Health Advocacy involves more than just translation and interpreting; it is also about representing the client’s needs and requires a longer-term relationship with the client. Advocacy allows cross-cultural communication which simple language translations do not (for instance, because of different concepts of health and illness). Advocacy for minority ethnic groups works at individual, group and population levels.
At the individual level it provides that interpreting for non-English speakers is available, that sources of support are identified, and that help for the interpretation and support is secured from mainstream services. At the group level, it provides for health education, promotion of the use of services (such as, for example, screening and immunization), and that people’s awareness of their rights is increased.
At the level of population, health advocacy works by means of encouraging services to provide better support to groups within the population and assisting in the planning of health care or health improvement programs (Dylan Ronald Tomlinson, Winston Trew, 2002, p 82-95). Without a strong advocacy voice, and the development of these forms of support, many minority groups get ignored or marginalized by mainstream services (SILKAP, 2000). The training of health workers gives little attention to diversity issues, so the educational role they play is important.
However, health advocacy still faces major problems in gaining acceptance in the mainstream because its benefits are not widely accepted (the evidence base remains weak from lack of research). It is also marginal to most organizations’ lists of priorities. Advocacy services frequently receive short-term funding, making it hard to develop staff and infrastructure. A King’s Fund study of voluntary sector funding from the NHS found that the amounts secured were small and that very little of it was for advocacy work or capacity building (Mocroft et al. , 1999).
The King’s Fund is, at the time of writing (April, 2001) concentrating on developing health advocacy in London, and key areas of interest are: integration of health advocacy into NHS mainstream services; means of developing formal training, regulation and accreditation for health advocacy; and ways of helping voluntary sector organizations that are active in this area to get statutory sector contracts (Dylan Ronald Tomlinson, Winston Trew, 2002, p 82-95).
Conclusion Improvements in health have become expected in wealthy countries. But both within and between countries there are substantial inequalities in health that have remained despite overall improvements. In some cases, these inequalities have become even more clearly visible. While universal access to high quality, affordable medical care is a social goal that should have high priority, it alone will not eliminate social inequalities in mortality rates.
The fact that inequalities in health are not limited to worse health among the poor but that a gradient runs across society, in combination with the close link between income inequalities and health, indicates that relative deprivation is an important determinant of health inequalities. Such deprivation influences life-style choices and differential access to high quality social environments.
Providing more people with fulfilling jobs, adequate compensation, and social environments that foster good relationships may be of crucial importance in reducing inequalities in health.
Reference: Airey, C. and Erens, B. (Eds) (1999) National Surveys of NHS Patients: General Practice, 1998, a survey for the NHS Executive, London: Stationery Office.