Study On The Health Status Of Different Nationalities

BackgroundAlong with the evolution of health view and medical model, as well as the health demand advanced and changed of people, social and culture factors play more and more important role in keeping complete state of physical mental and social well-being. Many studies revealed that health attitudes, values, behaviors may differ from one culture to another. Some health promotion programs fail, in part because the health-related perspectives and values held by individuals who develop the programs are inconsistent with those held by members of the target population. In our study culture is defined as "a system of symbols consists of thought and consciousness, values and criterions, religion and faith, behaviors and life style, which are shared ,learned, and passed on from generation to generation".There are 49 nationalities in Guizhou province , 18 of them are inhabit there for generations.The national health service census in 2000 indicate that there are more than 13 millions Minority ethnic populations,which hold the 36.8% of the total population in Guizhou province. Minority Miao, Buyi ,Gelao and Dong are the main Minority which occupy 50 to 96.5 percent of the nation Minority respectively. Guizhou province rich in ethical culture which were created by different groups and have their own national characters. Different ethical minority group have different apperceive to health and disease, which will be reflect the health status of themselves.At the same time the traditional health evaluating methods and indicator system such as survival rate, incidence rate and prevalence rate haven't reflected the integrity of human being which possess biologic, psychological and social character. Health indicators have developed from single index to compound index. Quality of life(QOL) is such an indicator system to evaluate people's health ststus. QOL research group of WHO defined "QOL is individual's perceptions to living status related to their goals ,expectations, standards and issues they concerned about, who live in different culture and value systems". So,it is a subjective evaluating indicator which should be evaluated by oneself and relies on certain culture and must be set up in such culture-value system. Unfortunately, very little is known about the QOL in Minority population. The present study use QOL to evaluate crowd health condition.The present study hope to offer warranty for the all levels health decision-making department to allot and use the health resource reasonably, to organize health services scientifically and formulate health guide line, plan, strategy and policy and other aspects base on the results of the health levels ,health status distribution and health influence factors in Minority groups. We also want to impel health decision-maker to think health programs in a broad background by analyze the complex relationships between sub-culture factors and health.ObjectivesThe specific aims are: 1. to investigate and evaluate the quality of life and its main social, economic influential factors according to different demographic characteristic in Minority Miao, Buyi, Gelao ,Dong in Guizhou province. 2. to know properly the extent and the track that the sub-culture influential factors affected on health or QOL of the Minority populations. 3.The present study also want to explore the relationships among health value ,health-related behaviors and quality of life, and tried to explain the behavior differences with perceived value on health by compared the health-related behaviors of minority groups with Han. 4. to provide evidences for valid health education and promotionmeasures to improve the health of target population.SubjectsAnlong, Xingyi, Ansun, Zunyi and Yuping county ,Guizhou province were selected for this survery. All of the people aged 15 or over of Miao, Gelao, Dong and Buyi living in the five counties were invited to participate in this study. A total of 915 respondents completed the questionnaires.ContentsA structured questionnaire survey was undertaken in the study. The questionnaire involved five parts as fellows:1. Family and individuals' social demographic characteristics of respondents.2. Two weeks prevalence and chronic disease prevalence of the subjects.3. Quality of life (eight items were developed to assess QOL of the participators).4. Health value (six items were developed to assess health value).5. Health-related behaviors( the health-related behaviors included in the survey covered: cigarette smoking; alcohol drinking; drinking water treatment; blood pressure check; and access to health information).6. knowledge about health(five questions were developed to assess the health information the respondents had).We also collect the datum related with social, economic and health status of the five selected counties, Guizhou province and country.MethodData collection methodFour main research methods have been implemented in the project, which are questionnaires investigation, face to face interviews, literature review and expert consultation. The questionnaire was formed by the research group. Data was collected by interviewers who were trained before formal investigation. Considering the Minority have their own language, local health officers were also trained to help the investigation . Face to face interviews were used by interviewers to collect information such as mind, sense and behavior related to health.Data analysis methodThe measurement of QOL adopt adjective five-point scale , each scale ranging from "without"((score 100) to "utmost"(score 0) , with higher scores indicating better health status. To each of the questions assess to health value , the respondents were asked to rate their attitudes on a five-point scale ranging from "strongly agree" (score 5) to "strongly disagree" (score 1). The scores were added (6-30), with higher scores indicating greater values placed on health. The score of knowledge about health from "5" to "0". We also tripartite the health value and knowledge of health, which represent the highest score group, middle and the lowest.The Epi-data software was used to manage the data. The statistical analysis was performed using SPSS software package (11.0 edition) and SAS software package(8.02 edition), which included frequency analysis, independent-samples Mann-Whitney Test and Kruskal-Wallis Test or one way analysis of variance to test gender differences, age, marital and educational differences of QOL and health values, and Chi-square test to test group differences of health related behaviors. Stepwise regression analysis method are used to test the quality of life and its influential factors. The internal consistency of the questionnaire was evaluated by Cronbach's alpha coefficient. Validity test including face validity, content validity and construct validity. Correlation and factor analysis were used to evaluate the construct validity. The Pearson correlation coefficients were calculated to examine the association among QOL, health values and health related behaviors. Path Analysis was performed using SAS8.02 software package.Results1. The economy of minority ethnic area was lag to equal Han area. Hygiene condition and sanitation were also poor. Comparing with the outcome of health services survey in 2000, the rate of adult knowing words was lower and two weeks prevalence and chronic disease prevalence of the subjects were higher .Migration of surplus labor force in rural lead to new threat to the health of remain elder, women and children.2. There were differences among the groups of quality of life . The quality of life of Minority was higher than Han's. QOL of all respondents were decreased along with the age and improved with educational levels. There were significant differences between the married and the widowers or divorced especially aged 65 or over subjects. The QOL of patients with chronic disease or with physician contact within two weeks were lower than that of non-patients.3. The main influential factors of QOL were chronic diseases prevalence, age , value on health , net-revenue of residents, and attach to cooperative medical service .There was litter difference between minority and Han counterpart in influential factors of QOL.4. There were significant differences among the groups of health value. The score of Miao, Buyi minority were the lowest. In general , health value were increased by educational levels. The five factors which affect health value were access to health information, nationality, inhabitation years ,age and number of generations lived together.5. The Han's score of knowledge-related to health was higher than that of Minority group's. There were significant differences between the two groups. All of the scores were improved along with eduacational levels. The score of the minority men was higher than that of the minority women.6. Health risk behaviors such as smoking , alcohol drinking and drinking un-boiled water were more prevalent in the minority than in the Han counterpart. The rate of health promote behaviors such as check blood pressure, ask for health-related information were less prevalent in the minority than in the Han counterpart .The minority men were more likely to have negative health-related behaviors compared to the minority women. The above mentioned health-related behaviors also changed with education levels. In general, the minority group suffered from more serious health risks than its Han counterpart. 7. Person's health value related to their information about health. The relationship between health value and QOL was explored in Han group. Those who valued health more tended to have less health risk behaviors. The study also showed that health value related to health-related behaviors. There have no enough evidence to prove the relation between QOL and health information.Conclusions1. The health status of minority ethnic group is not well-content .Many factors such as geographical location , economical and educational level and so on were influenced the improvement of health. We should do our best step by step to meet the health services need of vast people and to further protect and improve the health level of inhabitants .For example, take measures to provide safe drinking water and improve water closet.2. We should advanced the health view of bio-psycho-social medical model in minority remote areas owing to the minority ethnic group still think QOL or health is only means physical (body) health. We should adhere to the principle of measures to suit local conditions while we establish and implement public health police .3. We should bring health promotion into sustainable development scheme, put people's health as center and give priority to health in the sustainable development scheme. Promote the development of education in remote rural areas. Through health education, the people's knowledge of medicine and sanitation can be improved continually, which will beneficial to establish public's health faith and health consciousness.