Women's Heart Health in Singapore: a Culture-Centered Framework
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CARE WHITE PAPER SERIES 2013 VOL. 1 Women’s Heart Health in Singapore: A Culture-Centered Framework Sarah K. Comer & Mohan J. Dutta THE CARE WHITE PAPER SERIES IS A PUBLICATION OF THE CENTER FOR CULTURE-CENTERED APPROACH TO RESEARCH AND EVALUATION (CARE), NATIONAL UNIVERSITY OF SINGAPORE Requests for permission to reproduce the CARE White Paper Series should be directed to the Department of Communications and New Media, Faculty of Arts and Social Sciences, National University of Singapore. DEPARTMENT OF COMMUNICATIONS AND NEW MEDIA CARE WHITE PAPER SERIES 11 Computing Drive, AS6 Level 3 National University of Singapore Singapore 117416 T (65)6516-4971 W http://www.fas.nus.edu.sg/cnm Women’s Heart Health Mohan J. Dutta, Head [email protected] in Singapore: A Culture-Centered Framework Copyright of this paper resides with the author(s) and further publication, in whole or in part, shall only be made by authorization of the author(s). Sarah K. Comer & Mohan J. Dutta Design, layout, and editing: Daniel Teo, CARE Research Assistant CARE is online at http://www.care-cca.com. CARDIOVASCULAR DISEASE (CVD) is the Stampfer, Hu, Manson, Rimm, & Willett, ABOUT CARE leading cause of death globally (Bonow, 2000), diet (Heidemann et. al, 2008; Funded by a $1.9 million grant from the the problems conceptualized by them. Smaha, Smith, Mensah, & Lenfant, Odegaard, Koh, Gross, Yuan, & Pereira, National University of Singapore (NUS), 2002; Bonow, Smaha, Smith, Mensah, & 2011; Rankin & Bhopal, 2001), and CARE seeks to: (a) create a strategic CARE is a global hub for health commu- research core for the social scientific study Lenfant, 2011; Howson, Reddy, Ryan, & smoking cessation (Bhalla, Fong, Chew, nication research that uses participatory of health communication issues in Asia Bale, 1998; Mathers, Boerma, & Ma Fat, & Satku, 2006; Cutter, Tan, & Chew, and culture-centered methodologies driven by the cultural worldviews of local 2009; McKay, & Mensah, 2004; Michaud, 2001; Doll, Peto, Boreham, & Suther- to develop community-driven health communities, (b) develop health commu- Murray, & Bloom, 2001; Murray & land, 2004; Woodward et al., 2005; Yusuf communication solutions. CARE is an nication interventions and policies that are affiliate organization of the Department Lopez, 1997; National Institutes of Health et al., 2004; Yusuf, Reddy, Ôunpuu, & culturally-centered via the participatory of Communications and New Media at the [NIH], 2012; World Health Organization Anand, 2001). However, cultural values capacity of local communities to create Faculty of Arts and Social Sciences, NUS. [WHO], 2012). It is a non-infectious, affect conceptualizations of health, and culturally meaningful and locally respon- non-transmissible disease that can be in effect, engagement in preventative CARE is driven by the core principle that sive health solutions, (c) disseminate the prevented by protective behaviors such behaviors. We argue that the presenta- communities know best the solutions that core principles and lessons learned from are relevant to the problems that they the culture-centered projects within Asia as exercise (Goldstein et. al, 2001; Lee, tion of health promotion materials will identify as critical. CARE works closely with and across other sectors of the globe, and Sesso, Oguma, & Paffenbarger, 2003; lead to decreases in unhealthy behavior community organizations, policymakers, (d) build health communication research program planners and evaluators in capacity in Asia by creating a training hub Sarah K. Comer is a Research Assistant at CARE. She holds a Masters Degree in developing culturally-centered solu- for the next generation of health commu- Interpersonal and Health Communication from the University of Georgia. tions that are envisioned by community nication theorists, researchers, practi- members in the grassroots in response to tioners, and policymakers across Asia. Mohan J. Dutta is Director of CARE and Head of the Department of Communications and New Media at the National University of Singapore. 2 3 CARE WHITE PAPER SERIES WOMEN’S HEART HEALTH IN SINGAPORE only when the culture of the target one of the top three causes of death for accounting for non-European voices needs and capacity assessments, com- public is centralized in the development worldwide through year 2030 (Mathers in heart disease prevention. Entities like munity-based programs, and popula- of intervention programs. & Loncar, 2006; WHO, 2012). the American Heart Association (AHA) tion-based approaches. In other words, have developed community guidelines culturally-centered data that is specific It is critical to develop culturally for heart health promotion to provide to the local population is required to appropriate health interventions that GLOBAL RESPONSE TO a framework for community leaders, develop appropriate and effective heart are rooted in the cultural logics of WOMEN’S HEART HEALTH policy makers, and healthcare prac- health interventions. local communities (Dutta, 2008, 2011; titioners to effectively promote CVD Dutta-Bergman, 2004a, 2004b) to ef- In response to CVD rates among prevention through strategies including fectively identify and address the barriers women, a wide variety of heart health education via mass media and environ- WOMEN’S HEART HEALTH to health behavior. Additionally, the interventions have been developed mental change (Montoya et al., 2011; INFORMATION IN SINGAPORE structural loci of factors causing heart globally (e.g., Mosca et al., 2007; Pearson, et al., 2003). disease, such as stress, access to healthy Rosamond et al., 2000; Wilcox, Parra- Singapore is a nation dealing with food, access to spaces for exercising, and Medina, Thompson-Robinson, & Will, Overall, scholars have suggested that chronically high CVD mortality rates. access to preventive heart health care, 2001; Yusuf et al., 2004). Previous heart health initiatives created for a CVD has remained the major causes of suggest the relevance of heart health interventions have shared two common Western audience may not be suited for mortality for Singaporeans (Registry advocacy directed at promoting heart focuses: (a) maximizing interven- other non-Western target populations, of Births and Deaths, 2004, Registry of healthy social and community struc- tion effect through targeting a broader such as Singaporean women. Noting the Births and Deaths, September 2012), tures (Dutta, 2008; Fuster & Kelly, 2010; population to increase efficiency at worldwide variance in CVD risk factors especially women. In 2008, CVD was Melkote, 2000; Yusuf, Reddy, Ôunpuu, minimal cost (Bovet & Paccaud, 2012; (both behavioral and biological), Yusuf responsible for the deaths of 2,500 & Anand, 2001). CVD is especially Murray et al., 2003; Pearson et al., 2003; et al. (2004) observed that: women in Singapore, almost a third of important to women, being the largest Yusuf et al., 2004), or (b) targeting the all female deaths for the year (Robless, single cause of mortality among women individual in promoting healthy preven- … researchers are unsure to what extent 2012; Singapore Heart Foundation worldwide (Jacobs & Eckel, 2005; tative behaviors (Dehghan et al., 2012; […] findings apply worldwide. Some data [SHF], 2010). Mikhail, 2005; Society for Cardiovas- Odegaard, et al., 2011; Rossouw et al., suggest that risk factors for coronary heart cular Angiography and Interventions 1993; Tian et al., 1995). disease vary between populations – e.g., However, amidst the high rates of [SCAI], 2012; Soroptimist, 2007; WHO, lipids are not associated with this disorder CVD in Singaporean women, research 2004a; Women’s Heart Foundation , Major global initiatives such as the in South Asians, and increases in blood focusing on Asian women with CVD in 2006;). CVD causes 8.5 million deaths INTERHEART project (Yusuf et al., pressure might be more important in Singapore is “sorely lacking” (National among women annually, accounting 2004) focused on specific risk factors Chinese people. (p. 937) University Heart Centre Singapore for one-third of all deaths in women for CVD as a necessary precursor to [NUHCS], 2009, para. 3). Few up-to- around the globe (American Heart intervention development. This project Similarly, Fuster & Kelly (2010) rec- date nationwide reports on the state of Association[AHA], 2004; Odegaard et (a) illuminated the need for more non- ognized the need to have localized CVD among women exist. The most al., 2011; WHO, 2004b; World Heart Eurocentric studies for CVD; (b) pointed knowledge of a population and its heart recent report was published by SHF in Federation, 2013). Furthermore, there out that it would be a mistake to assume health situation. The scholars recom- 2010. There is also an alarming lack of does not seem to be an end in sight with that all CVD interventions are applicable mended a more comprehensive approach literature on the experiences of women researchers projecting CVD to remain everywhere; and (c) suggested the need to heart health interventions focusing on which contribute to their risk of CVD, 4 5 CARE WHITE PAPER SERIES WOMEN’S HEART HEALTH IN SINGAPORE calling into question how past efforts to Programme. Implemented in 1992, the CULTURE-CENTERED Methodological Biases improve the heart health of Singaporean National Healthy Lifestyle Programme HEART HEALTH PROMOTION women were developed. was a nation-wide initiative to improve Within populations, there remain the overall health of Singaporeans CVD might be a global issue, but there differences in access, participation, and and prevent