Health in Cultural Context Symposium

Health in Cultural Context – 21st June 2012

University of Dundee and University of St Andrews
Place: Seminar room 2, Medical and Biological Sciences Building,
University of St Andrews

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Programme
9:30-10:00     Registration

10:00-10:15   Welcome and Introduction  Nick Hopkins – University of Dundee

10:15-11:00   ‘Collective Experience and Health: A Longitudinal Study of Collective   Participation in a Hindu Festival in India’
 Sammyh Khan - University of Dundee
11:00-11:45   ‘Culture and depression: investigating the communication of emotions in northern cultures using an interdisciplinary approach’  Isobel Cameron -University of Aberdeen

11:45-12:30   ‘Health behaviours during Magh Mela: Explanations for health behaviours given by Hindu pilgrims’
Gozde Ozakinci -University of St Andrews
12:30-2:00    LUNCH

2:00-2:45     ‘Group Identification and Mental Health’  Fabio Sani – University of Dundee
2:45-3:30     “Understanding and explaining the role of cultural differences in systematic reviews of randomised controlled trials”
Steve MacGillivray – University of Dundee
3:30-3:45     COFFEE

3:45-4:30     PANEL DISCUSSION  Nick Hopkins – University of Dundee, Thilo Kroll – Director of Social Dimensions of Health Institute

Abstracts

Sammyh Khan:
This presentation will describe a longitudinal study that investigated the impact of participation in a large-scale collective event upon health in an Indian context – the Magh Mela at Allahabad. The Magh Mela is the largest religious festival in the world and has a history spanning centuries with millions of pilgrims participating each year. Specifically, the study aimed to examine if, and if so, why, participation in a collective event would lead to improvements in health. First, using a matched sample of participants and non-participants, we show that pilgrims’ health improved significantly after having participated in the Magh Mela. Second, we show that the increase in health can be explained by cognitive and behavioural crowd processes derived from Social Identity Theory (SIT). We end the presentation by discussing the applicability of SIT has to health psychology in different cultural contexts.

Fabio Sani:
We all belong to social groups (e.g., family, work group, sport team). However, we may identify with a group (i.e., have a sense of belonging to the group and of commonality with other group members) to different extents. I will discuss research demonstrating that higher identification with one’s family, work-place, support group, or school predicts higher mental health across different European countries. This research also suggests that the positive health implications of group identification are stronger than, and relatively independent from the effects exerted by the amount of social contact one may have with other in-group members.

Stephen MacGillivray:
The paper will introduce the purposes, methods and products of meta-anlysis; outline the problem of heterogeneity; consider the role of cultural differences in contributing to heterogeneity; and consider methodological approaches to understanding and explaining it. I will be focussing
on depression as an exemplar and thus will also be considering the international epidemiology and specific cultural factors that are known to exist across cultures regarding the diagnosis/recognition and treatment/management.

Isobel Cameron:
How people express their emotions is viewed to be integral to the cultural knowledge systems in which they are immersed. Yet emotions such as depression are commonly understood from a Euro- American perspective. This is reflected in the international classification systems which are applied in the diagnosis of affective disorders and in tools used to assess depressive symptoms in clinical settings. As such, caution should be applied when making sense of affect through specific cultural lenses. If northern inhabitants differ in their emotional expression from a standardised international norm, this has important implications for the recognition and treatment of affective disorders. This presentation will set out the rationale for, and describe the methods to be applied in an interdisciplinary programme of research being undertaken at the University of Aberdeen beginning in October 2012. This programme will investigate the nature of emotional expression in northern cultures by applying a wide range of methods and expertise drawn from health services research, psychiatry, anthropology, the arts, psychology, education, computing and medical sciences.

Gozde Ozakinci:
This presentation will describe the qualitative analyses of the open-ended entries that the Hindu pilgrims provided on their health behaviours during Mela and any changes they observed in their behaviours. We proceeded by asking them the reasons for these changes and the responses were thematically analysed. The findings showed that the reasons for these changes included the role of context (ie. Conditions in Magh Mela) as well as social and spiritual aspects for their behaviours.

For further information or to register for the symposium please contact Gozde Ozakinci (go10 @st-andrews.ac.uk)

Congratulations Professor Annalu Waller!

Dr Annalu Waller who leads the Augmentative and Alternative Communication (AAC) Research team in the School of Computing and who is affiliated with SDHI has been promoted to Professor.

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SDHI is delighted about this well deserved recognition of Annalu’s work in the area of cutting edge research, education and service user engagement. Annalu is working with colleagues from various academic disciplines, including nursing and dentistry, the charitable sector (Capability Scotland), and many private sector company partners. Her work is making real contributions to the lives of children and adults with disabilities. She works closely with service users in the development of innovative technologies, disseminates research findings widely (to date over 100 publications), and collaborates internationally. You can find more information about Annalu’s background here.

Complex obesity debate

A report by Vikki Entwistle, Associate Director, SDHI.

On Friday 18th May we were delighted to welcome a diverse audience that included public health leads and practitioners from NHS Tayside and NHS Fife as well as academic colleagues from a range of disciplines from the Universities of St Andrews and Dundee to a seminar given by Dr Stacy Carter from the Centre for Values, Ethics and the Law in Medicine at the University of Sydney.
Stacy took us through a carefully constructed and well illustrated argument against presenting public health activity as activity against obesity. She started by stressing that body weight is related to health, but in a complex variety of ways, so weight loss contributes significantly to health gain in some people (e.g. those who have diabetes or pre-diabetes) but not all people, and efforts to lose weight can be harmful in various respects. Thus while support for weight loss can be a very appropriate and important goal in the clinical care of some individuals, it is potentially problematic as a public health goal.

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Stacy argued that at a population level, talking about obesity as a target problem to be addressed is just one way of ‘framing’ (or looking at) a cluster of important contemporary health and social problems. As some collective (public) actions that aim to improve population health or the broader wellbeing of communities already illustrate, we can identify factors that tend to contribute to poor health and wellbeing in a range of sectors (transport, food policy, industry regulation, housing, social development etc.). Stacy’s key point was that not only was it important to support collective action to tackle all of these, it would be more ethical to present the target of such action not just or primarily as obesity but rather as the social causes of poor health. She explained that that the obesity frame reinforces the negative labelling and stigmatisation of people who are obese, and directs attention to the ‘canary in the coal mine’ rather than the ‘gas leak’ of conditions producing poor health that should be the primary concern. An alternative framing of the problem that focused more explicitly (in words as well as in action) on the social contributors to poor health, would raise fewer ethical problems.

Stacy’s presentation stimulated a wide-ranging and vigorous debate that highlighted the contestability of some key public health concerns and approaches. For me, this confirmed a need to consider the ethical as well as the empirical aspects of public health, and to promote robust conversations between policy leaders, practitioners and researchers about both.

The slides from this presentation will follow shortly.

Another way to follow what’s going on

SDHI is now on Tumblr. Tumblr will contain occasional reflections, photographs, creative visualisations of themes, topics, and issues relevant to SDHI research and knowledge exchange. We will use it in addition to our regular newsblog updates and frecent Twitter feeds, both of which are more used for information sharing, project and event updates. Tumblr will allow us to tap into the visual and creative side. Tumblr is integrated with Twitter. If you are following us on Twitter you will

receive Tumblr updates as well. You can find us here

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Patient Reported Outcome Measures (PROMS): Challenges for people with low literacy and learning disabilities

The May 9th SDHI Webinar “Patient Reported Outcome Measures (PROMS): Challenges for people with low literacy and learning disabilities”, which was presented by Karen Ritchie, Head of Knowledge Management and Deepa Jahagirdar, Research Associate at Health Improvement Scotland, is now available to view on line!

The full webinar can be viewed here

Communication in health care: Are we failing in medical education?

Professor Alan Bleakley, Penninsula Medical School believes that current medical education is not addressing communication issues in the training of new doctors as best as it could. He discussed the importance of communication in medical as part of a co-hosted seminar between the Centre for Medical Education and the Social Dimensions of Health Institute (SDHI) at the University of Dundee today.

More than 40,000 deaths in the UK are estimated to be the result of medical error. Human failings by far outstrip any other cause for these errors of which many lead to preventable mortality or lasting impairment. Particular, cross-team communication is error prone and may result in fatal mistakes. A range of factors have been found associated with ‘hypocompetence’ or underperformance, including status asymmetry, high/autoritarian control style and lack of team coherence and cooperation.

A key facet that is currently missing in medical education is that future doctors are not encouraged to develop a ‘tolerance of ambiguity’. Guidelines, safety standards, risk aversion, fear of litigation, targets etc. constrain the space in which tolerance would flourish.

At the same time, doctors are confronted with different styles of working. Frequently, in training and later practice they are not connected to one ward but ‘float’ between different units, work in transient rather than stable teams. Alan Bleakley calls this with reference to Deleuze and Guattari’s thinking ‘nomadism’.

In world that is multi-connected the traditional paternalistic (‘male gaze’) authoritarian style in health care is misplaced and a more collaborative, less hierarchical approach is required. Education needs to be mindful of the increasingly ‘fluid world’, in which we operate and recognise the need for democratisation.

There is rising evidence that empathy is on the decline in medical doctors. Doctors remain poor at ceding authority, managing confrontations and maintaining eye contact with patients. In an era of targets and evidence-based practice, ‘complexity’ is often not acknowledged and formulaic solutions and guidance are sought.

At present, medical education seeks to provide communication ‘skills’ and effect behaviour change. What it fails to do is understand the value constructions that underpin behaviours. Bleakley diagnoses a lack of ‘democratic literacy’ in new doctors. A more holistic, biographical approach is needed to improve clinical capabilities.

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Communication matters: doctors must learn with, from and about colleagues and patients

The Centre for Medical Education at the University of Dundee is hosting a seminar with Professor Alan Bleakley, Peninsula College of Medicine and Dentistry, University of Plymouth in collaboration with SDHI on this topic on Tuesday 15 May 2012, 1-2pm, Room 2S13, Dalhousie Building, University of Dundee.

Rates of medical error are considerable and there is a growing body of evidence that most of these errors are grounded in miscommunications within the healthcare system and in clinical teams. Educational strategies can help reduce the number of miscommunications within and between teams but related skills are rarely taught to medical students and professionals. Medical system culture can change if democratic habits and literacy are embedded in medical education curricula. The presentation will highlight opportunities and practical examples how this might be achieved.

Alan Bleakley is Professor of Medical Education at Peninsula Medical School, UK, where he is Deputy Director of the Institute of Clinical Education, which is internationally recognised as a leading medical education academic and research centre. His academic background spans zoology, physiology, biochemistry, neuroscience and psychology. Alan has also been a practicing psychotherapist for the past 25 years. His work is widely published and his latest book ‘Medical Education for the Future: Identity, Power and Location’ published by Springer (2011) was co-authored with John Bligh and Julie Brown. Another book, ‘The Heart of the Matter: Patient Centredness in Transition’ is currently under review.

Please join us for an exciting presentation. We would appreciate if you confirmed you attendance in advance to Lynn Thomson l.e.thomson @dundee.ac.uk (Centre for Medical Education)