Problematizing "Planning Ahead": A Cross-Cultural Analysis of Vietnamese Health and Community Workers' Perspectives on Advance Care Directives

Informed by values of autonomy and self-determination, advance care planning assumes that individuals should independently take control of their future health. In this article, we draw on research conducted with Vietnamese health and community workers to problematize individualized approaches to planning ahead, reframe notions of "cultural and linguistic barriers," and expose how homogeneous messages about care at the end of life are not readily translatable within and across diverse groups. Anthropological and feminist critiques of inclusion and exclusion are used to reorientate Anglophone framings of the individual and of cultural and linguistic differences. In this article, we suggest that it is the narrow singularity of care for the self-rather than diverse relationalities of care-that should be overcome if aging and end-of-life care policy and practice is to be broadened and made relevant to migrant and non-English-speaking groups.

Health/Service Providers' Perspectives on Barriers to Healthy Weight Gain and Physical Activity in Pregnant, Urban First Nations Women

The purpose of this article is to examine health/service providers' perspectives of barriers to healthy weight gain and physical activity for urban, pregnant First Nations women in Ottawa, Canada. Through the use of semi-structured interviews, we explored 15 health/service providers' perspectives on the complex barriers their clients face. By using a postcolonial feminist lens and a social determinants of health framework, we identified three social determinants of health that the health/service providers believed to have the greatest influence on their clients' weight gain and physical activity during pregnancy: poverty, education, and colonialism. Our findings are then contextualized within existing Statistics Canada and the Ottawa Neighbourhood Study data. We found that health/service providers are in a position to challenge colonial relations of power. We conclude by urging health/service providers, researchers, and policymakers alike to take into consideration the ways in which these social determinants of health and their often synergistic effects affect urban First Nations women during pregnancy.