Maria Veronica Svetaz, MD MPH
5th Annual MN Childhood Injury Summit
Workshop Objectives
For our diverse communities, basic needs for food, shelter,
protection from violence and prevention of self-harm
may be paramount.
How do we address unintentional injury effectively in this context?
Dr. Svetaz will explore
1)
How to build an agenda that includes prevention of
unintentional injuries. The role of fatalism within certain
communities as a barrier to injury prevention and how to help
individuals reclaim power.
2)
How to craft meaningful messages for teenagers and for
diverse communities in general.
First Stop: Who is most at risk?
For children, teens and young adults,
unintentional injuries are the
leading cause of death.
Children aged 1–4 have the highest rate of
emergency department treatment for
unintentional injury, followed by
15–19 year-olds, 10–14 year-olds
and people in their early 20s.
Preventing Unintentional Injury in Minnesota:
A Working Plan for 2020
Second Stop:
Trends and Challenges
Increasing cultural diversity.
Perceptions and definitions of safety may vary by
culture. Minnesota’s diverse population
requires cross-cultural sensitivity, competence
and effective partnerships, and
engagement on the terms of other cultures.
Just providing information doesn’t work;
traditional methods of reaching those at risk
are not effective across all ages or cultures.
The challenge is not only outreach, but also
inclusion.
Preventing Unintentional Injury in Minnesota:
A Working Plan for 2020
SAFETY
Safety is the state of being "safe" (from French sauf),
the condition of being protected against physical,
social, spiritual, financial, political, emotional,
occupational, psychological, educational or other
types or consequences of failure, damage, error,
accidents, harm or any other event which could be
considered non-desirable.
 Safety can also be defined as the control of
recognized hazards to achieve an acceptable level of
risk.

Health Equity and your world
Social Determinants and Your
Community
Social Determinants and Race
Health Disparities: A type of difference in health that is
closely linked with social or economic disadvantage.
Health disparities negatively affect groups of people
who have systematically experienced greater social or
economic obstacles to health. These obstacles stem
from characteristics historically linked to
discrimination or exclusion such as race or ethnicity,
religion, socioeconomic status, gender, mental
health, sexual orientation, or geographic location.
Other characteristics include cognitive, sensory, or
physical disability [4].
Social determinants of Health- CDC
Social Determinants and You
Culture Identity and
your view of the world

Your LENSES, the way you learned to see the
world, what is acceptable or unacceptable, what is
expected or not

All those unwritten rules that form cultural
values and cultural norms.
From Western Cultures From Eastern Cultures
created byYang
Liu, who was born
in China and
educated in
Germany
From Western Cultures From Eastern Cultures
1.
created byYang Liu,
who was born in
China and
educated in
Germany
From Western Cultures From Eastern Cultures
1.
created byYang Liu,
who was born in
China and educated
in Germany
From Western Cultures From Eastern Cultures
created byYang
Liu, who was born
in China and
educated in
Germany
The “KOA” ephyfany: Your reality
may not be my reality!
PART OF BEING INCLUSIVE IS ASKING THESE QUESTIONS:

What you are seeing/living/needing is NOT the same as what I
am seeing/living/needing due to social differences and
completely different realities

How you are seeing/living/needing is NOT PERCEIVED in the
same way I am perceiving them due to different cultural identity
formation.
Discourses and Messages:
And how to impact Motivation
cross culturally
How to start seeing that unknown/foreign reality that
certain families are going through?
Awareness of different agendas and unmet needs
II. Creation of Empathy
III. Realization that safety means a very different thing
in a wealthy community than in a community
enduring poverty
IV. Creating real patient-provider partnerships
I.
Discourses and Messages:
And how to impact Motivation
cross culturally
How to start realizing that my world view might be
different than others?
I.
II.
III.
IV.
Asking
Exploring (listening)
Open/ended questions
Non judgmental questions/answers
Where Fatalism sits in all of this?
Freeman's poverty-cancer spiral concept offers insights into why traditionally
underserved populations articulate and employ fatalistic perspectives
(Freeman 1989). Freeman notes that poverty and its associated ills—
undereducation, lack of employment, poor housing, lack of health care access,
poor health outcomes—create a downward spiral, a self-fulfilling prophecy,
and, ultimately, adverse health outcomes. Freeman describes the process by
which poverty intersects with medical care and creates fatalism. First, unless
there are discernible symptoms, poverty oftentimes forces people to focus on
a day-to-day existence that stands in sharp contrast to a health prevention
mode. By the time cancer symptoms are present, the disease has progressed
beyond the localized stage, which necessarily limits treatment options and
leads to poorer outcomes. Poor outcomes decrease the likelihood of survival
and increase suffering, ultimately reinforcing fatalistic perspectives, as families
and community members witness this cycle of late stage cancer diagnosis,
more complicated, disfiguring, and painful treatments, poor outcomes, and,
ultimately, death (Shankar et al. 2002).
Deconstructing Fatalism: Ethnographic Perspectives on
Women's Decision Making about Cancer Prevention and
Treatment
Elaine M. DrewDepartment of Family and Community Medicine
Medical College of Wisconsin
Fatalism and Patient Activation
“In Western mainstream culture, where the
expectation is to be autonomous, independent,
self-directed and a manager over ones future,
expressions of fatalism strike many as benighted,
irrational, and counterproductive.Yet as our case
studies reveal, “fatalism is an entirely rational way
of coping with a world in which one feels
powerless and has potential benefits, such as
enhanced enjoyment of the present that Western,
achievement oriented cultures tend to discount”
Deconstructing Fatalism: Ethnographic Perspectives on Women's
Decision Making about Cancer Prevention and Treatment
“Indeed, we argue that fatalism in the context of our two
case studies represents a form of what medical
anthropologist Mark Nichter refers to as “cultural
idioms of distress,” which “are socially and culturally
resonant means of experiencing and expressing
distress in local worlds … evocative and index past
traumatic memories as well as present stressors, such
as anger, powerlessness, social marginalization and
insecurity, and possible future sources of anxiety, loss
and angst.” (2010:405)
Deconstructing Fatalism: Ethnographic
Perspectives on Women's Decision Making about
Cancer Prevention and Treatment
“Our work and others indicates that people actually do
express fatalistic ideas. What we propose is that there is
good reason why they express these ideas, and that such a
reason tends to be located within resource-constrained
conditions, such as those found in the Appalachian
context. Furthermore, our narratives suggest that such
rhetoric is not the primary determinant of health
behavior but rather a culturally acceptable idiom of
distress. Seeking a middle ground, we reject attempts to
either toss out this frequently used idiom or to use the
construct as an explanatory factor in supposed irrational
health decisions. Instead, we advocate for a great
appreciation of the complexities and nuances of fatalism”
Deconstructing Fatalism: Ethnographic
Perspectives on Women's Decision Making about
Cancer Prevention and Treatment
INCLUSIVITY: The PRACTICE
A word on Patient Activation
Most of our Models in HCH measure patient centeredness and part of that is Patient
Activation
But most indicators that measure Health Patient Activation, and the model seems
VERY “mainstream”: see next picture
int Slide for Teaching
INCLUSIVITY: The PRACTICE
A word on Patient Activation
Racial/Ethnic Disparities And Consumer Activation In Health
Health Affairs, 27, no. 5 (2008): 1442-1453
doi: 10.1377/hlthaff.27.5.1442
© 2008 by Project HOPE
What preventions mean in light of
current adversity?
How to create powerful awareness of the need of prevention in the
midst of current adversity?
= Sharing the agenda: “What is the most oppressing/urgent thing
that is in your mind today?”
= framing prevention as a way of decreasing potential future stress
and feeling pro-active
= Meeting human beings where they are, and not judging.
= Using their strengths and their resources as a starting point: “you
are really family oriented, how can we make your home more
safe for all your family to enjoy?”
= When providers start seeing strengths, the families served by them
will too, an unknown feeling for most, and they will start feeling
power-full , and able to create stronger safer futures.
TEENS!!! And young adults
(think brain development :11-24)
= Present oriented
= Powerful? INVINSIBLE!!!
=Concrete thinkers, the younger. Under
development abstract thinking for most of them,
but do not generalize!!
=They need to belong! So be aware of peer pressure
=They are wired to take risks, help them to be
savvier on that (risk reduction)
TEENS: The How To
= Listen, don’t judge! Poker Face!
= Add fun and humor to your recommendations: make
it real for their world! Their world is today, and it has
to be cool!
= Discuss with them invincibility and how it feels, to
start creating insight around that
= Discuss with them how their behaviors will change
with peers, and make them reflect about this (Have
you noticed that you do different things when you are
around friends? And make different decisions? With
time, I had!), and work with them on how to resist
pressure and how to say no.
TEENS!!!

Parents of teens were “left behind”, don’t have the
tools they need to continue to parent in a
developmentally appropriate way: SUPPORT
PARENTS of TEENS!!!

Work with parents to create Teen “Coaches”
The coach concept for parents
C reate confidence
O bserve
A dvise (reflect)
C almly let them go to play, sorry, live!
H elp them debrief the experience
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