antropolgie hoofdstuk 1.pdf

# Superdiversity and its dimensions Superdiversity signifies a complex societal landscape characterized by the multiplicative interplay of numerous, often overlapping, individual and group characteristics. It represents a significant shift from simpler notions of diversity, moving beyond a focus on single categories like ethnicity or nationality to an understanding of how multiple attributes interact to shape social realities [36](#page=36). ### 1.1 Understanding diversity concepts Before delving into superdiversity, it is crucial to define related terms: * **Monoculture:** An ideal that posits a society with a single language, a single people, and a single nation [36](#page=36). * **Multiculturalism:** Refers to the existence of distinct cultural and ethnic groups within a single society [36](#page=36). * **Diversity:** Encompasses all conceivable differences that can exist among people living together in a society [36](#page=36). * **Superdiversity:** Characterized by the "diversification of diversity," where formerly distinct minorities collectively become the majority. It is defined as "a dynamic interplay of variables among an increased number of new, small and scattered, multiple-origin, transnationally connected, socio-economically differentiated and legally stratified people" (Vertovec, 2007) [36](#page=36). ### 1.2 Dimensions of superdiversity Superdiversity arises from the interaction and combination of various individual and group characteristics. The document highlights several key dimensions that contribute to this complexity: #### 1.2.1 Age Age is a fundamental demographic characteristic that contributes to societal diversity. The age structure of a population, often visualized through age pyramids, reflects different life stages and their prevalence within a society [13](#page=13). #### 1.2.2 Sex, gender, and orientation These dimensions refer to biological sex, social gender roles and identities, and sexual orientation. The interplay of these factors creates diverse experiences and social positions within a population [14](#page=14) [15](#page=15). #### 1.2.3 Health and disability Conditions related to health and the presence of disabilities are significant aspects of individual variation that contribute to societal diversity [16](#page=16). #### 1.2.4 Ethnicity and migration background This dimension encompasses shared cultural traits like language, religion, customs, history, and geographical origin, which relate to identity and group belonging rather than purely physical characteristics [19](#page=19). * **Ethnicity:** A cultural category based on shared traits such as language, religion, customs, history, and sometimes geographical origin, linked to identity and group feeling [19](#page=19). * **Race:** A socially constructed concept categorizing people based on perceived physical characteristics like skin color, hair texture, or facial features. It lacks scientific biological basis but has significant societal impacts due to racism and discrimination [19](#page=19). * **Origin (Afkomst):** A broader, more neutral term referring to where an individual or their ancestors come from geographically or familially [19](#page=19). Migration is a primary driver of ethnic diversity and superdiversity. People migrate due to various factors, including violence, climate change, and socio-economic inequality. The term "superdiversity" is contrasted with the concept of "omvolking" (great replacement) in discussions of ethnic diversity [20](#page=20) [26](#page=26) [27](#page=27) [28](#page=28). > **Example:** An individual may hold Belgian nationality, have Congolese origin, belong to the Luba ethnicity, and be perceived as "Black" in Belgian society [19](#page=19). #### 1.2.5 Socio-economic status This dimension includes economic diversity, referring to variations in wealth, savings, and real estate ownership [29](#page=29). * **Capitalism:** Economic systems, including capitalism, contribute to socio-economic diversity and inequality [30](#page=30). #### 1.2.6 Other contributing factors Beyond the primary dimensions, superdiversity is further shaped by a multitude of other variables: * Educational level [34](#page=34) [35](#page=35). * Language [35](#page=35). * Health literacy [35](#page=35). * Religion/ideology [31](#page=31) [35](#page=35). * Place of birth [35](#page=35). * Parents' place of birth [35](#page=35). * Migration context [35](#page=35). * Place of residence [35](#page=35). * Home situation [35](#page=35). ### 1.3 Interplay of dimensions Superdiversity highlights how these dimensions do not exist in isolation but interact and intersect to create unique social positions and experiences. For instance, combinations of migration background with religion socio-economic status or income illustrate this complex interplay. Similarly, income can be combined with educational level to further delineate societal stratification [31](#page=31) [32](#page=32) [33](#page=33) [34](#page=34). > **Tip:** When analyzing superdiversity, it is crucial to move beyond single-axis thinking and consider how multiple characteristics simultaneously shape individual and group experiences. The document presents superdiversity as a multifaceted phenomenon where the sheer increase in the number of variables and the diverse origins and backgrounds of people lead to a qualitatively different societal composition compared to earlier forms of diversity [36](#page=36). --- # Intersectionality and individual identities This topic explores the theory of intersectionality, explaining how multiple identities interact and shape individual experiences, using models like the diversity wheel, kaleidoscope, and iceberg. ### 2.1 Understanding intersectionality Intersectionality is a critical strand of diversity theory that posits individuals occupy unique social locations based on multiple, coexisting, and mutually reinforcing social identities such as gender, sexuality, social class, race, and ethnicity. The experiences attached to these locations reflect systems of oppression and privilege at a socio-structural level. A multidimensional perspective on diversity, beyond focusing on a single group, offers significant gains by appreciating the coalescence of factors that condition people's lives. This framework can provide a more complex and dynamic approach to diversity, especially in fields like medical education, by analyzing how intersecting socio-cultural and biosocial group memberships influence identity and health, thereby enhancing understanding of patients' unique needs and experiences [52](#page=52). ### 2.2 Core concepts and models #### 2.2.1 The diversity wheel The diversity wheel is a model used to visualize and understand the multifaceted nature of individual identities [43](#page=43). #### 2.2.2 Identities as fluid and contextual Identities are not universal but evolve and are context-dependent [44](#page=44). #### 2.2.3 The kaleidoscope model The kaleidoscope model illustrates intersectionality by comparing each identity to a tiny stone within the kaleidoscope. Each turn represents a new moment or position where a particular identity comes to the foreground, broadening one's perspective [45](#page=45) [46](#page=46). #### 2.2.4 The iceberg model The iceberg model, applied to identity, distinguishes between what is visible above the water and what lies beneath. Above the water are observable aspects like customs, language, and clothing, while submerged are deeper elements such as values and core beliefs about what is truly important. This model encourages a deeper understanding of individuals [47](#page=47) [48](#page=48). #### 2.2.5 Crossroads thinking (Kruispuntdenken) Crossroads thinking suggests that a person is a dynamic intersection of various dimensions [50](#page=50). ##### 2.2.5.1 Micro-level perspective At the micro-level, especially within a consultation space, this idea emphasizes that an individual belongs to many different groups [51](#page=51). ##### 2.2.5.2 Macro-level perspective At the macro-level and within society, crossroads thinking highlights that the power influence or limitations associated with belonging to these various groups can mutually reinforce each other [51](#page=51). ### 2.3 Case study: Felicia #### 2.3.1 Felicia at 5 years old Felicia is presented as a case study with the intersecting identities of stuttering, being Black, and being a woman [53](#page=53). #### 2.3.2 Felicia at 35 years old Individuals who stutter often share recognizable experiences, such as anxiety before introducing themselves, apprehension during phone calls, or being laughed at in school when reading aloud. However, personal narratives are never entirely the same. The experience of stuttering is influenced by other aspects of one's identity, including gender, origin, age, sexual orientation, profession, religion, and more. This confluence of different social identities is termed intersectionality. Some identities may offer more opportunities, while others can present disadvantages [54](#page=54). Intersectionality clarifies that an individual's experience cannot be understood by examining one identity in isolation from others. For instance, the experience of a Black woman who stutters cannot be disconnected from her womanhood, her racial background, or other factors. From a societal perspective, it is crucial not only to focus on stuttering itself but also to acknowledge the multiplicity of identities each person carries [54](#page=54). ### 2.4 Superdiversity Intersectionality is closely related to the concept of superdiversity [55](#page=55). --- # Sub-topics of diversity and their health implications This section examines how various dimensions of diversity, including age, sex, gender, sexual orientation, health status, ethnicity, and socio-economic status, contribute to health inequalities and shape health outcomes. ### 3.1 Age The document does not provide specific details on the health implications solely related to age as a dimension of diversity within the specified pages, but it is listed as a key area of diversity influencing health [57](#page=57). ### 3.2 Sex, gender, and sexual orientation This sub-topic explores how sex, gender, and sexual orientation impact health and contribute to health disparities. #### 3.2.1 Sex and gender differences * Women tend to live longer but experience more years of ill health compared to men [59](#page=59). * Women are more likely to experience side effects from medications than men [62](#page=62). #### 3.2.2 Sexual orientation and gender identity * Men are less likely to seek professional help for mental health issues and are more likely to discontinue treatment if they do [62](#page=62). * Lesbian, gay, and bisexual+ youth report suicidal ideation twice as often as heterosexual youth and have more than four times the rate of suicide attempts [62](#page=62). * Two-thirds of transgender individuals report feeling lonely, with a quarter experiencing severe loneliness [62](#page=62). * Bisexual individuals experience poorer mental health (26%) compared to gay and lesbian individuals (17%) and heterosexual individuals (11%) [62](#page=62). * The health and safety of LGBTQI+ migrants, or migrants with diverse sexual orientation, gender identity, or expression (SOGIE), is an under-studied area, especially during transit [83](#page=83). * Depression, anxiety, and post-traumatic stress disorder (PTSD) are prevalent among SOGIE migrants, particularly when linked to detention or camp environments and exacerbated by social isolation [83](#page=83). * Barriers to healthcare access exist for SOGIE migrants, with specific sexual health services often lacking, particularly for transgender individuals [83](#page=83). * During transit, SOGIE migrants are highly susceptible to experiencing double marginalization due to their migrant or minority status and their gender identity [83](#page=83). ### 3.3 Illness and disability Health status, including illness and disability, is identified as a dimension of diversity that influences health. Further details on its specific implications are not provided in the specified pages [57](#page=57) [63](#page=63). ### 3.4 Ethnicity and culture This section focuses on how ethnic background and cultural factors, including migration, affect health outcomes and contribute to health inequalities. #### 3.4.1 Migration and mortality advantage * The "migrant mortality advantage" refers to the observation that international migrant populations often have lower death rates than non-migrant populations [67](#page=67). * At older ages, most migrants exhibit an overall mortality advantage compared to non-migrants, even with lower socio-economic status [67](#page=67). * However, specific migrant groups, such as Turkish migrants and French and Eastern European male migrants, may have an overall mortality disadvantage, partly attributable to lower socio-economic status [67](#page=67). * Despite the general mortality advantage, migrants experience higher mortality from specific causes like infectious diseases, diabetes-related conditions, respiratory diseases (Western migrants), cardiovascular diseases (non-Western female migrants), and lung cancer (Western female migrants) [67](#page=67). * Mortality differences between older migrants and non-migrants are influenced by the cause of death, age, sex, migrant origin, and socio-economic status, and can be linked to lifestyle, social networks, and healthcare utilization [67](#page=67). * Policies to reduce mortality inequalities among older migrants should address their specific health needs and socio-economic disparities [67](#page=67). #### 3.4.2 Socio-economic position and migration advantage * Adjusting for socio-economic position (SEP) generally amplifies the migrant mortality advantage. This can lead to an increase in existing advantages, the disappearance of disadvantages, or the transformation of disadvantages into advantages [68](#page=68). * **Example:** For Moroccan migrants, unadjusted models showed a 30% mortality advantage for men and 26% for women. After accounting for employment status, this advantage increased to 50% for men and 46% for women [68](#page=68). * **Example:** SSA women initially had a 16% excess mortality. After including SEP variables, there was no longer a mortality difference compared to Belgian women [68](#page=68). * **Example:** Eastern European men initially had a 10% excess mortality. After including ownership and employment status, they showed a 5% mortality advantage compared to native Belgian men [68](#page=68). #### 3.4.3 Health risks and disparities for migrants * Migration itself carries health risks. Refugees and undocumented migrants are particularly vulnerable to psychological problems due to their migration history and living conditions [72](#page=72). * Migrants and ethnic minorities in the Netherlands generally experience poorer health than the average population. This is attributed to stress from the migration process, socio-economic position, discrimination, ethnic variations in morbidity, and insufficient healthcare accessibility due to communication barriers and differing perceptions of illness [72](#page=72). #### 3.4.4 Ethnic diversity in diseases and treatments * Ethnic diversity in diseases and treatment responses can be influenced by genetic factors, country of origin, skin color, and cultural customs [73](#page=73). * Individuals with a migration background may have different prevalent conditions or require different treatments than those typically seen in the general population [73](#page=73). * Genetically determined conditions like Behçet's disease, hemoglobinopathies, and familial Mediterranean fever are more common in people with a migration background and are rare in the general Dutch population [73](#page=73). * Individuals of Sub-Saharan African or South Asian (India, Pakistan, Bangladesh, Sri Lanka, Indo-Surinamese) origin have a significantly increased incidence of cardiovascular diseases, necessitating risk profiling from a younger age [73](#page=73). * Screening for chronic hepatitis B or C, tuberculosis, or HIV should be proactively offered to migrants from Africa, Eastern Europe, or Asia [73](#page=73). * Certain cancers are more prevalent in migrant populations, including nasopharyngeal cancer (China, Africa), stomach cancer (Armenia, Turkey), and cervical cancer (Antilles) [73](#page=73). * Culturally specific beliefs about illness, self-care, and treatment side effects should be inquired about and understood [73](#page=73). #### 3.4.5 Genetic variation and medication response * Genetic variations, particularly in cytochrome P450 enzyme gene variants, can cause differences in medication response between individuals and ethnic populations [74](#page=74). * General practitioners should consider this possibility in patients who respond unexpectedly to medication, experience significant side effects at low doses, or report prior negative medication experiences. This is more common in individuals with ancestry from the Horn of Africa, West Africa, or Southeast Asia [74](#page=74). * Clinically relevant variations are described for antidepressants, antipsychotics, beta-blockers, statins, coumarins, and antiarrhythmics. Treatment should start at low doses for groups with many slow metabolizers and increase gradually for groups with many fast metabolizers [74](#page=74). ### 3.5 Socio-economic status This dimension of diversity highlights the strong link between socio-economic factors and health. #### 3.5.1 Income and health * The principle "Arm maakt ziek" (Poverty makes ill) underscores the direct relationship between low income and poorer health outcomes [77](#page=77). * This is presented as a general principle influencing health [75](#page=75) [76](#page=76). #### 3.5.2 Education and health * Data from the Belgian health survey indicates a connection between education level and health outcomes. Specific details on the nature of this relationship are presented visually in the document with charts showing differences across education levels [78](#page=78) [79](#page=79) [80](#page=80) [81](#page=81). #### 3.5.3 Combined factors: Education and sex * The interaction between education level and sex can further influence health and healthcare utilization, as suggested by an overview of combined factors [82](#page=82). ### 3.6 Overviews and combined diversity dimensions * The document presents an overview of diversity in health and healthcare use, analyzed from data in the Belgian health survey [80](#page=80) [81](#page=81). * The interplay of different diversity dimensions, such as education and sex, can lead to complex patterns in health [82](#page=82). * The combination of migration and gender is also explored, highlighting the unique challenges faced by LGBTQI+ migrants regarding their health, safety, and well-being during migration [83](#page=83). --- # Mechanisms leading to health inequality This section outlines the multifaceted mechanisms contributing to health inequalities, encompassing social position, privilege, discrimination, stereotypes, micro-aggressions, structural violence, specific forms of oppression, poverty, health literacy, and the concept of embodiment. ## 4. Mechanisms leading to health inequality Health inequalities arise from a complex interplay of social, economic, and structural factors that create differential access to resources, opportunities, and social support, ultimately impacting health outcomes. These mechanisms often operate at both individual and societal levels, perpetuating cycles of disadvantage [86](#page=86). ### 4.1 Position and privilege **Position** refers to an individual's social standing within society, which can confer unearned advantages or disadvantages. **Privilege** represents the often-invisible benefits individuals possess due to their societal position. For example, an individual holding multiple privileged identities (e.g., being male, white, heterosexual, highly educated, and born in Belgium) occupies a position that affords significant advantages in many societal spheres. Conversely, individuals with marginalized identities (e.g., being female, non-heterosexual, from a minority background, or a young intern) often face headwinds and disadvantages due to their position. Understanding privilege is crucial for recognizing how certain groups are systematically advantaged, contributing to health disparities [87](#page=87) [88](#page=88) [89](#page=89) [93](#page=93). ### 4.2 Discrimination, stereotypes, and bias **Discrimination** is the unequal treatment of individuals based on characteristics such as origin, gender, age, or religion, leading to detrimental consequences for the disadvantaged group. In healthcare, this translates to inequitable care based on group affiliation [94](#page=94). **Stereotyping** involves attributing simplistic and generalized characteristics to an entire group of people. This can lead to **bias**, which are unconscious or conscious preferences or aversions influencing judgment, often rooted in stereotypes. Explicit stereotypes are consciously recognized, while implicit stereotypes are formed through unconscious brain associations, making them harder to influence [95](#page=95) [97](#page=97). **Stigmatization** is the process of applying a negative label to an individual or group, leading to social exclusion or inferior treatment. **Micro-aggressions** are subtle, often unconscious remarks or behaviors that are discriminatory or hurtful to marginalized groups. These can manifest as seemingly innocent or humorous comments that cause discomfort, stress, or a feeling of not being accepted. Examples include questioning why someone has a smartphone if they lack money or suggesting they "try to find work" or "make better choices," which reduce complex social issues to individual responsibility [95](#page=95). Experiencing discrimination is linked to a higher risk of diseases like depression and hypertension. Social exclusion disproportionately affects low-income individuals, negatively impacting their physical and mental health [96](#page=96). ### 4.3 Structural violence and exclusion **Structural violence** refers to the way social structures (e.g., in education, healthcare, labor market, housing) embed inequality and disadvantage, leading to poorer chances and health outcomes for certain groups. It describes societal structures that systematically disadvantage or harm a particular group. This is closely linked to **oppression**, the systematic restriction of opportunities or rights for a group, often embedded in societal structures and **exclusion**, which involves barring individuals or groups from full participation in society [95](#page=95). Examples within healthcare can include co-payments and supplements, digital appointment systems and reimbursement via apps or eID, lack of interpreters, and not providing adequate time for all patients . ### 4.4 Specific forms of oppression #### 4.4.1 Ageism **Ageism** is discrimination and oppression based on age . #### 4.4.2 Sexism **Sexism** involves discrimination and oppression based on sex or gender. Research indicates that female patients are interrupted more often by physicians than male patients, and female physicians interrupt less frequently than male physicians. This can contribute to issues like the underdiagnosis of myocardial infarction in women due to research historically focusing primarily on men. Sexism also extends to non-heterosexual individuals, with reported increases in anti-homosexual violence . #### 4.4.3 Validism **Validism** refers to discrimination and oppression based on health status, often framing conditions as "sick" versus "healthy" rather than a spectrum . #### 4.4.4 Racism **Racism** is discrimination and oppression based on race or ethnicity, though the document emphasizes it's not about race itself but the discriminatory practices. Health issues can be misattributed or not properly understood due to racial bias. Healthcare providers can exhibit explicit and implicit discriminatory attitudes towards minority groups, referred to as 'racial bias'. This bias can lead to perceptions of patients from minority backgrounds as less intelligent or friendly, having increased risk-taking behavior for infections, or being therapy-noncompliant. Crucially, pain in individuals with darker skin tones may be underestimated and undertreated compared to white individuals. Racial bias increases the risk of unequal treatment, including less explanation, less empathetic communication, misdiagnosis, and inappropriate treatment plans. "Colorblind racism," where individuals claim to treat everyone the same, can actually perpetuate inequality by failing to recognize and address existing differences and disadvantages . #### 4.4.5 Classism or socioeconomic status **Classism** or discrimination based on socioeconomic status, income, occupation, education level, or social background can lead to health inequalities. Financial constraints often lead to delays in seeking healthcare . ### 4.5 Poverty **Poverty** is defined as the inability to meet primary life needs due to insufficient financial or bartering resources. The poverty line, or the income required to meet basic needs, varies by country, culture, and time. In Belgium, the poverty risk threshold for a single person in 2025 is less than 1,520 euros per month. Poverty also entails a network of social exclusions that separate individuals from mainstream societal patterns of life, which they cannot overcome independently . The concept of "outsourcing" daily tasks (e.g., cooking via delivery apps, cleaning, childcare, therapy) highlights how those with financial resources can delegate to manage their time and well-being, a luxury unavailable to those in poverty . Poverty is strongly linked to poor health outcomes, as it limits access to care, leads to unhealthy living conditions (poor housing, lack of nutritious food, unsafe environments), and causes chronic stress affecting mental health. Conversely, poor health can contribute to poverty through loss of income, additional costs, and limited opportunities. In Belgium, a significant percentage of households live below the low-income threshold, with specific vulnerable groups including refugees, migrant families, single-parent families, and single individuals under 65. Financial hardship is a direct reason for not visiting a general practitioner for 10% of people . #### 4.5.1 Poverty thresholds and benefits * **Poverty threshold:** The income needed to cover basic needs . * **Poverty risk threshold:** 60% of the median standardized disposable household income. In Belgium this is less than 1,520 euros/month for a single person and 3,191 euros for a family of two adults and two children . * **Poverty risk rate:** The percentage of individuals with a disposable household income below the poverty risk threshold . * **Living wage (Leefloon):** A minimum income provided by the OCMW (Public Centre for Social Welfare) under certain conditions if income is insufficient and the situation cannot be changed by the individual. In Belgium this is 1,314.20 euros/month for a single person and 1,776.07 euros/month for a person living with dependents . * **Unemployment benefit:** Initially 65% of the last earned salary for the first three months, then 60% for the following nine months . * **Sick pay/disability benefits** . * **Working poor:** Individuals who have a job but still fall below the poverty line. This risk is higher for those in precarious jobs, flexi-jobs, single parents, and due to unforeseen costs, inflation, or energy prices . ### 4.6 Health literacy **Health literacy** encompasses the skills needed to obtain, understand, and apply health-related information. These skills support informed decision-making, shared decision-making, self-management, and control over one's own health . ### 4.7 Stress and embodiment **Chronic stress** is a significant contributor to both physical and psychological health differences . #### 4.7.1 Causes of chronic stress Causes are numerous and can include financial worries, discrimination, poor housing, neighborhood issues, unemployment, complicated mail, difficulty navigating, doctor's appointments, arguments, loss of a loved one, divorce, moving, and migration. Individuals in vulnerable social positions with unfavorable living conditions often experience a cumulative burden of these stressors . #### 4.7.2 The vicious cycle of stress Stress can lead to impulsive behavior, resulting in "unhealthy" choices for short-term relief, which can exacerbate problems and lead to guilt, further increasing stress . #### 4.7.3 Health consequences of chronic stress * **Physical:** Cardiovascular diseases, diabetes, obesity, premature aging, reduced fertility, and a weakened immune system . * **Cognitive:** Impaired concentration, memory, impulse control, planning, organization, emotional regulation, and increased risk of addiction, Alzheimer's disease, depression, and anxiety . Recognizing, discussing, and investigating the causes of chronic stress are important. Normalizing and explaining the causes and physical consequences of chronic stress can help bridge the connection between medical and social issues . #### 4.7.4 Ecosocial theory and embodiment Ecosocial theory and the concept of **embodiment** explore how social, economic, and political contexts shape the body and health over a lifetime. This perspective highlights how external societal conditions become inscribed on the body, influencing health trajectories . --- # Moral choices for equitable care Providing equitable care in a diverse society necessitates making conscious moral choices that address systemic inequalities and ensure all individuals receive appropriate and respectful healthcare, irrespective of their background . ### 5.1 Defining equitable care Equitable care is defined as a system where access to care, the process of care delivery, and the outcomes of care do not vary based on patient characteristics such as gender, ethnic background, or income, but solely on the patient's need for care. This principle encompasses three key aspects : 1. Equal access for equal needs . 2. Equal treatment for equal needs . 3. Equal outcomes for equal needs . The overarching goal is to provide equivalent care for everyone. This means that attitudes towards patients should not be influenced by their beliefs, political convictions, social status, ethnicity, nationality, language, gender, sexual preference, age, illness, or disability . > **Tip:** Understanding equity is crucial. It's not about giving everyone the exact same thing (equality), but about providing what each person needs to reach a similar outcome. ### 5.2 Key concepts in equitable care Several interconnected concepts are vital for understanding and implementing equitable care: * **Superdiversity:** This refers to the increasing complexity of societal diversity, encompassing a wide range of ethnic, cultural, linguistic, religious, and socioeconomic backgrounds, often intersecting within individuals and communities . * **Intersectionality:** This concept highlights how various social identities (e.g., race, gender, class) intersect and overlap, creating unique experiences of discrimination and privilege, which can significantly impact health outcomes . * **Health inequality:** This refers to the avoidable, unfair, and systematic differences in health status between different groups of people . ### 5.3 Levels of moral choices in care provision Moral choices for equitable care can be examined across micro, meso, and macro levels, integrating person-centered and structural approaches . #### 5.3.1 Person-centered care (Micro-level) At the micro-level, person-centered care focuses on the direct interactions between healthcare providers and individual patients. Moral choices here involve : * **Respecting patient autonomy:** Ensuring patients have agency in their care decisions . * **Culturally sensitive communication:** Adapting communication styles to be understandable and respectful of a patient's background, including language barriers . * **Individualized treatment:** Recognizing that each patient's needs are unique and tailoring care accordingly, considering their personal circumstances and preferences . * **Empathy and non-judgment:** Approaching patients without prejudice, understanding that their life experiences shape their health and healthcare interactions . #### 5.3.2 Structural care (Meso-level) Meso-level structural care involves changes within healthcare organizations and systems that can either perpetuate or mitigate health inequalities. Moral choices at this level include : * **Normalizing equitable practices:** Integrating principles of equitable care into the routine functioning of the organization . * **Systematic improvements:** * **Agenda/triage adaptation:** Adjusting appointment systems and triage processes to better accommodate diverse patient needs and reduce waiting times for vulnerable groups . * **Multidisciplinary teamwork:** Encouraging collaboration among different healthcare professionals to provide holistic and coordinated care . * **Fair remuneration models:** Considering models that ensure providers are adequately compensated for treating diverse patient populations, such as forfaitaire (lump-sum) or geconventioneerd (contracted) arrangements . * **Interpreter services:** Providing professional interpreters to overcome language barriers, ensuring accurate communication and understanding . * **Promoting positive health:** Shifting focus towards a broader understanding of health that includes well-being and resilience, not just the absence of disease . * **Sociocratic approaches:** Implementing decision-making structures that ensure all voices are heard and valued . > **Example:** An organization might implement a policy to always offer professional interpreter services for patients who do not speak the primary language of the facility, rather than relying on family members to translate. This ensures accuracy and patient confidentiality. #### 5.3.3 Structural care (Macro-level) Macro-level structural care focuses on societal structures and policies that contribute to health inequalities. Moral choices here aim to address the root causes of these disparities. This involves : * **Raising awareness:** Highlighting structural causes of health inequality and advocating for their resolution . * **Leveraging power:** Healthcare providers and systems possess certain resources that can be used to effect change : * **Strong discourse:** Using authoritative communication and evidence to advocate for change . * **Numbers:** Demonstrating the scale of the issue through data and patient numbers . * **Connections:** Building networks with other organizations, policymakers, and community groups . * **Expertise:** Utilizing professional knowledge and evidence to inform policy and practice . * **Methods of advocacy and action:** * **Showing impact:** Creating compelling content like opinion pieces, videos, debates, lectures, and engaging in media advocacy to highlight issues . * **Making demands:** Engaging in lobbying, forming coalitions, participating in demonstrations, signing manifestos, speaking at council meetings, and conducting direct meetings with politicians and policymakers to influence policy. This includes providing evidence, publishing policy briefs, and participating in committees . * **Developing new practices:** Innovating and implementing new healthcare models to demonstrate alternative, more equitable ways of working . > **Tip:** Macro-level advocacy requires strategic thinking about how to best influence policy and public opinion. Combining evidence with compelling narratives can be highly effective. --- ## Common mistakes to avoid - Review all topics thoroughly before exams - Pay attention to formulas and key definitions - Practice with examples provided in each section - Don't memorize without understanding the underlying concepts

| Term | Definition | |------|------------| | Superdiversity | A concept describing a society characterized by a complex interplay of multiple, overlapping, and often rapidly changing diversities among people, including their origins, socioeconomic status, and identities. It signifies a diversification of diversity itself, where minorities collectively become the majority. | | Intersectionality | A theoretical framework that examines how various social identities, such as race, gender, class, and sexual orientation, overlap and create unique systems of discrimination or privilege. It emphasizes that these identities cannot be understood in isolation but must be considered together to grasp an individual's experiences and social position. | | Diversity Wheel | A visual tool used to represent the multiple dimensions of diversity that shape an individual's identity and experiences. It typically includes demographic categories like age, gender, ethnicity, sexual orientation, religion, and socioeconomic status, alongside more internalized aspects. | | Kaleidoscope | A metaphor used to describe how individual identities are fluid and change depending on the context and perspective. Just as a kaleidoscope rearranges its pieces to create new patterns, a person's dominant identities can shift, highlighting different aspects of their being at various times. | | Iceberg Model | An analogy used to illustrate the concept that only a small portion of a person's identity and culture is visible (above the water), while the majority, including values, beliefs, and attitudes, remains hidden (below the water). This highlights the importance of looking beyond superficial aspects to understand individuals. | | Kruispuntdenken (Intersectionality Thinking) | A framework that views individuals as dynamic intersections of various social dimensions. It posits that the influence or limitations stemming from belonging to multiple groups can reinforce each other, shaping unique life experiences and social locations. | | Micro-aggressions | Subtle, often unintentional, verbal or non-verbal behaviors that communicate hostile, derogatory, or negative slights and insults toward members of marginalized groups. While seemingly small, they can accumulate and cause significant psychological distress. | | Structural Violence | The systemic ways in which social structures and institutions harm people by preventing them from meeting their basic needs. This can include unequal access to resources, opportunities, and power, leading to disparities in health and well-being. | | Privilege | Unearned advantages or benefits that individuals receive based on their membership in dominant social groups. These advantages are often invisible to those who possess them but significantly impact their life experiences and opportunities compared to marginalized groups. | | Ageism | Discrimination and prejudice based on a person's age. It can manifest as stereotypes, exclusion, and the denial of opportunities or respect based solely on how old someone is. | | Sexism | Discrimination and prejudice based on sex, typically directed against women. It involves the belief that one sex is superior to another, leading to unequal treatment and opportunities in various societal spheres, including healthcare. | | Racism | Discrimination and prejudice based on race or ethnicity. It involves the belief that certain racial groups are inferior to others, leading to systemic disadvantages, marginalization, and negative health outcomes for targeted communities. | | Classism | Discrimination and prejudice based on social class or socioeconomic status. It involves the unfair treatment and negative stereotyping of individuals from lower socioeconomic backgrounds, impacting their access to resources and opportunities, including healthcare. | | Ableism | Discrimination and prejudice against individuals with disabilities. It is based on the belief that non-disabled people are superior and can lead to the exclusion, marginalization, and inadequate support for people with disabilities. | | Health Literacy | The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. It encompasses skills for reading, understanding, and acting on health information. | | Chronic Stress | A prolonged and heightened stress response that can have detrimental effects on physical and mental health. It often arises from ongoing stressors like financial difficulties, discrimination, poor living conditions, and social isolation. | | Embodiment | The process by which social, economic, and environmental factors are translated into biological outcomes. It refers to how external social conditions become physically inscribed on an individual's body, influencing health and disease. | | Equity | The principle of fairness and justice in healthcare, where individuals receive the care they need without being disadvantaged by personal or social circumstances. It acknowledges that different people may need different levels of support to achieve similar health outcomes. | | Person-Centered Care | A model of healthcare that focuses on the individual patient's needs, preferences, and values. It emphasizes shared decision-making, respect, and a holistic understanding of the patient's well-being, integrating their unique identity and circumstances. | | Structural Care | A level of healthcare intervention that addresses the broader social, economic, and political factors influencing health and healthcare access. It involves advocating for policy changes and systemic improvements to reduce health inequalities. |