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Cultural And Society Diversity In Health Care
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1. Briefly discuss the social determinants of health as they apply to the identified cultural groups.
2. Describe health related risk factors for people from the identified cultural group.
3. Critically discuss strategies in place for the provision of health care to address the identified risk factors.
4. Based on available evidence and your understanding of the critical health issues among the identified cultural group, suggiest possible strategies and recommendations to address deficits.
5. Present a coherent summary that identifies similarities and differences between the two case studies.
Over the past ten years, there is an increase in the number of ethnic minorities in Hong Kong (Cho, 2014). In Hong Kong, the significant amount of migrant workers constitutes of foreign domestic helper (Cortes & Pan, 2013). This immigrant community provides an opportunity for understanding "Social determinants of health." Across the nations, there is the increase in trend of hiring paid domestic helpers from other countries by the household to delegate their household activities. The reason being, their nationals are not inclined to do domestic work. Therefore, less developed countries (Indonesia, Pakistan, Bangladesh, etc.) are taken advantage of their domestic workers (Law & Lee, 2016). Due to a high cost of labor and its shortage, workers were recruited from foreign countries. According to national survey reports of Hong Kong, in 2013, there was total of 320,000 foreign domestic and other workers. Out of which, 50 percent of these employees were from the Philippines, 47% from Indonesia and the rest from other places (Constable, 2016). Therefore, Hong Kong is trying to promote culturally competent care.
In this assignment, the author will discuss two case studies one of domestic helper and other working in Hong Kong. One of them is Indonesian domestic helper, and the other is South Asian (Pakistani) living in Hong Kong. The author will detail the social determinants of Health as they apply to the identified cultural groups. From each of these groups, health-related factors for the people would be described as the people. Further, the author will critically discuss the strategies in place for the provision of health care to address the identified risk factors. Based on the evidence of the critical health issues among the identified cultural group, the author will suggest possible strategies and recommendations to address deficits. Lastly, the similarities and differences between the two case studies will be summarized. The author will perform a literature search on recent articles to support the facts and arguments.
Case study of Indonesian domestic helper
This case study belongs to Mrs. X a 33-year-old Indonesian woman moved to Hong Kong, three years ago. As per the information, her involuntary nature of work includes agency fees of $3000 HKD for seven months. Her passport and contract are confiscated by Hong Kong agent. She was misinformed of her terms of employment, and other details were deceptive. She has little knowledge of English but speaks Cantonese. She was one of the several cases of the victim of forced labour and debt. She worked for 18 hours a day, and lived in a servant room and slept on the floor. During her working days, she was verbally and psychologically abused, treated like a slave, and was tortured by her employer for several months. She was beaten daily on head by a mope handle, punched on face including other indecent assaults. She had no rest days. She received no salary for first six months and later she was the underpayment of $200 initially and $2100 and survived on insufficient and mainly sweetened food. She was locked in the house by the householder most of the time. She escaped after two years and nine months. She was later admitted in hospital and her medical history shows respiratory difficulties and musculoskeletal strain. During her treatment she had difficulty in communicating with nurse due to language barrier.
Social Determinants of Health
The contemporary approach to taking action on inequalities of health requires identification of social determinants. The environmental conditions in which people live and resources such as education, transportation, food supply and social relationships that improve the quality of life together comprises social determinant (Law & Lee, 2016).
The identified social determinant associated with health issues of Mrs. X. includes socioeconomic status, income inequality, and ethnicity. These ethnic groups are treated miserably as the employers are aware that these women have low education attainment, poor economic background, and poverty.
According to studies of (Cortes & Pan, 2013), a majority of workers from Indonesia working in Hong Kong suffer from oral health issues and remain untreated. As a result of low wage and long working hours, these employees neglect their health checkups and personal hygiene such as brushing teeth and use of dental floss. Living in an untidy environment and lack of healthy food, privacy and freedom to participate in self-care activities, made her physically weak and prone to respiratory difficulties. Confined in the house, they lack social connectedness thus are lonely and depressed giving rise to other psychological disorders. Therefore, only "biology" is not always responsible for the various health outcomes. Without any friends and family support, they are unable to relieve distress, obtain health information. Eventually, it decreases their ability to control their circumstances and lives. The figure below represents the public health framework. It depicts how the macro, micro and the intermediate determinates of health are related.
Health-related risk factors
The health-related risk factors are several mental disorders, respiratory difficulties, hypertension, depression and occasional insomnia, musculoskeletal strain, dental caries and periodontal diseases.
Strategies for health care to address the identified risk factors
There should be a regular distribution of information related to mental disorders and those with available effective therapeutic treatment. At a local level, there should be information related to "social, economic, and environmental stressors” (Cortes & Pan, 2013). Additionally, community engagement is necessary for the intervention to psychological distress by involving residents in problem solving. Knowledge should be provided on how local social, environmental and economic factors contribute or ameliorate psychological distress. There should be the proper assessment of all health care facilities and initiatives on their impact on "physical and mental health equity”. Indonesia must put effort to “enhance positive family involvement” and support to domestic workers abroad. Hong Kong must address the "loneliness and depression" by providing support to improve family by cheaper means of communication (Mathews & Wai-chi, 2016).
Showing culturally competent care by nurses may help patients motivated. Mrs. X must open her heart and mind. It will help her understand others cultures and “global socio-political and health issues” which in turn increase her commitment to improve her “personal and professional growth”. She must learn to develop cultural competence. Improvement of counselling services in other languages instead of only Chinese should be promoted to make intervention effective for the ethnic minorities. Public hospitals must publicize about their intervention and interpretation and other TransLingual services by internet, newsletters or posters printed in ethnic minority languages about details of application and charges. These services must at least cover 18 minority languages (Malhotra et al., 2016).
It is recommended that Mrs. X and other workers like her must get medical facilities free of cost. The employers are entitled to take care of medical emergencies of their employees but in vain. Therefore, the employment agencies must ensure that the companies abide by the government rules strictly. The government of countries sending and receiving domestic helpers must implement policies to provide minimum education for all the girls with English as a compulsory subject. This will enable them to fetch better jobs and at least read the documents properly before signing any official agreements or bonds (Tong, 2014).
According to (Iskandar, 2015) the domestic workers of Indonesia are at serious risk of "human and labor right violations" in Hong Kong. Researchers are required to understand better the "epidemiology" of such conditions faced by female foreign domestic workers. A concerted effort is needed from the government of labour-sending and receiving countries.
These social determinants imply for effective policy making in Hong Kong as well as in countries exporting domestic helpers. During the policy making, the interests of domestic workers, employers, stakeholders, employment agencies, non-government organizations must be considered.
According to (Constable, 2013) Hong Kong followed "Two Week Rule," which states that no employee is allowed to stay for more than two weeks in the country after being terminated from the job. Hence, there was no option but to escape from the place for these domestic workers. These workers must be entitled to visit their native lands thrice in a year.
Nurses must be open-minded while caring for ethnic group as they communicate with people from different backgrounds. They should not avoid victims of domestic violence making them wait for long hours in hall. Such attitude should be made punishable by the government. Government of Hong Kong must take strict actions against lack of such professional ethics leading to endanger of victims (Constable, 2015).
Case study of Pakistani worker
This case study belongs to Mr F. a 65-year-old Pakistani man moved to Hong Kong, thirty years ago. As per the information, he works as building worker. He could well speak Cantonese but does not speak English. He has low education attainment. He was one of the several cases of the victim of forced labour and debt. He worked for 14 hours a day. During holy month of Ramadan, he had to fast for long hours and was permitted to work for six hours a day. During fast he was not supposed to chew gums, smoke, eat or drink. He was not allowed to pray namaz during his work and was discriminated on the basis of racial ground. He was treated brutally by the Chinese communities. He had two rest days every month and survived on insufficient food and had poor hygiene. He is frequently admitted in the hospital foe his weakness. His family lives in Pakistan and had to take care of himself. He had chemical dependency mainly “Tobacco”. He was admitted in hospital earlier and was diagnosed with tumour in his left cheek.
Social Determinants of Health
The identified social determinants here are socioeconomic status, religion, low income, malnutrition, stressful work, and ethnicity. The other factors are same as that of the ethnic group of Indonesia.
Health-related risk factors
The health-related risk factors include hypertension, risk of ventilometric dysfunction, and respiratory difficulty due to inhalation of dust particles, musculoskeletal strain, intestinal parasitic infections, and suppressed immune functions and oral cancer.
Strategies for health care to address the identified risk factors
The strategies for addressing health issues are same as that mentioned for ethnic group of Indonesia. According to (Tong, 2014) both “motivational and intervention phases” should be included in the mental health interventions programs. It uses both patient histories to address the health issues as well as evidence-based practices. In addition to this, there should be a provision of palliative care in these communities. It s recommended that these ethnic minorities must avoid using folk medicines. Keeping in mind the age of Mr F he should completely avoid sedentary lifestyle and include diet lacking in saturated fats. He must regularly get his blood pressure and cholesterol checked. He should completely avoid having Tobacco. Rehabilitations are best options for such people (Cho, 2014).
The recommendations for this ethnic group are same as that of the former. Additionally, it is recommended that the government should ensure the protection of the human rights. There should be no discrimination against people with different religion, mental illness and psychosocial disability. The government should bridge the gap present in the mental health treatment. These domestic workers must have improved access to the “health and social care” (Kuo, 2014).
Policies should be framed for health care providers to prevent sexual exploitation of these ethnic clients who attempt to receive abortion care or STI treatment. The government of Hong Kong must take actions against denial of medical services by physicians. The government of countries sending and receiving domestic workers must provide programs for awareness on various health risk factors and its prevention (Tong, 2014).
Government of Hong Kong must ensure that the religious needs of this ethnic group are fulfilled. It is recommended to the healthcare organisation that more facilities and resources should be provided to promote “culturally competent care”. Nurses should be provided training to overcome linguistic barriers so that that can communicate well with patients of different cultures. Government of Hong Kong must formulate policies to ensure training programs for ethnic minorities to teach language and cultural competencies of Hong Kong (Constable, 2015).
There is a difference in both the cases discussed above in terms of discrimination. It is evident and can be interpreted from the first case that most of the domestic helpers underwent similar trauma, pain and agony working in Hong Kong. In the second case, the discrimination was based on the ground of religion.
It is clear that these foreign workers were exploited due their low socioeconomic status and were taken advantage of weak income opportunities in their nations. They were subjected to abuse and discrimination due to racism and their ethnicity (Chung et al., 2015).
Due to lack of proficiency in English, they had difficulty in communicating their health issues to the nurses in the admitted hospitals. Mr. F did not suffer from oral health issues as Mrs. X but suffered other major health issues such as cancer. Mrs. X received the minimum salary in addition to trauma, but Mr. F suffered lesser mental trauma and more of discrimination due to religion and ethnicity. Unlike, Mrs. X the health issues of later was mainly because of his occupation and his own addiction of Tobacco. Mr. F did not go through any sort of physical violence.
Hong Kong being commercial and economic based Metropolitan has been a great attraction for foreign domestic helpers. With the help of this case studies, the author described the vulnerabilities of the immigrant groups. It is also a major concern for many countries including Pakistan, Hong Kong, and Indonesia sending and receiving domestic helpers. These immigrant victims provide an opportunity for social determinants of health.
The poor health of the ethnic minorities correlates with their social circumstances. Various psychosocial, material and behavioural pathways link the diseases and their prevalence in these underprivileged groups. Therefore, it is essential to address the social context, as focusing only on an improvement of the health behaviours will exaggerate the health inequalities. It is advocated to address the upstream determinants of health. Recently, due to rising voices and legal actions from some of the victims these immigrants are receiving worldwide attention. Presently, the well-being of these ethnic minorities in Hong Kong is the highest priority of World Health Organisation and International Labour Organisation (Cortes & Pan, 2013).
Cho, H. Y. (2014). FOREIGN DOMESTIC WORKERS IN HONG KONG AND THEIR RIGHTS TO STATUTORY MINIMUM WAGE. FRONT COVER, 107.
Chong, A. M., Kwan, C. W., Chi, I., Lou, V. W., & Leung, A. Y. (2014). Domestic Helpers as Moderators of Spousal Caregiver Distress. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, gbu034.
Chung, R. Y., Mercer, S., Lai, F. T., Yip, B. H., Wong, M. C., & Wong, S. Y. (2015). Socioeconomic Determinants of Multimorbidity: A Population-Based Household Survey of Hong Kong Chinese. PloS one, 10(10), e0140040.
Constable, N. (2013). Migrant workers, legal tactics, and fragile family formation in Hong Kong. Oñati Socio-Legal Series, 3(6).
Constable, N. (2015). Temporary Shelter in the Shadows: Migrant Mothers and Torture Claims in Hong Kong. Migrant Encounters: Intimate Labor, the State, and Mobility Across Asia, 92.
Constable, N. (2016). Surveillance, Discipline, and the Ins and Outs of Prison for Overstayers and Undocumented Workers in Hong Kong. Migration, Mobility, & Displacement, 2(1).
Cortes, P., & Pan, J. (2013). Outsourcing household production: Foreign domestic workers and native labor supply in Hong Kong. Journal of Labor Economics, 31(2), 327-371.
Gao, X., Chan, C. W., Mak, S. L., Ng, Z., Kwong, W. H., & Kot, C. C. S. (2014). Oral Health of Foreign Domestic Workers: Exploring the Social Determinants. Journal of Immigrant and Minority Health, 16(5), 926-933.
Ho, W. Y. (2015). The emerging visibility of Islam through the powerless: Indonesian Muslim domestic helpers in Hong Kong. Asian Anthropology,14(1), 79-90.
Iskandar, P. (2015). Shifting the Boundaries of Constitutionalism: Making Space for International Law in Indonesia. Available at SSRN 2589986.
Kuo, H. (2014). Lessons from the West: Re-Evaluating the Rights and Regulation of Domestic Workers in Hong Kong by Learning from Canada and the United States. Journal of Law, Technology and Public Policy®, 1(1).
Ladegaard, H. J. (2013). Demonising the cultural Other: Legitimising dehumanisation of foreign domestic helpers in the Hong Kong press.Discourse, Context & Media, 2(3), 131-140.
Law, K. Y., & Lee, K. M. (2016). Importing Western values versus indigenization: Social work practice with ethnic minorities in Hong Kong.International Social Work, 59(1), 60-72.
Malhotra, R., Arambepola, C., Tarun, S., de Silva, V., Kishore, J., & Østbye, T. (2013). Health issues of female foreign domestic workers: a systematic review of the scientific and gray literature. International journal of occupational and environmental health, 19(4), 261-277.
Mathews, G., & Wai-chi, C. (2016). Detaining the Immigrant Other in Hong Kong. Detaining the Immigrant Other: Global and Transnational Issues, 105.
Tong, K. W. (Ed.). (2014). Community Care in Hong Kong: Current practices, Practice-Research Studies and Future Directions. City University of HK Press.
Wang, S. H. (2015). Constable argues that babies ‘born out of place’‘cut right to the heart of many prob-lems surrounding temporary labor migration in the world today’(p. 2). Chapter 1 sketches out four such problems in Hong Kong: 1) laws governing foreign domestic workers ‘make it virtually impossible to be a good worker as well as a good wife, mother and daughter’(p. 9), forcing many to. Work, employment and society, 29(4), 692-698.
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