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Epilogue
Cultural, health and social justice
Debra Jackson
Professorial Fellow, School of Nursing, Family and Community Health, University of Western Sydney, NSW
Article Text
As nurses we are facing some of the greatest tests in the history of the discipline. In a climate of persistent international volatility and instability, and with ever diminishing resources, we are challenged to provide increasingly complex care to incredibly diverse and/or fractured communities. We are further challenged to provide inclusive, sensitive, accessible and user friendly services that defy entrenched, cumbersome sometimes inflexible health care cultures.
In addition, the provision of health care occurs in progressively more politically fragile contexts. Nurses come face-to-face with the legacies of past injustice and entrenched social inequities that are inextricably linked to past and present health status and health care outcomes.
Nurses work in a climate of continual tension between level of need and availability of resources. Nowhere is the chasm between the rich and the poor more visible than in the provision of health care.
While those with wealth demand health care that is increasingly complex, expensive, and dependent on high-tech intervention, there is still a struggle to provide the poor with basic services, such as immunization, and the even more basic life essentials on which health is dependent – essentials such as safe shelter, clean water and an adequate diet.
Kevin White argues in his Editorial on the UK's 1980 Black Report (Townsend & Davidson, 1982) and WHO's 1998 Report on Social Determinants of Health (Wilkinson & Marmot, 1998), in Contemporary Nurse (August 2002:):
'Unequal societies result in unequal sickness and disease experiences, with those at the bottom getting sicker and dying sooner – from what are known to be preventable and modifiable social circumstances.'
Several of the papers in this collection attest that in many parts of the world social disadvantage, including poverty, is associated with membership of particular ethnic and/or cultural groups. Even in wealthy nations there are people and communities affected by social inequality, poverty and its associated health problems. Evidence builds on the impact of the profound social changes associated with globalization, economic rationalism and pluralism, on social cohesion, integration and cultural identity (Edwards et al. 2003 summary). There is overwhelming evidence (see, eg, Morrissey 2003a summary, 2003b summary) that persons of marginalised cultures and ethnicities are over-represented among the poor all over the world.
As nurses are called upon to advocate for social justice for the groups and communities they care for, it has become increasingly difficult to separate culture from health and social justice issues.
The articles in this collection provide compelling evidence that culture is fundamental to personhood and can be a crucial variable in human experiences around health, illness, recovery and rehabilitative processes. Baldock et al. are currently undertaking a large research project comprising cross-cultural analyses of the impact of transnational migration on care-giving relations between immigrants and refugees living in Australia, and their parents residing in Ireland, Italy, The Netherlands, Singapore and Iran (cited in Baldock 2003: 45 summary). These articles echo the extant literature that entire families are affected when they are isolated and marginalized by a health sector that fails to meet their needs (see for example: Daly et al. 1998).
Though it may seem that the situation is impossible and the challenges overwhelming, within them lie opportunities – opportunities to extend and develop practice, to examine the ways that nursing and health care is delivered, to continue to develop our understandings of spirituality and culture, and their relationship to health and well-being. There are opportunities to explore ways of delivering care that resonate with and respect people's cultural values, traditions and beliefs – to foster services that are acceptable and culturally compatible with the people they aim to serve. Cameron-Traub (2000: 246) issues a challenge for nurses when she says:
'Nursing practice must accommodate differences between people, but it must also be flexible and innovative in order to bridge, rather than accentuate, the gaps between service provision and human need.'
Around fifty years after Leininger began her work into transcultural nursing, from which her Theory of Transcultural Nursing developed, we might hope that cultural considerations are so embedded in nursing care and nursing interactions with clients and families, that there is no further need to highlight them. However, as we stand at the beginning of the 21st Century it is clear that nurses practicing in today's world need a transcultural sensibility, perhaps more than ever before. All aspects of nursing activity – clinical activity, teaching activity and research activity – require an approach that positions culture as fundamental to personhood.
References
Cameron-Traub E. (2000) Meeting health care needs in Australia's diverse society, In: Contexts of nursing: an introduction, Daly J, Speedy S & Jackson D (eds), MacLennan & Petty, Sydney.
Baldock C. (2003) Long-distance migrants and family support, Health Sociology Review, 12(1) 45–54. summary
Daly J, Jackson D, Davidson P, Wade V, Chin C & Brimelow V. (1998) Illuminating the experiences of female spouses of myocardial infarction (MI): a study of Lebanese born women in South Western Sydney, Australia, Journal of Advanced Nursing, 26(8) 1199–1206.
Edwards J, Cheers B & Graham L. (2003) Social change and social capital in Australia, Health Sociology Review, 12(1) 68–85. summary
Jackson D, Brady W & Stein I. 1999. Towards (re)conciliation: (re)constructing relationships between Indigenous health workers and nurses, Journal of Advanced Nursing, 29(1) 97–103.
Morrissey MJ. (2003a) Poverty and indigenous health, Health Sociology Review 12(1) 17–30. summary
Morrissey MJ. (2003b) The social determinants of indigenous health, Health Sociology Review 12(1) 31-44. summary
Townsend P & Davidson N (eds). (1982) Inequalities in Health: The Black Report and the Health Divide, Pelican, Harmondsworth [originally DHSS (UK), August 1980].
White K. (2002) Editorial: Vulnerability to sickness and disease, Contemporary Nurse 13(1) 5–9. full text
Wilkinson R & Marmot M (eds). (1998) Social Determinants of Health – The Solid Facts, World Health Organization, European Office.
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