Category Archives: Interactions

Social Determinants of Health in US Populations

Required:

  • Link and Phelan. 1995. “Social Conditions as Fundamental Causes of Disease” Journal of Health and Social Behavior pp.80-94
    • In this foundational article, social epidemiologists Bruce Link and Jo Phelan argue three main points:
      1.  social conditions (e.g., SES, inequality, racism, segregation) have a causal effect on health and well-being,
      2. to understand patterns of disease prevalence and incidence, we need to contextualize risk factors and understand what conditions put people “at risks of risks” (i.e., people in poor neighborhoods have an elevated risk of exposure to crime which increases the risk of stress accumulation), and
      3. researchers need to acknowledge that social conditions are not just distal causes of disease, they are FUNDAMENTAL causes, meaning that the relationship between the social conditions (e.g., SES) and health is robust and will remain present even as the risk factors for disease and the leading causes of disease/death change.
    • This is because high SES individuals are afforded flexible resources that they can use to avoid risks and minimize the consequences of disease.
  • Frieda, Misha. 2016. “For Native Americans, Health Care Is a Long, Hard Road Away”.
    • NPR : https://www.npr.org/2016/04/13/473264076/for-native-americans-health-care-is-a-long-hard-road-away
  • Social Determinants of Health PPT

White Fragility

Activities 1-3

  1. Read pages 54-58 (stop before the section Factors that Inculcate White Fragility) in the article White Fragility, by Robin DiAngelo
    • Discussions about race and racism can be inherently uncomfortable. Acts of racism can take all forms and it is important to consider intent versus impact when racist behavior is exhibited. Much of this is driven by societal norms and socialization.
  2. Review In-class handout: The Art of Mindful Inquiry and Health Ways to Communicate
    • In order to have a deeper discussion please review recommendations for inquiring about difficult topics and look over the discussion points that will be discussed.
  3. Watch the video clip Just Be American from the film Color of Fear.
    • This video in an excerpt from the 1994 film The Color of Fear. Eight men of different backgrounds, races and ethnicities were gathered by director Lee Mun Wah, for a dialog about the state of race relations in America as seen through their eyes. This is a response by David C. after hearing about experienced racism from other members of the group.

Your goal for each activity

  1. Create a personal definition of white fragility.
  2. Understand how societal norms can lead to power differentials that exist between racial groups.
  3. Create a framework for discussions that may be difficult or challenging.
  4. Create a framework for understanding why talking about racism may be more difficult for some than others.

 

Bridging Difference: An approach to conflict with colleagues

Conflict is frequent and inevitable in healthcare.  Why?

  • We have different personal and professional values. Moral issues and values often play a role in medical care and decision-making, and the values of individual team members may at times conflict.
  • We may have a different understanding of the same patient or situation. For example, one physician may see a patient as having a potentially treatable illness, while another sees him as someone who is suffering and should be allowed to die peacefully.
  • There is often not a single “right” or evidence-based answer. The different experiences of team members may lead to different approaches to the same patient or issue.
  • We come from diverse cultural backgrounds. Team members – including patients – all bring their personalities and cultures to the table, and icebergs can bump.
  • Working in healthcare is stressful and can cause individual ‘resource depletion’. Fatigue, stress, and burnout all make conflict more likely.
  • We may have inadequate institutional resources, leading to tussles to get our patients what they need – the next operating room, an expensive medication, etc.

Health professionals AND medical students need to have a constructive approach to conflict

  • To provide the safest and highest quality care for patients
  • To create a safe learning and working environment for ourselves and our colleagues
  • To build and maintain relationships with each other. Health care team members often work together for years.  Medical school classmates will be a source of support for each other, and may find themselves in the same residency programs and ultimately practicing together.

Conflict Handling Modes

TKI Conflict Handling Modes

TKI Conflict Handling Modes

Competing

A competing style is higher in assertion and lower in cooperation.  Someone using a competing style might approach the conflict by making as strong a case as they can for their own position.  They may be very amiable and polite about it – competing does NOT mean harsh – but they have a viewpoint that they strongly assert.

Perhaps someone using a competing style is very confident that hers is the correct position.  She may be in a position of power and intend to pursue this course even if it is unpopular with others – a competitive style may avoid wasting time in meaningless discussion if the course is already set.

Collaborating

A collaborating style is both assertive and cooperative.  Someone using a collaborative style might approach a conflict as an opportunity to work together to build the best possible understanding or solution.  He would express his own perspective, but would also elicit and listen to the perspectives of others.

Perhaps someone using a collaborative style knows that each member of the group is likely to have different ideas and input, and that all might be contribute to the group’s understanding of a critical issue, or to solving a challenging problem.  He may want to build strong relationships within the group, even though it might take a lot more time than a less cooperative style.

Compromising

A compromising style is medium in both assertiveness and cooperativeness.  Someone using a compromising style might approach the conflict as an opportunity to meet in the middle, to give and take to find something all group members can live with.

Avoiding

An avoiding style is low in both assertiveness and cooperativeness.  Someone using an avoiding style does not share their own perspective or listen to others – they don’t want to engage with this conflict right now!

Perhaps someone using an avoiding style needs time to process their own thoughts or cool down, and they plan to return to the topic later on.  Or perhaps the issue is unimportant to them, or they don’t think they have the power to make change.

Accommodating

An accommodating style is low on assertiveness, but high in cooperativeness.  Someone who is using an accommodating style is putting the concerns or needs of others ahead of their own.

Perhaps someone using an accommodating style knows that the issue is far more important to the other(s) than it is to them, or that the relationship is more important than the issue.

An Approach to Handling Conflict

Can we insert vital talk web page here?  http://vitaltalk.org/guides/conflicts/  ALT TEAM

 

Social Ecological Model

Social Ecological Model

McLeroy, Bibeau, Steckler and Glanz are generally credited with creating the social ecological model of care.  A quick Google search for the social ecological model will reinforce how widely it has been adopted.  There are numerous community, state, national and international organizations that utilize this model in their programs.

Think back to your session in immersion on the social history.  How often do you think beyond the individual and interpersonal factors that influence you and your patients health?

Image result for social ecological model uw

 

From CDC Colorectal Cancer Control Program (CRCCP)