Adapting health services for mobile, migrant and minority populations

1. The Globalized Patient
Adapting health services for mobile,
migrant and minority populations

2. Julia Puebla Fortier
Executive Director
DiversityRx – Resources for Cross Cultural Health Care
www.diversityRx.org

3. DiversityRx:
Improving health care for a diverse world
! Policy development Working with:
! Research ! Hospitals and health
departments
! Information dissemination
! Universities
! Education and training
! Phillanthropic foundations
! Government agencies
! International organizations

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

5. Migrants Indigenous people
Foreign workers
Refugees
Minorities
Medical tourists
Foreign brides
International students
Expat professionals

6. ! Preventing
disease and
promoting health
Goals of ! Improving quality
health care ! Reducing errors
systems ! Efficiency
and cost
effectiveness
! Good health outcomes
! Fostering
good patient and
community relations

7. 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

8. Structural barriers
! Eligibility for health schemes
! Portability of health insurance
! Undocumented status
! Low-income/inability to pay
! Availability/accessibility of health services

9. How can we achieve health care
goals for the globalized patient?
! Practice
! Policy
! Strategic Alliances
! Presentation References:
www.diversityRx.org/HPH-Resources

10. Practice:
Clinical interventions: one size does not fit all
! Language services
! Sensitive
and informed care delivery – individual level
! Epidemiological factors, cultural background, social
determinants
! Tailoredpopulation services
! Health promotion, disease prevention, disease
support
! Cultural support staff
! Intercultural
mediators, community health workers,
patient navigators

11. Challenge: Communication
Remote medical interpreting
! Use of telephone, video, mobile technology to link in
interpreters from remote locations
! Cost effective and efficient use of resources
! United States
! Japan

12. Challenge: cultural differences
Intercultural mediators
! Community representatives trained to explain cultural issues
and support mediation between patients and staff
! Belgium
! Germany

13. Challenge:
Preparing the health care workforce
! 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

14. Practice:
Career pathways for immigrant health professionals
! Portugal: support for professional requalification
! United States: requalification courses and retraining as
interpreters and cultural mediators

15. Policy:
! Regional/International frameworks
! Country level policies
! Professional accreditation
www.diversityRx.org/HPH-Resources

16. Policy:
International Frameworks
WHO-HPH Task Force on
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17. Policy:
Country level policies
! Spain: universal access, regardless of status. Demographic
health status monitoring
! Australia: Cultural responsiveness framework
! United States: CLAS standards

18. Policy:
Professional accreditation
! 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

19. Strategic Alliances
Collaboration between stakeholders to promote
engagement
! Health professional bodies
! Health policymakers
! Cross-sectoral actors
! Community and patient representatives
! Local, national and international non governmental
organizations
www.diversityRx.org/HPH-Resources

20. Strategic Alliances
What needs attention
! Coordinated, comprehensive action
! Institutionalization
! Information about best practices and model policies
! Structural fixes: financing access to social protection
! Insertion into other health agendas

21. Quality for the globalized patient
An achievable goal
! 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.

22. Contact: rcchc@aol.com
www.diversityRx.org/HPH-resources