Bridging Alternative Paths to Health:
Holistic approaches promoting culturally meaningful and equitable approaches to wellbeing
Ester Shapiro Shirley Tang
Tariana V. Little & Tri V. Quach
UMASS Boston Transnational Cultural & Community Studies Program (visit us: https://www.umb.edu/academics/cla/interdisciplinary_programs/transnational_cultural_and_community_studies_ms
Yvette Modestin, Encuentro Diaspora Afro, Boston MA
Workshop 12/4/15 @ Conference Building Inclusive Communities: From Neighborhoods to Nations
· Drawing on our courses, including Gender, Culture & Health Promotion (Shapiro) & Digital Storytelling in Asian American Studies (Tang) at UMB & Encuentro’s arts & racial/cultural justice programs (Modestin) we will share our strategies for engaging students/participants & community partners in connecting to culturally grounded, holistic understandings of wellbeing and cultural resilience resources foundational to health with equity
· Below are online resource in the intersecting fields of complementary & alternative medicine within biomedicine, traditional/indigenous wellness, holistic and integrative medicine as each:
o Strives to reconcile specialty care, primary care, and cultural/holistic approaches to health & wellbeing
o Shifts towards a vision of culturally grounded, person-family-and-community centered care
o Recognizes the centrality of culture, spirituality, and social justice in shared journeys towards wellness
· View Professor Shirley Tang’s keynote presentation, “Media and Digital Literacy via Asian American Studies Pedagogies of Wholeness” https://umbmedia.wordpress.com/2012-citedtech-conference/
· View Yvette Modestin & Brandi Waters talk about Encuentro Diaspora Afro’s work: https://vimeo.com/65380110 ; & visit her blog: http://diasporaafro.blogspot.com/
· View Tariana V. Little’s work in health, communications, & social change: http://www.emvision-productions.com/tariana/
· View “Self-Portrait” by Tri V. Quach: http://www.umassmedia.com/art_lifestyle/self-portrait-by-tri-quach/image_48abdc4e-ba51-11e2-8c6f-001a4bcf6878.html
Culture Holistic Health & Equity resources (based on Gender Culture & Health (Shapiro) course principles & Shapiro published articles, bibliography below):
I. Re-thinking high technology medicine & biomedicalization of everyday life through the lens of culturally/spiritually grounded & equitable approaches to holistic health
a. Robbie Davis Floyd makes the distinction between technocratic, humanistic & holistic/cultural spiritual approaches to health care, based on work in indigenous childbirth and the role of culturally meaningful spirituality and ritual in life course transitions, each plays a key role:
http://davis-floyd.com/uncategorized/the-technocratic-humanistic-and-holistic-paradigms-of-childbirth/
b. Wellness & Flourishing in contexts of equity as starting points, rather than fragmented & decontextualized symptoms of illness (as in Prilleltensky 2012, Wellness as Fairness: http://www.education.miami.edu/isaac/public_web/Articles/69.%20Wellness%20as%20Fairness.pdf Keyes 2013, measuring/focusing on flourishing not just on illness/symptoms) http://tapartnership.org/enterprise/docs/RESOURCE%20BANK/RB-PUBLIC%20HEALTH/General%20Resources/Promoting_and_Protecting_MH__Keyes_2007.pdf
c. Social Determinants of Health explores contexts, justice and health impacts both global and U.S. resources: Unnatural Causes: Is Inequality Making us Sick? http://www.unnaturalcauses.org/ ; UN/global: Closing the Gap in a Generation (2008): http://www.who.int/social_determinants/thecommission/finalreport/en/
d. Human Development approach to economic development measures how well nations & U.S. states spend money to benefit people, based on Amartya Sen capabilities approach looks at Income/Employment & Wages, Health/Life Expectancy, and Education as indicators: U.S.: http://www.measureofamerica.org/ UN/global: http://hdr.undp.org/en/humandev
e. Health care reform in U.S. and globally uses principles of patient-centered, systems-minded, and knowledge-based care (Berwick, 2002); patient centeredness is necessary but not sufficient in addressing issues of equity and cultural diversity: http://content.healthaffairs.org/content/21/3/80.full
f. Literatures on social resilience & rebuilding after disasters focused on local cultural communities and equity (Ungar, 20111; http://resilienceresearch.org/ Lykes, 2013 https://www2.bc.edu/~lykes/
II. Participatory health promotion research, community science, & transdisciplinary research offer ways to engage individuals within their communities or settings (as in UMB), as well as the community as a whole;
a. Participatory research helps us learn what impacted individuals need to support their own efforts toward wellness and healing: recommend Campus Community Partnerships for Health: https://depts.washington.edu/ccph/commbas.html
b. Reaching out to communities to develop culturally meaningful solutions to health issues (Prevention Institute resources including Spectrum of Prevention: http://www.preventioninstitute.org/ ).
c. Wandersman Getting to Outcomes: http://www.rand.org/content/dam/rand/pubs/technical_reports/2004/RAND_TR101.pdf
Connecting culture and health to participatory methods and empowerment:
a. Barrett et al (2003/4) defines holistic health practice consistent with culture & equity, highlights themes of HEAL: Holism, Empowerment, Access and Legitimacy: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466673/pdf/0020253.pdf
b. Many of us turn to holistic practices when we have complex medical conditions requiring culturally contextualized, systemic/life-course understandings: for Ester it was chronic fatigue in my 30’s and cancer in my 60’s that led me to Chinese medicine
c. Requires disease specific/specialized care when needed, while seeking resources for health both within & outside the health care system: high-technology/specialty care, primary care, & wellness/holistic care including treatment, problem prevention and health promotion/wellness
d. A holistic approach focuses on person-centered quality of life or lived experience a term often used in qualitative research and person-centered care.
III. Holistic health as a way to address burdens of stress due to societal inequalities, discrimination, overall stress and the idea of allostatic load which is the body’s burden of self-regulation in response to stressors and a pathway by which inequalities compromise health and cultural resources protect health; McEwan & Seeman (2009) McArthur Network on SES & Health for an overview: http://www.macses.ucsf.edu/research/allostatic/allostatic.php
IV. Addressing discrimination & promoting Health equity through cultures: awareness of discrimination & critical social determinants approach to cultural competence helps us look at contextual stressors & targeting of certain groups due to discrimination/ barriers to resources, AND culturally based resilience strategies & strengths: National Center for Cultural Competence: http://nccc.georgetown.edu/ ; Kirmayer (2012) Rethinking Cultural Competence: http://tps.sagepub.com/content/49/2/149.long
a. Cultural Competence & Health Equity: Connecting holistic health, cultural competence & equity through culturally informed social justice/resource rights
b. Resistance & Resilience: Help individuals and communities balance confrontation/challenge of inequalities and self-protective distance/acceptance as recommended in meditation practices
c. Linking personal health and social change: Help diverse communities become aware of impacts of inequalities, in ways that promote personal and collective action toward change
· Addressing effectiveness: How do we know culturally grounded/CAM works? Thompson et al (2011) developed a measure for self-evaluation of change: http://www.biomedcentral.com/content/pdf/1472-6882-11-136.pdf
· Culture, Storytelling, Narrative Medicine & Terms of Engagement: Culture plays a role in personal and collective engagement/empowerment—how do we become activated to take charge of our health? To join with others? What motivates a sense of purpose? How to understand those whose experiences of being discriminated against or protected/privileged we do not share? Storytelling promotes compassion & empathy for self & others: http://www.narrativemedicine.org/bibliography.html
Culture & Holistic Health
· Excellent glossary of terms used in Integrative Medicine and in Cultural Competence: http://www.hogg.utexas.edu/uploads/documents/Glossary.pdf
· Ted Kaptchuck on the power of placebo effect as it connects to healing rituals across cultures: article I recommend on placebo effect (provider support/beliefs in provider as healer) & how to think about it in terms of ritual theory: http://g.virbcdn.com/_f/files/5b/FileItem-112338-KaptchukritualPhilTranB.pdf
Cultural Resources for Diverse College Students
Jenkins, T. (2013). My Culture, My Color, My Self: Heritage, Resilience and Community in the Lives of Young Adults. Philadelphia: Temple University Press, book chapters and articles available on her site: http://tobyjenkins.weebly.com/
Professor Ester Shapiro, References:
Shapiro, Ester (2014). Translating Latin American/US Latina Frameworks and Methods in Gender and Health Equity: Linking Women’s Health Education and Participatory Social Change. International Quarterly of Community Health Education.
Shapiro, E., and Atallah-Gutierrez, C. (2012). Latina Re-Visionings of Participatory Health Promotion Practice: Cultural and Ecosystemic Perspectives Linking Personal and Social Change. Women and Therapy, Special Issue, Latinas in Therapy. 35(1-2), 120-133.
Shapiro, E. (2013). Chronic illness and family resilience. In Becvar, D. (Ed.), Handbook of Family Resilience. NY: Springer.
Shapiro, E., and Modestin, Y. (2013). Women of Color and the Arts: Creativities in Everyday Life As Wellsprings of Resistance and Resilience. In Comas-Diaz, L., and Greene, B. (Eds.). Psychological Health of Women of Color: Intersections, Challenges, and Opportunities. NY: Prager.
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