![]() ![]() These factors are known as social determinants of health. Population health focuses on specific populations looking at a broad range of factors that affect health. Population health is defined as health outcomes of a group of individuals. In order to improve the health status of an individual, the health status of the population in which the individual lives and works needs to be improved. In 2009, I accepted the post of Medical Director of an Aboriginal Community Controlled Health Organization in the Northern Territory, providing comprehensive primary health care and population health. This provided me the opportunity to work Indigenous Aboriginal Communities in the Northern Territory of Australia and to learn the customs and needs of the local communities. Following this I took up an appointment as Public Health Medical Officer with the Department of Health of the Northern Territory in Australia and was based in Alice Springs, developing and implementing STI control activities. I became Professor of Medicine at the University of Zimbabwe College of Medicine and later became Dean of the College of Medicine. During this time I also worked as a consultant for the World Health Organization and was able to visit numerous countries where I was involved in training doctors and health staff and develop and set up programs for the management and control of sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV) infection. After specializing I joined the Department of Medicine of the University of Zimbabwe Medical School where I was involved in teaching undergraduates and postgraduates and conducting research and other academic activities. I worked as a medical officer in the Harare City Health Department where I introduced the concept of the syndromic management of sexually transmitted infections. After graduation in 1969, I worked as an intern, senior house officer, and a general practitioner before specializing in internal medicine and sexual health. Professor Goldsmid emphasizes that human behaviour and cultural practices can have a profound effect on the range and prevalence of diseases suffered by communities and that human behaviour is the forgotten factor in disease prevalence and transmission. More recent publications are also available, and a paper by Professor John Goldsmid is referenced here. ![]() ![]() As medical students, we took part in the “Medical Anthropology” described in the book, and, as part of this we visited remote communities in Zimbabwe (then Rhodesia) and learnt how traditional practitioners delivered health care to clients that consulted with them for their needs. We were taught that “unless you approach your patients with understanding you will fail to win them over and as a result you will often be unable to cure them.” This is quoted in a review of the publication in the Journal of the American Medical Association in 1964. A number of texts by the very distinguished and respected Professor Michael Gelfand were available. In the early days of our own training, more than 50 years ago, we were made to learn of these factors. This commentary discusses the above factors and provides example cases from the author’s own career of where such factors have affected the health of individuals or groups. Culturally “unsafe” clinical service has serious adverse effects. Practical training should be conducted under supervision in remote settings so that trainees appreciate what their clients experience on a daily basis. Training in delivering culturally safe services should include both theoretical and practical components. The development and delivery of culturally safe services is more acceptable to community members and is important if a difference is to be made in health inequities. Cultural sensitivity is needed if one is to make a change in health outcomes in culturally diverse environments. While some determinants of health are modifiable others are not, in addition it is emphasized that cultural safety in delivering health care is crucial if services provided are to be appropriate and acceptable to health care seekers. The objectives of this paper are to provide a review of the author’s personal experiences working in culturally diverse environments and to emphasize the importance of recognizing the social determinants of health.
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