies. In this workshop we will discuss how this research/community process and our commitment to supporting the developing of sustainable community-based interventions led to successful implementation and outcomes in both communities. Additionally, we will provide a summary of the research findings that guided planning for the second year and the important events that made up each intervention. Lessons learned include: a) the importance of partnerships and perspective-sharing between clinics and community based organizations, b) the value of technical methods (e.g., GIS mapping applications) as practical community service tools, and c) the use of participatory research as a strategy for organizational change. Elisa Sobolewski has worked the past two years at the Center for Health Training in Seattle, WA as the Research Associate for the Service Delivery Improvement Project. In this work she has found a productive way to blend her background and interest in cultural anthropology and social research with the project focus on improving FP/RH services for diverse populations with LEP. Before arriving at CHT, Elisa assisted in data collection for the Developmental Pathways Project study on teen depression at the University of Washington. She has also worked as a behavior analyst for Girl Games, Inc., a consulting firm that aims to address the needs of young girls in the video gaming industry for educational and play purposes. In addition to studying and working with diverse subcultures and groups, Elisa has lived and worked in both public and private entities in Korea, Japan and Poland and traveled extensively throughout Africa, Eastern and Western Europe, Australia and Eastern Asia.
Bridging the data gap: Partnering with Minnesota’s Somali refugees to implement a community-based health surveyMinnesota has become the ‘Somali capital of the United States’ and is home to over half of all the Somali refugees living in the US. Population estimates range from 20,000 to 40,000. Although Minnesota prides itself on being one of the healthiest states in the nation, there are still very large health disparities that persist within immigrant and refugee communities. To bridge the health gap between the Somali community and other Minnesotans, Minnesota International Health Volunteers successfully launched the Somali Health Care Initiative (SHCI) in March 2002 in partnership with two Somali-led community organizations: the Confederation of Somali Community in Minnesota, and the Leadership, Empowerment, and Development Group. The SHCI is funded through the Minnesota Department of Health and addresses six health topics: breast and cervical cancer, diabetes, cardiovascular disease, infant mortality, HIV/AIDS, and immunizations. Somalis face numerous barriers when trying to access health care but the development of culturally-appropriate health education materials and programs is hindered by a lack of data about the health of this community. As part of a larger initiative that included education and outreach to both Somali community members and health care providers, we implemented a survey to better understand health knowledge, practices, and behaviors in the Somali community. Collecting meaningful data that truly reflects disparities in the Somali community (and other minorities) is needed to ensure that health education efforts are targeted, specific, and culturally relevant. The survey process was truly collaborative and included input from our two Somali partners as well as consultation and advice from Somali health professionals and other community leaders. Our project also engaged Somali media to assist with publicizing the survey through cable television and radio announcements. For the survey, we successfully recruited and trained 17 Somali interviewers who conducted a total of almost 300 in-person surveys (2/3 of which were women) with Somali residents of the Twin cities and rural Minnesota. The questionnaire tool that was developed covered basic socio-demographic information, health insurance coverage, use of primary health care services, prenatal and care during pregnancy, breast and cervical cancer screening, nutrition and physical activity. The data has been analyzed and will be shared widely with the Somali community and health providers in Minnesota. This presentation will discuss the process, findings, challenges, and lessons learned from the survey. Specific resources that will be shared will include the practical steps involved in designing and conducting a health survey with full community participation, and a bibliography of publications on the health of Somali refugees. Nathaly Herrel holds a BSc from the University of Bristol, England, in Biology. She completed her Masters of Science at the London School of Hygiene and Tropical Medicine with a focus on Infectious Disease Control and Public Health in Developing Countries. She worked for two years in Pakistan as the principal investigator of a research initiative on malaria and irrigation and has several publications in peer-reviewed journals. From March 2002-June 2004, she coordinated the Somali Health Care Initiative at MIHV in Minnesota. This position has involved training CHW's, coordinating outreach to the Somali community, organizing cultural competency seminars for health providers, developing culturally-sensitive health education materials for Somalis, and conducting community-based participatory research with the Somali refugee population of Minnesota.
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National Conference is presented by State University of New York Downstate Medical Center, Resources for Cross Cultural Health Care, Arthur Ashe Institute for Urban Health, US Department of Health and Human Services, Joint Commission on Accreditation of Healthcare Organizations |
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| As with the rest of Diversity Rx, this section
is a work in progress and we welcome information on other efforts, programs,
and reports that will expand upon the information offered here. Please
let us know if you have other examples to include here. |
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Diversity Rx is sponsored by: |
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 Resources for Cross Cultural Health Care |
 Henry J. Kaiser Family Foundation |
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