By Izabel and Kinjal
Introduction
Taiwan has an impressive universal healthcare system. Every citizen gets an insurance card that they can take to any hospital or clinic in the country, and they will receive care at a relatively low cost. It is great because everyone can get the care that they need, as long as they have the card. However, that only negates some of the different social determinants of health that influence the health of people in Taiwan. You might be thinking, “Social determinants of health, what’s that all about?” Well, it’s all the stuff that affects how healthy you are, like where you were born, where you live, and even your job. Different populations in Taiwan experience various social determinants of health to differing degrees, and this blog post is our opportunity to discuss some elements we’ve witnessed here during our program duration in Taiwan.
Economic Factors
Socioeconomic status is one of the most significant social factors that affect health outcomes. Though Taiwan has a universal health care system, belonging to a higher socioeconomic status means you will likely have better health outcomes.
During our stay in Taiwan, we visited many healthcare facilities and hospitals. One of these was the Fu Jen Catholic University Hospital. During our tour of that hospital, we were shown a unit in the hospital called the International Department. This area of the hospital was for hospitalized patients who wanted a more comfortable experience. The hospital rooms had large windows that showed a panoramic view of the city. They were decked out with the most fashionable and luxurious furniture.
Additionally, we were shown another unit in the hospital where people could come to get their annual physical exams in a more comfortable setting. This unit had everything: x-ray machines, CT scanners, ultrasound technology, ENT examination technology, colonoscopy and endoscopy rooms, etc. Both of these units were filled with the most luxurious-looking furniture and equipment. However, both these units are only for people who can afford them. People of lower socioeconomic status would not be able to afford to stay in the International Unit if they were hospitalized for an extended time and would also not likely be able to afford to get examined in the other unit.
Image 1: Group Picture at Fu Jen Hospital VIP Floor. Left to right: Dr. Gary Lin, CEO Shiauyuh Yang, Molly Warner, Hana Nakamura, Izabel Kickner, Kinjal Patel, Dr.Tammy Bray, and Arthur Kreiter.
Geographic Isolation
In addition to socioeconomic status, geographic location is also a significant determinant of health in Taiwan. Some indigenous communities are located in remote or mountainous areas, which can limit access to healthcare services. This geographic isolation can lead to health disparities. While we were in Faxiang village in Nantou, we saw this first-hand. While the village had a health clinic, it was minimal and did not have the latest and greatest medical technology. For any medical emergency, the closest medical center was a two-hour drive from the village. Additionally, while there is a primary school in the village, to attend high school, children from the village have to drive 30 minutes to another town for schooling. This geographic isolation also means that there is less access to other things, like food and other supplies and services.
Image 2: View Of Faxiang Village From Our Hostel
Addressing Discrimination and Dispelling Stereotypes
Despite advancements in societal awareness, persistent stereotypes continue to undermine the reputation of indigenous communities in 2023. As indigenous individuals in Taiwan frequently encounter discrimination and stigma, this can profoundly impact both their mental and physical well-being. These adverse experiences often manifest as heightened stress, increased anxiety, and a hesitancy to access essential healthcare services.
Regrettably, some individuals, including influential figures like teachers, perpetuate the notion that indigenous people are inherently less intelligent or diligent. Consequently, these stereotypes can compromise educational standards, leading to a reluctance to support indigenous youth.
It is crucial to recognize the significant contribution of indigenous people to the workforce, as reflected in compelling statistics displayed at The National Museum of Prehistory in Taitung. Despite comprising only 2.3% of Taiwan’s total population, indigenous individuals represent 7% of the military and an impressive 60% of special forces. These figures stand as a testament to the capabilities and dedication of the indigenous population, dismantling unfounded stereotypes and promoting a more inclusive and accurate understanding of their role in society.
Social Norms: Substance Use
Another significant social determinant of health for Taiwanese people is the social norms surrounding substance use. Substance abuse can be an important issue in many populations in Taiwan, which can lead to various health problems. Understanding the underlying causes and providing appropriate support and treatment is crucial.
Image 3-4: No Smoking Poster at Fu Jen University’s MRT station.
While at Fu Jen Catholic University, ignoring the abundance of “no smoking” signs scattered across the campus was impossible. Surprisingly, despite the explicit directives, we frequently encountered individuals openly smoking, some even right in front of these prominent signs. This disregard for designated smoking areas raised concerns about the effectiveness of the anti-smoking measures in place.
Our observations extended beyond the university grounds to the streets of Taipei City, where discarded cigarette butts were a common sight. Smoking appeared to be deeply ingrained in the local social culture, with the prevalence of this habit evident in public spaces. A similar cultural pattern emerged concerning alcohol consumption, a widespread social activity not only in urban areas but also among various indigenous communities.
The use of cigarettes, alcohol, and betel nuts is notably prevalent among Taiwan’s diverse indigenous tribes. Understanding these practices necessitates viewing them through a cultural lens and acknowledging their significance within these communities. Consequently, any proposed solutions must be culturally sensitive and realistic for implementation among indigenous groups.
Attempting to restrict or suppress cultural practices, such as the consumption of betel nuts, would be impractical. Instead, a more constructive approach involves developing solutions that respect and integrate these cultural elements, promoting healthier alternatives, or providing educational resources to mitigate potential health risks associated with these practices. By recognizing the cultural context, we can work towards sustainable solutions that address health concerns without infringing on the rich cultural heritage of indigenous communities.
Social Support and Community Networks
Strong social support systems within indigenous communities can positively impact health, as these networks can provide emotional support and access to resources. Within the Faxiang Village, we worked with the Cultural Instructor affiliated with the local elementary school, who is devoted to his role of preserving Atayal cultural practices. We enjoyed learning various cultural practices, such as weaving traditional headbands and bracelets, practicing archery, and learning to play some cords on the ukulele.
Personal story: Experiencing craving at Faxiang
While we were in Nantou, we were taught some of their cultural practices. One of my favorite activities that we did was carving the Jew’s harp out of bamboo. It took a lot of precision and hand dexterity, but I loved every minute of it. Walis is so gifted at carving and playing the harp; I loved learning everything he taught us.
Image 5: OSU Student Kinjal Patel Displaying the Harp She Made
Conclusion
All these social determinants contribute to the health outcomes of Taiwanese people. Addressing these social determinants of health is essential to developing culturally sensitive policies and programs focusing on education, economic development, healthcare access, and preserving cultural identities. Collaboration with leaders and communities is crucial in creating solutions that work for everyone and improve everyone’s overall health and well-being.
If any country can do this, it’s Taiwan. Throughout our trip here, we have seen how willing everyone is to support and collaborate with each other to improve people’s lives. Through this collaboration, improving social determinants is definitely possible and inevitable.
Image 6: Group picture of OSU students with Faxiang students and Cultural Instructor Wallis.
