Creating a Culture of Health and Wellness

There are many determinants of health when at a disadvantage resulting in inequalities, disparities, and inequities. These determinants can be biological, social, and environmental. Through the evaluation of social factors and socioeconomic gradients in health, the index of disparity can be measured (Center for Disease Control and Prevention [CDC], 2014). The magnitude of this public health problem differs based on the population evaluated but despite how big or small, it is an ongoing issue that needs to be addressed and reduced. As a future healthcare professional, I plan to stay true to my values and beliefs in addition to following the four moral pillars to aid in this combat.

To create a culture of health and wellness for all, traditional approaches need to be abandoned and cultural competence and health literacy must be established and promoted. This can be done through the modification of evidence-based medicine practices, development of organizational policies and training, community-based research, and clinical advocacy.

Health is defined by the World Health Organization (WHO) (2014) as “a state of complete physical, mental and social well-being, not just the absence of sickness or frailty.

” An individual’s state of health is influenced by biological, socioeconomic, psychosocial, behavioral, and social factors. These factors include but are not limited to an individual’s genetic make-up, employment, education, income, mental health, ethnicity, and race. A population’s health is said to be determined by genetics, individual behaviors, social and physical environments, and health services (Center for Disease Control and Prevention [CDC], 2014).

Health inequalities exist when the attainment of health is different among individuals and groups of individuals.

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When these differences are due to socio-economic positions, it is considered a health disparity. The distribution of money, power, and resources throughout civilization determines socio-economic status. The lower the socioeconomic position the greater the risk of poor health due to systemic obstacles that place the individual(s) at a baseline disadvantage. If differences in health outcomes between individuals or groups of individuals are avoidable or unjust, a health inequity exists (CDC, 2014). A culture of health and wellness for all cannot exist when these variations and inequalities in healthcare occur. These disproportions can be combated through the establishment of the right governmental policies, and the promotion of cultural competency throughout the healthcare field.

My values of trust, respect, honesty, and integrity are what drove me to the profession of pharmacy. As a pharmacist, we vow to our profession’s code of ethics, one in which we state we will respect the covenantal relationship that exists between us and the patient (American Pharmacists Association [APA], 1994). To have a covenantal relationship I must be able to build trust, not only from my patient but from society as well. When I have this trust, it is my moral duty to protect it. As a pharmacist, I must respect the autonomy and dignity of each patient that I treat and care for. I do this by encouraging patients to participate in their healthcare decisions and allowing the patient to determine the course of their treatment. For this to be thoroughly achieved, I must ensure health literacy is established by communicating at an understandable level. Most of all I respect personal and cultural differences that exist among each patient and I expect the same respect in return. I act with honesty and integrity in all relationships that I establish, personally and professionally (APA, 1994).

I believe that it is my duty as a pharmacist to serve the individual, community, and societal needs. Often these needs are beyond what I can accomplish on my own, in which advocacy and establishment of inter-professional relationships are necessary. Through the following four pillars for moral life (respect, justice, non-maleficence, and beneficence) health inequalities can be reduced (Jahn, 2011). Growing up in Metro-Detroit, I recognized early on that that discrimination and exclusion based on mental illness was a major health disparity. Mental illness is defined by the American Psychiatric Association as “health conditions which involve changes in emotion, thinking, or behavior” which includes substance use disorders (Parekh, 2018). Thousand thegh my experience professionally in behavioral health units, andthe class types have recognized the magnitude of this epidemic and the major impact this disparity has on public health. My passion for treating the underserved and overlooked is what has driven me to become a board-certified psychiatric pharmacist with further certification in pain management. There is a consistent cycle between mental illness and communicable diseases, for example, Human Immunodeficiency Virus (HIV) and mental illness are closely interlinked (Pascoe & Richmond, 2009). Roughly 23% of those who are mentally ill are also HIV+ as compared to 0.3% of the general population; and up to 40% of HIV+ individuals will experience major depression due to their belonging to social disadvantage and marginalized populations (Bridge, 2016). Often, these patients do not seek or have access to their proper healthcare needs (Pascoe & Richmond, 2009). It is my goal, through my work as a psychiatric pharmacist, to move towards health equity establishment in this patient population to provide better patient health outcomes and quality of life.

The first step in establishing this health equity is maintaining cultural competency. Cultural competence is defined by the U.S. Department of Health and Human Services as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations” (CDC, 2014). Through my attainment of my Masters in Health Services Administration (MHSA), it is my goal to attain an administration position. Being a pharmacy administrator I would have the authority to implement these policies and visions to establish cultural competence. Modifying evidence-based practices (EBPs) are a necessity (American Psychologist, 2006). Often studies are not tested among different patient populations, especially those who are minorities. Being vigilant of this, evaluating research performed in these populations, and guiding treatment based on these appropriate studies is crucial for equal health outcomes and the attainment of equity. As an administrator, I would ensure my organization would be assessing whether the EBM utilizes the needs of the community in its entirety, clinically and culturally.

In regards to behavioral health, a cultural factor to consider and evaluate within the institution is their view of mental illness. Is there a holistic health treatment approach, and what degree of stigma exists? These are assessments I would make and then utilize the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration’s (SAMHSA) toolkit to modify the necessary EBMs. The steps to improving cultural competency suggested by SAMHSA’s toolkit include first breaking down the EBM and determining which components are needed to be modified, followed by the development of these changes, documentation, testing out the changes, and then evaluating the difference (Bridge, 2016).

In the National Institute of Health’s (NIH) Journal of Behavioral Medicine “Discrimination and Racial Disparities in Health: Evidence and Needed Research,” Williams and Mohammed (2018) evaluated discrimination and racial disparities’ effect on health outcomes, discovering “racial discrimination has a direct link to physical illness” (p. 32). Their studies showed those who endured discrimination based on race developed health conditions ranging from hypertension to breast cancer, and additional disease risk factors (Williams & Mohammed, 2018). In “Preventing Race-Based Discrimination and Supporting Cultural Diversity in the Workplace: An Evidence Review” VicHealth, Trenerry, Franklin, and Paradies (2012) performed an evidence review of two case studies evaluating the magnitude of this racial discrimination within the workplace. Their evaluation resulted in the development of five key motives for its elimination: implementation of organizational accountability and development, diversity training, resource development and provision, service as a site for positive inter-group contact, and service as role models in anti-discrimination and pro-diversity practice for other organizations. Trenerry, Franklin, and Paradies (2012) discussed that the key principle for racial discrimination elimination within an organization is to include a “top-down” central team that has a wide array of responsibilities for senior members to lead, while also implementing a “bottom-up” strategy to promote transparency and trust of its employees.

Per community studies performed by Williams, Neighbors, and Jackson (2003) race discrimination results in negative health outcomes including depression, psychologicintergrouppsychological distress, and anxiety. When facing race in those who are mentally ill, American Psychological Association (APA) has adopted practice guidelines to assist in tailoring their treatment algorithms and approaches. Evidence based psychological practice guidelines developed, require attention to race in addition to many other cultural differences. (APA, 1994) I would utilize all these strategies when facing “race” within my facility as an administrator and as a psychiatric pharmacist.

The American Journal of Public Health published an article: “Translating Research Evidence into Practice to Reduce Health Disparities” in which Koh, Oppenheimer, Massin-Short, Emmons, Geller, and Viswanath (2010) used a social determinant approach to create evidence-based a public health system in hopes of eliminating health disparities completely. They suggest requiring a heightened emphasis on translating and spreading proven interventions in ways that will reach all people. Koh et al. (2018) utilized the RE-AIM Model for this translation in an attempt to reduce the gaps between research and practice implementation. This model focuses on real-world changes and emphasizes “scaling up.” Scaling up is further explained as calling on researchers, practitioners, and policymakers to move beyond pilots, time controlled time-controlledand specific targets, and move towards expanding treatment access and adherence support (Koh et al., 2018)

The Annual Review of Public Health suggestsclass-type an additional approach to improve public health by reducing disparities through the establishment of “Community-Based Participatory Research (CBPR).” CBPR involves the gathering of academicians, community members, and clinical researchers. (Israel, Schulz, Parker, & Becker, 1998). Through research performed by Isarel, Schulz, Parker, and Becker (1998), CBPR can further drive the pioneering research necessary to control this public health problem by taking an “all-view” approach. The WHO’S report “Health Equity Through Intersectoral Action” (2003) demonstrated the impact of interdisciplinary work through the evaluation of 18 case studiestudies class type countries. This report outlines how taking a social-determinant approach reduces health inequities and therefore health disparities (Glasgow, Lichtenstein, & Marcus, 2003). As a healthcare provider and an administrator, I would utilize this approach within my practice.

In conclusion, health inequalities, disparities, and inequities are a major public health problemproblems we as healthcare providers need to work towards reducing in our future careers and practices. For all individuals to have the same opportunity to attain their full health potential without any disadvantages due to socio-economic factors, it is going to take different approactrainingisrainings than what are considered conventional. As a future, psychiatric pharmacist and health service administrator, it is my goal to incorporate my values of trust, respect, honesty, and integrity to combat the index of disparity that faces the mentally ill. I will do this through EBM assessment and modification via the SAMHSA toolkit, utilization of Trenerry, Franklin, and Parady’s five key motives, implementation of policies and protocols that promote the “top-down” and “bottom-up” approach, integration of community-based research, and via the utilization of a social determinant approach within my organization. With interdisciplinary work, advocacy, and passion, we as the future generation of healthcare professionals can make a positive change in public health and wellness and reduce inequalities.

References

1. American Pharmacists Association. (1994). Code of Ethics. Retrieved from https://www.pharmacist.com/code-ethics
2. Bridge, T. (2016, March 01). SAMHSA’s Program to Achieve Wellness. Retrieved from https://www.samhsa.gov/wellness-initiative/program-achieve-wellness
3. Center for Disease Control and Prevention. (2014). Definitions | Social Determinants of Health | NCHHSTP | CDC. Retrieved from https://www.cdc.gov/nchhstp/socialdeterminants/definitions.html
4. Evidence-Based Practice in Psychology. (2006). American Psychologist,61(4), 271-285. doi:10.1037/0003-066X.61.4.271
5. Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why Don’t We See More Translation of Health Promotion Research to Practice? Rethinking the Efficacy-to-Effectiveness Transition. American Journal of Public Health,93(8), 1261-1267. doi:10.2105/ajph.93.8.1261
6. Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). REVIEW OF COMMUNITY-BASED RESEARCH: Assessing Partnership Approaches to Improve Public Health. Annual Review of Public Health,19(1), 173-202. doi:10.1146/annurevannual.publpub healthhealth.19.1.173
7. Jahn, W. T. (2011). The 4 basic ethical principles that apply to forensic activities are respect for autonomy, beneficence, nonmaleficence, and justice. Journal of Chiropractic Medicine,10(3), 225-226. doi:10.1016/j.jcm.2011.08.004
8. Koh, H. K., Oppenheimer, S. C., Massin-Short, S. B., Emmons, K. M., Geller, A. C., & Viswanath, K. (2010). Translating Research Evidence Into Practice to Reduce Health Disparities: A Social Determinants Approach. American Journal of Public Health,100(S1), 72-80. doi:10.2105/ajph.2009.167353
9. Parekh, R. (2018). What Is Mental Illness? Retrieved from https://www.psychiatry.org/patients-families/what-is-mental-illness
10. Pascoe, E. A., & Richmond, L. S. (2009). Perceived Discrimination and Health: A Meta-Analytic Review. Psychological Bulletin,135(4), 531-554. doi:10.1037/a0016059.supp
11. Trenerry, B., Franklin, H., & Paradies, Y. (2012). Preventing race-based discrimination and supporting cultural diversity in the workplace. Victorian Health Promotion Foundation,1-68.
12. Williams, D. R., Neighbors, H. W., & Jackson, J. S. (2003). Racial/Ethnic Discrimination and Health: Findings From Community Studies. American Journal of Public Health,93(2), 200-208. doi:10.2105/ajph.93.2.200
13. Williams, D. R., & Mohammed, S. A. (2008). Discrimination and racial disparities in healthhealth disparities: Evidence and needed research. Journal of Behavioral Medicine,32(1), 20-47. doi:10.1007/s10865-008-9185-0