Diabetes care in Brazil and Cambodia could offer life-saving strategies for Washingtonians.
That’s what students in a new University of Washington Dept. of Global Health class argued, as they presented their final projects analyzing how health care approaches in low- and middle-income countries could be adapted to treat illness close to home.
The new course, called “Global Perspectives on Local Health Issues: Glocal Health”, is in response to a current movement to rethink global health. Historically, global health researchers, health leaders, and funders from high-income countries have gone to middle- and low-income countries and implemented health programs. More recently, however, the field has increasingly emphasized “decolonizing global health,” which calls for more equitable, reciprocal partnerships. This approach recognizes that knowledge and innovation exist in all settings and highlights the importance of co-creating health solutions through mutual learning between countries and communities.
Additionally, changing diversity and demographics of the US have led to more globally connected Washington state communities, said Glocal Health course instructor and assistant teaching professor Kata Mucha. That means it's important that courses train students to consider how global health exists right in their own neighborhoods. The course teaches cross-cultural health, and how to create health programs that understand and support communities’ culturally-driven behaviors and beliefs. Students learn about immigrant and refugee health and how root causes of migration can impact well-being.
“We have a responsibility to serve our populations who are living here in Washington to improve the lives of every member,” Mucha said. “There's a need to study global health right here in our own backyard, so we can better understand and serve the diverse communities that call Washington home.”
The new course also reflects a growing interest from students in learning how to improve the health of the diverse communities they represent in Washington, Mucha said, from rural areas to agricultural workers to immigrant and refugee populations.
Public Health-Global Health major Diana Brannan has been applying her training from the class in her job as a hospital Spanish language interpreter. The course teaches cross-cultural competency and cultural humility, or the importance of understanding a patient’s culture, beliefs, and practices to better support their health care. For instance, if a patient has diabetes and needs support with their diet, a provider who understands that patient’s food customs, work schedule, and grocery store access can recommend culturally appropriate suggestions for incorporating more vitamin-rich foods or eliminating sugar-heavy ones.
“The class was amazing; as an interpreter, now I'm seeing the ‘why’ behind everything that is happening at the hospital” said Brannan, who found that the class complements the learning experience of the program. “The class gives you a clear understanding of how to approach health care beyond just biomedical care. It's the whole person, and this class helps us understand that concept."
For Brannan’s final project, her student group suggested how a program in Brazil could be applied to patients in rural communities in Washington to help with diabetes care. Diabetes has significant public health impacts on Washingtonians, but finding expert providers in rural neighborhoods is challenging. Care involves seeking nutritionists and endocrinologists, but those specialties are often concentrated in cities, meaning patients may need to commute hours for care.
Brazil’s ECHO program helps solve this problem by providing virtual mentoring for health care providers in rural settings from diabetes specialists. Through this virtual training, providers in rural areas like general practitioners or nurses learn how to better care for their patients with diabetes. The students suggested building on this model with an app to help rural health providers in Washington monitor their patients' health and suggest care that was supported by experts. This care could also reduce months-long wait times that are typical when seeking health care specialists for diabetes, Brannan said.
Another student group suggested how a program in Cambodia could be adapted for Native American populations in Washington who have diabetes. The Cambodia program uses peer health educators to share important diabetes care information through trusted messengers. To do this, a health care provider trains people with diabetes on how to manage their care and educate others. The students’ proposed model for Washington state suggested implementation through cross-sector partnerships such as the Washington State Department of Health, Native health organizations such as Seattle Indian Health Board and Urban Indian Health Institute, Indian Health Services, and local county and tribal health jurisdictions. A peer-centered health intervention can be helpful for communities who have historically experienced marginalization in health care. When trusted peers can deliver health care education in a culturally appropriate way, this can be more effective for helping treat chronic illnesses like diabetes.
“Having an example of someone who was able to survive and thrive with those health conditions helps people who have been recently diagnosed to manage it,” said Solveig Smith, one of the undergraduates who worked on the project. “Building trust and capacity within communities was important because there's limited resources right now, especially in public health, so we’re thinking about how we can leverage existing programs and implement interventions that are lower cost.”
Several student groups focused on maternal health in Washington state, where behavioral health challenges like drug use are some of the biggest drivers of maternal mortality. Students suggested that adapting a community health worker model from Kenya could provide postpartum women with regular check-ins to monitor their well-being. Another group adapted a strategy from Nigeria to train birthing partner advocates, such as husbands, to monitor for concerning symptoms during pregnancy. The students expanded this idea to include anyone close to the birthing mother so that more people could help support maternal health during pregnancy.
Another group focused on improving mental health amongst immigrant youth in the state. In some immigrant communities, there can be stigma and intergenerational differences around discussing and supporting mental health. To help with this, the students found a program in the Philippines that helped youth overcome stigma around mental health through social cafes where youth could gather and talk with trained peers. The students suggested adding an app to this model in Washington where youth could connect with peers virtually and then meet up in-person at these types of cafes.
“It's not just taking that program or intervention and exactly copying it, but considering the different social determinants and health factors at play here in Washington,” Mucha said. “It might be the same health outcome, but there could be different reasons why it's occurring. The students did a good job of conducting comparative analyses of the root causes of some of these health issues.”
The course is open to students of all majors, not just public health students, in the hopes that students can learn how to best serve the communities across Washington state.
“There might be innovations, programs, or interventions that are happening in low- and middle-income contexts that can be applied back to populations here that are vulnerable or marginalized, and we can do this sort of reciprocal back and forth of adaptations of things that have worked in other settings," Mucha said.