Publikationer

Health care delivery in the Circumpolar North is challenged by a scarcity of culturally relevant health care services, few medical providers trained in cross-cultural care, and high costs of transportation. Community health workers (CHWs) are primarily Indigenous individuals who provide on-the-ground health care and health promotion services in their own communities.The CHWs’ scope of work varies from health education to clinical care and often focuses on upstream factors that impact the public’s health. Although often overlooked and underutilized, the CHW role is an innovative approach to promoting more sustainable and culturally relevant care within health systems. Investigating and understanding the potential ways that CHW-integrated health care systems support health and wellness could allow for a clearer understanding of how to translate this approach to other regions seeking a transition to sustainability in health and wellness. Drawing on experiences with CHWs in the Circumpolar North, this article introduces a conceptual model summarizing pathways that describe how integrating CHWs supports wellness in their communities. The proposed model includes five pathways for how CHWs could support wellness: (1) the recruitment of CHWs from within a community promotes community capacity and control; (2) the CHW role allows them to advocate to address structural and systemic inequalities that contribute to ill health, if CHWs are supported to organize their communities around wellness; (3) CHWs have the potential to support and empower community members; (4) CHWs have the potential to develop culturally relevant, feasible, and effective health promotion strategies; and (5) CHWs have the potential to build on community strengths. This model allows for CHW-integrated health care systems to be critically examined to both test and refine this proposed model, and support and empower community health workers as a transition to a more sustainable health care delivery system that reduces inequities and promotes health.

One view on trust that has largely gone unexamined in the literature is the process perspective. The process perspective advances the view that trust develops over time in the local context through a history of interaction between knowledgeable social actors. The term ‘knowledgeable social actor’ implies that individuals respond actively to unfolding events in the context and modify their responses to meet changes in circumstances. Within a process perspective, this chapter looks closely at the relationships between a group of young men with minority ethnic backgrounds, a team of youth workers, a job consultant and a police officer, to shed light on trust- and distrust-building processes. This chapter addresses the frames used by the young men to organize public sector employees, either as trusting or distrusting, together with some of the cultural tools used to construct these frames. The key question that the chapter considers is: how can trust and distrust be understood as cultural frames? The research reveals that both trust and distrust can be influenced and manipulated through social interaction over time and through the subsequent sense-making processes in the particular context. The chapter contributes towards understanding of the micro-processes at play in trust- and distrust-building processes.