The Globalized Patient Adapting health services for mobile,

migrant and minority populations

Julia Puebla Fortier

Executive Director

DiversityRx – Resources for Cross Cultural Health Care

www.diversityRx.org

DiversityRx: Improving health care for a diverse world

!  Policy development

!  Research

!  Information dissemination

!  Education and training

Working with:

!  Hospitals and health departments

!  Universities

!  Phillanthropic foundations

!  Government agencies

!  International organizations

Scenario:

You have gone to a conference in another country and suddenly you don’t feel well…

Medical tourists Foreign brides International students

Expat professionals

Migrants Indigenous people Foreign workers Refugees

Minorities

Goals of health care

systems

! Preventing disease and promoting health

! Improving quality

! Reducing errors

! Efficiency and cost effectiveness

! Good health outcomes

! Fostering good patient and community relations

Challenge of treating the globalized patient

! Access and appropriate utilization

! Communication barriers

! Different cultural practices or disease constructs

! Discriminatory or insensitive treatment

! Unique issues of mobility: ! Unfamiliarity with regionally prevalent illnesses ! Effects of displacement, trauma, torture,

trafficking

Structural barriers

! Eligibility for health schemes

! Portability of health insurance

! Undocumented status

! Low-income/inability to pay

! Availability/accessibility of health services

How can we achieve health care goals for the globalized patient?

! Practice

! Policy

! Strategic Alliances

!  Presentation References:

www.diversityRx.org/HPH-Resources

Practice:

! Language services

! Sensitive and informed care delivery – individual level ! Epidemiological factors, cultural background, social

determinants

! Tailored population services

! Health promotion, disease prevention, disease support

! Cultural support staff

!  Intercultural mediators, community health workers, patient navigators

Clinical interventions: one size does not fit all

Challenge: Communication

!  Use of telephone, video, mobile technology to link in interpreters from remote locations

!  Cost effective and efficient use of resources

!  United States

!  Japan

Remote medical interpreting

Challenge: cultural differences

!  Community representatives trained to explain cultural issues and support mediation between patients and staff

!  Belgium

!  Germany

Intercultural mediators

Challenge:

! Training for clinical, support and administrative personnel ! Epidemiological context ! Responsiveness to linguistic and cultural issues ! Non-discrimination and rights to health services Qatar: training for medical students and health professionals at Weill Cornell Medical College and Hamad Medical Corporation

Preparing the health care workforce

Practice:

!  Portugal: support for professional requalification

!  United States: requalification courses and retraining as interpreters and cultural mediators

Career pathways for immigrant health professionals

Policy:

!  Regional/International frameworks

!  Country level policies

!  Professional accreditation

www.diversityRx.org/HPH-Resources

Policy: International Frameworks

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WHO-HPH Task Force on Migrant Friendly and Culturally

Competent Health Care

WHO Resolution on Migrant Health and Global Consultation

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Policy:

!  Spain: universal access, regardless of status. Demographic health status monitoring

!  Australia: Cultural responsiveness framework

!  United States: CLAS standards

Country level policies

Policy:

!  United States: Joint Commission accreditation of hospitals standards for patient-centered communication

!  New Zealand health professionals registration boards requirements for cultural competence

!  Canada (Ontario) nursing requirements for cultural competence

Professional accreditation

Strategic Alliances

!  Health professional bodies

!  Health policymakers

!  Cross-sectoral actors

!  Community and patient representatives

!  Local, national and international non governmental organizations

Collaboration between stakeholders to promote engagement

www.diversityRx.org/HPH-Resources

Strategic Alliances

!  Coordinated, comprehensive action

!  Institutionalization

!  Information about best practices and model policies

!  Structural fixes: financing access to social protection

!  Insertion into other health agendas

What needs attention

Quality for the globalized patient

!  In order for hospitals and health systems to achieve their overall quality goals, they must provide quality services to ALL patients.

!  Models from around the world show us that quality health care for the globalized patient – migrant, mobile, minority and other vulnerable populations – is achievable.

!  Let’s use their examples to examine our current practices and policies and build strategic alliances to improve access raise health status for all.

An achievable goal

www.diversityRx.org/HPH-resources

Contact: rcchc@aol.com