The importance of appropriate health policies underlies the health of entire communities, regions, and both culturally diverse and culturally homogeneous populations. Ensuring that users of health care services have confidence both in the health care system itself and the process used to access health care is a challenge that is often not met by providers, administrators, facilities, or ancillary health professionals. While often studied and evaluated for effectiveness, operative health policies that address the cultural diversity and the needs of individual societies or traditions are rarely realistically and successfully put into practice at the local or community level.
Observing and recording both effective and more prevalent, ineffective strategies for creating health policy has been undertaken by many areas of scholarship. Public health, anthropology, sociology, psychology, political science, and epidemiology are just a few of the areas that regularly monitor and study the users of health care and the effectiveness of policy. An example of the ineffectiveness of informing health policy comes from anthropology. Campbell (2011) reported that the effect of anthropology’s influence “is quite small ― seeing that it is grouped with a half-dozen behavioural sciences as one of the five informants of policymaking. The reason for anthropology’s minimized role in health policy development is likely founded in its primary methodological approach: ethnography” (n.p.). The stalling point seems to lie somewhere between the study of the effectiveness of health policy and the creation of effective policy.
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"Culture and Policy Development".
Engaging the support of the individual community or culture or tradition that needs health policy is a critical first step to creating an effective strategy to ensure proper health care for that community. Whether the community is a city, a rural area, a cultural pocket within an urban area, or any number of other culturally or societally or socioeconomically defined areas, if the participants that are utilizing or need to utilize the health care system don’t trust the process or the policy, that policy will fail. But localized policy-making isn’t the only concern regarding general health policy.
In addition to a focal concentration on specific populations or cultures or traditions, there is also a need for an outward, or global focus for health policy as well. “Many of the health issues that policy-makers face today remain, strictly speaking, international health issues” (Lee, Buse, & Fustukian, 2002, p. 5). The question, then, is how to balance the community-specific needs with the global influences of health policy.
A good example of addressing the needs of a focalized community lies within the concerted effort to stop the spread of HIV and AIDS in African nations. At one time, the exponential spread of these two life-threatening diseases wiped out huge numbers of Africans. In a study that looked at HIV and AIDS prevalence Uganda and Botswana in the 1990’s, Allen and Heald (2004) found that early discovery of and attention to preventative measures in Uganda were far more successful in assisting the HIV and AIDS cases to decline within a 10-15 year period. They also found that “the control programmes in the two countries need to be assessed in the context of the local epidemiology of HIV/AIDS” (2004, p. 1151). This underscores the importance of warranting a local focus as an indicative factor in the success of health policy. But what is the answer to a broader arena of health policy?
To address the global scope of health policy, many academic and professional disciplines need to work together with providers and users of health care. Porter (2006) outlined the distinct differences between the health policy strategies of anthropology and epidemiology. He explained that communication methods differ between the two disciplines and where one has strengths, the other has weaknesses and vice versa. This is why so many entities need to take part in outline health policy. In theory, a generalized approach won’t work. Nor will it typically work in practice.
Theory and practice in health policy are two ends of the same wagging tail. In theory, combining the synergistic knowledge and expertise of multiple disciplines and practices is needed; in practice, this rarely happens. Nor does the engagement of the community in need of health policy. Neither theory or practice have thus far shown to acknowledge the importance of beliefs and behaviors when developing health policies. This is the fundamental missing link in many health policies that have failed.
Acknowledging these beliefs and behaviors when developing policy is crucial to the success of health policy. Regarding the specific population of Native Americans, one Native physician, Dr. Donald Warne (2008), felt that “the systems of healthcare have to be locally controlled, culturally appropriate, and flexible to meet the needs of diverse populations” (n.p.). The policy, then, must be able to accommodate the basic health needs of the community the policy serves. For Native Americans, there are well-documented issues with diabetes, for example. There are also well-documented issues with health care policy, especially on reservations, which include inferior medical care. Warne (2008) stated emphatically that “it’s really the role of the [medical] systems to learn to be flexible to meet community needs. The community should not have to become rigid, singular, homogeneous entities in order to meet the needs of the medical field” (n.p.). While not an easy undertaking, Warne believes that “perhaps we will see a culture of healthy integration of traditional values and beliefs with modern best practices in public health” (2008, n.p.). Beginning with an understanding of the needs of the culture or community to be served by health policy, then, is the groundwork that must be laid before moving on to the strategy of building that policy.
