hce_nchu
112年
英文
第 25 題
📖 題組：
Questions 21-25 refer to the following passage. PASSAGE 1 Indigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. Globally, type 2 diabetes disproportionately affects Indigenous populations, with documented rates in Canada 3–5 times higher in Indigenous compared with non-Indigenous populations. Indigenous people tend to acquire diabetes at younger ages, have complications sooner, and have poorer treatment outcomes. In Canada and other countries that share a colonial history, health inequities arising from the effects of colonization include deeply rooted disparities in the social determinants of health, social exclusion, political marginalization, and historical trauma. Researchers undertook a qualitative examination of Indigenous patients’ stories emanating from a sequential focus group method that concerned diabetes care experiences. They found that interactions and engagement with health services were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. Indigenous patients related such experiences to specific health policies and systemic discrimination in health care systems. Specifically, Indigenous patients reported that rushed appointments, writing prescriptions or medicating complaints, not listening, and negative judgments regarding Indigenous customs and communities created a lack of confidence in the health system and provider. These experiences led to Indigenous patients not disclosing all of their symptoms or health behaviors. Mistrust emerged as a substantial subtheme that stemmed from historical experiences. Some Indigenous patients suspected that during the mid-20th century, Indigenous patients with tuberculosis “were used as guinea pigs”, presumably observed or tested upon without access to the same interventions provided to non-Indigenous patients. On the other hand, other Indigenous patients acknowledged that, increasingly, hospitals set aside spaces for the Indigenous ceremony but noted that access to these is not always possible for patients confined to a bed. Likewise, it is not uncommon for Indigenous extended families to come to hospitals in support of a patient. A considerable challenge identified by Indigenous patients was that each visit to a clinic off-reserve could lead to interacting with a new provider, retelling one’s history, and leaving with yet another care plan. A shortage of on-reserve physicians threatened the continuity of care. Consequently, some Indigenous patients questioned doctor–patient ratios for Indigenous people across Canada, arguing that concern over doctor shortages should be amplified for populations with disproportionate rates of diabetes. In addition, the physical space in which clinical interactions took place was important. Indigenous patients often wanted services provided in their communities or in Indigenous health centers. Examination rooms could stir mistrust before a clinical interaction even began. Health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and play a role in mitigating past harms. The positive therapeutic relationships described by Indigenous patients involved physicians who showed empathy and patience, and who took a genuine interest in the patient. Attention to antiracism education, structural competency and advocacy for working with Indigenous populations holds great potential to address issues identified, as physicians are also health advocates and should promote health equity.
Questions 21-25 refer to the following passage. PASSAGE 1 Indigenous social determinants of health, including the ongoing impacts of colonization, contribute to increased rates of chronic disease and a health equity gap for Indigenous people. Globally, type 2 diabetes disproportionately affects Indigenous populations, with documented rates in Canada 3–5 times higher in Indigenous compared with non-Indigenous populations. Indigenous people tend to acquire diabetes at younger ages, have complications sooner, and have poorer treatment outcomes. In Canada and other countries that share a colonial history, health inequities arising from the effects of colonization include deeply rooted disparities in the social determinants of health, social exclusion, political marginalization, and historical trauma. Researchers undertook a qualitative examination of Indigenous patients’ stories emanating from a sequential focus group method that concerned diabetes care experiences. They found that interactions and engagement with health services were influenced by personal and collective historical experiences with health care providers and contemporary exposures to culturally unsafe health care. Indigenous patients related such experiences to specific health policies and systemic discrimination in health care systems. Specifically, Indigenous patients reported that rushed appointments, writing prescriptions or medicating complaints, not listening, and negative judgments regarding Indigenous customs and communities created a lack of confidence in the health system and provider. These experiences led to Indigenous patients not disclosing all of their symptoms or health behaviors. Mistrust emerged as a substantial subtheme that stemmed from historical experiences. Some Indigenous patients suspected that during the mid-20th century, Indigenous patients with tuberculosis “were used as guinea pigs”, presumably observed or tested upon without access to the same interventions provided to non-Indigenous patients. On the other hand, other Indigenous patients acknowledged that, increasingly, hospitals set aside spaces for the Indigenous ceremony but noted that access to these is not always possible for patients confined to a bed. Likewise, it is not uncommon for Indigenous extended families to come to hospitals in support of a patient. A considerable challenge identified by Indigenous patients was that each visit to a clinic off-reserve could lead to interacting with a new provider, retelling one’s history, and leaving with yet another care plan. A shortage of on-reserve physicians threatened the continuity of care. Consequently, some Indigenous patients questioned doctor–patient ratios for Indigenous people across Canada, arguing that concern over doctor shortages should be amplified for populations with disproportionate rates of diabetes. In addition, the physical space in which clinical interactions took place was important. Indigenous patients often wanted services provided in their communities or in Indigenous health centers. Examination rooms could stir mistrust before a clinical interaction even began. Health care relationships are central to addressing the ongoing colonial dynamics in Indigenous health care and play a role in mitigating past harms. The positive therapeutic relationships described by Indigenous patients involved physicians who showed empathy and patience, and who took a genuine interest in the patient. Attention to antiracism education, structural competency and advocacy for working with Indigenous populations holds great potential to address issues identified, as physicians are also health advocates and should promote health equity.
What is the most likely reason that in the final paragraph the “ongoing colonial dynamics” is mentioned?
- A to show through a metaphor that reality is, in the findings, such as a senior hospital administrator did not run a lodging service for Indigenous patients
- B to remind us that Indigenous people tend to acquire diabetes at younger ages and have poorer treatment outcomes in Canada
- C to reinforce the point that Indigenous patients with tuberculosis were used as guinea pigs during the mid-20th century in Canada
- D to reinforce the point that the interactions with health services were influenced by personal and collective historical experiences with health care providers
- E to illustrate the point that new physicians came to Indigenous communities to gain experience with complex and diverse diseases before moving on to better places
思路引導 VIP
請思考一下：當作者在文章最後一段談到需要透過「醫療關係」來解決「殖民問題」時，這個「殖民問題」在文章前面的段落中，具體體現在患者對醫師的哪些感受或行為上？這些感受又是從何而來的呢？
🤖
AI 詳解
AI 專屬家教
恭喜你準確掌握了文章的核心論述！這題你能答對，代表你不僅讀懂了表層的文字，還能洞悉作者如何透過總結性的詞彙，將前文提到的零散現象串聯起來。這正是高階閱讀理解中非常重要的「整合資訊」能力。
歷史脈絡與現代醫療的連結
在文章末段提到的 「持續性的殖民動態」（ongoing colonial dynamics），實際上是一個總括性的術語。它用來呼應文中第二段與第三段所描述的現象：原住民患者之所以對醫療系統產生不信任、甚至不願透露症狀，並非無中生有，而是源自於文中強調的個人與集體歷史經驗。選項 (D) 正確地指出了這個連結，說明醫療互動深受過去與醫療提供者相處經驗的影響，這正是作者在結論中強調必須透過「醫療關係」來修補過去傷害的原因。
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