HPH2013 - 21st HPH Conference Gothenburg 2013 - Welcome to HPH 2013

Plenary 2

Thursday, May 23, 2013 09:00-10:30

Psychoneuroimmunology And Empowerment
For The Coproduction Of Health

Health-Oriented Health System In Sweden


Minister for Health and Social Affairs, Stockholm (SWE)

Party: Christian Democrate Party



  • Born in 1959. Married with two children.


  • In-service training in the finance sector
  • Branch training organised by the insurance sector
  • Upper secondary education, Social Studies Programme

Positions and assignments

  • 2010-
    Minister for Health and Social Affairs
  • 2004-
    Chair of the Swedish Christian Democrats
  • 2006-2010
    Minister for Health and Social Affairs
  • 1991-2006
    Member of the Riksdag, the Swedish Christian Democrats
  • 1991-2006
    Member of the Executive Committee of the Swedish Christian Democrat Group in the Riksdag
  • 2002-2004
    Chair of the Riksdag Committee on Housing
  • 2002-2004
    Chair of the Board of Jönköping County Police Authority
  • 1998-2004
    Alternate Member of the Riksbank Executive Board
  • 1994-2004
    Member of the National Board of the Swedish Christian Democrats
  • 1998-2002
    Alternate Member of the Riksdag Committee on Finance
  • 1998-2002
    Alternate Member of the Riksbank Executive Board
  • 1991-2002
    Member of the Riksdag Committee on Industry and Trade
  • 1991-2002
    Leader of the Swedish Christian Democrat Riksdag Group
  • 1991-2002
    Member of the Speaker's Conference/Riksdag Board
  • 1993-1999
    Member of the Board of ASSI-Domän Insurance AB
  • 1994-1995
    Member of the Board of ASSI-Domän Packaging AB
  • 1992-1994
    Member of the Board of ASSI AB
  • 1989-1991
    Adviser at Alfred Berg Investment Bankers
  • 1988-1989
    Insurance consultant for WASA
  • 1985-1988
    Administrative Director, Swedish Christian Democrat Party Secretariat of the Riksdag
  • 1982-1986
    Member of Jönköping Municipal Council
  • 1981-1985
    Ombudsman for the Swedish Christian Democrats in the district of Jönköping
  • 1979-1981
    Secretary-General of Christian Democratic Youth in the Nordic countries (KDUN).
  • 1978-1980
    Ombudsman for the Christian Democratic Youth Association in the district of Jönköping

The Promise Of Psychoneuroimmunology For Health-Promoting Patient Interactions


DSN, RN, FAAN, Virginia Commonwealth University, Richmond (USA)




  • 1992-1995 - NRSA - Rush University, Postdoctoral Fellowship in Psychoneuroimmunology in HIV Disease (T32, J. Zeller)
  • 1993 - Graduate Certificate in Stress Management, Roosevelt University
  • 1983 - DSN - University of Alabama in Birmingham School of Nursing
  • 1976 - MN - University of Mississippi
  • 1973 - BSN - University of Mississippi

Awards, Fellowships & Honors

  • Visionary Leader, University of Alabama in Birmingham School of Nursing, 2010
  • Alumna of the Decade, University of Mississippi School of Nursing, 2008
  • Distinguished Researcher, Southern Nursing Research Society, 2008
  • Distinguished Alumna, University of Alabama in Birmingham School of Nursing, 2004
  • VCU School of Nursing Senior Research Award, 2002
  • VCU School of Nursing Outstanding Faculty Award, 2002
  • Fellow of the American Academy of Nursing, 2001
  • Medical College of Georgia Outstanding Faculty Award for the School of Nursing, 1988-1989
  • Sigma Xi, 1989
  • Sigma Theta Tau International Honor Society, 1983
  • Phi Kappa Phi National Honor Society, 1972

Selected Publications

  • McNallen, A.T., McCain , N.L., Elswick, R.K., Jr. , Menzies, V., & Leszczyszyn, D.J. (2013). Fatigue, sleep, and stress: Dynamic relationships in fibromyalgia. Fatigue: Biomedicine, Health & Behavior, 1, 64-80.
  • Menzies, V.M., Lyon, D.E., Elswick, R.K., Jr., Montpetit, A.J., McCain, N.L., & Gray, D.P. (2012). Effects of guided imagery on biobehavioral factors in women with fibromyalgia. Journal of Behavioral Medicine. Epub ahead of print. PMID:23124538
  • Lyon, D.E., McCain, N.L., Pickler, R.H., Munro, C., & Elswick, R.K., Jr. (2011). Advancing the biobehavioral research of fatigue with genetics and genomics. Journal of Nursing Scholarship, 43, 274-281.
  • Lyon, D.E., Walter, J.M., Starkweather, A.R., Schubert, C.M., & McCain, N.L. (2011). Tryptophan degradation in women with breast cancer: A pilot study. BMC Research Notes, 4: 156, doi:10.1186/1756-0500-4-156.
  • Robins, J., McCain, N., Elswick, R.K., Jr. (2011). Cardiometabolic risk in women. Biological Research in Nursing. [Epub ahead of print] PMID: 21406504
  • Starkweather, A.R, Sherwood, P., Lyon, D.E., McCain, N.L., Bovbjerg, D.H., & Broaddus, W.E. (2011). A biobehavioral perspective on depressive symptoms in patients with cerebral astrocytoma. Journal of Neuroscience Nursing, 43, 17-28.
  • Lyon, D., Walter, J., Munro, C.L., Schubert, C.M., & McCain, N.L. (2011). Challenges in interpreting cytokine biomarkers in biobehavioral research: A breast cancer exemplar. Biological Research in Nursing, 13, 25-31.
  • Driscoll, C.J., Lyon, D., & McCain, N.L. (2010). Integrating genomics into biobehavioral research: A transplantation exemplar. Biological Research in Nursing. [Epub ahead of print] PMID: 21196421
  • McCain, N.L., Gray, D.P., Elswick, R.K., Robins, J.W., Tuck, I., Walter, J.M., Rausch, S.M., & Ketchum, J.M.  (2008). A randomized clinical trial of alternative stress management interventions in persons with HIV infection. Journal of Consulting and Clinical Psychology, 26, 431-441.
  • Lyon, D.E., McCain, N.L., Walter, J., & Schubert, C. (2008). Cytokine comparisons between women with breast cancer and women with a negative breast biopsy. Nursing Research, 57, 51-58.
  • McCain, N.L., Gray, D.P., Walter, J.M., & Robins, J. (2005). Implementing a comprehensive approach to the study of health dynamics using the psychoneuroimmunology paradigm. Advances in Nursing Science, 28(4), 320-332.
  • McCain, N.L., Munjas, B.A., Munro, C.L., Elswick, R.K., Robins, J.W., Ferreira-Gonzales, A., Baliko, B., Kaplowitz, L.G., Fisher, E.J., Garrett, C.T., Brigle, K.E., Kendall, L.C., Lucas, V., & Cochran, K.L. (2003). Effects of stress management on PNI-based outcomes in persons with HIV disease. Research in Nursing & Health, 26, 102-117.
  • McCain, N.L., Lyon, D.E., Higginson, R., Settle, J., Wheeler Robins, J.L., & Fisher, E.J.  (1998). Revision of the HIV Center Medical Staging Scale. Journal of the Association of Nurses in AIDS Care, 9(5), 19-23.
  • Cella, D.F., McCain, N.L., Peterman, A., Mo, F., & Wolen, D. (1996). Development and validation of the Functional Assessment of HIV Infection quality of life instrument. Quality of Life Research, 5, 450-463.
  • McCain, N.L., & Zeller, J.M. (1996). Psychoneuroimmunological studies in HIV disease. Annual Review of Nursing Research, 14, 23-55.

Contact address

Nancy L. McCain, DSN, RN, FAAN
Nursing Alumni Distinguished Professor
P.O. Box 980567
Richmond, VA 23298-0567
Phone: (804) 828-3444
E-mail: nlmccain(at)vcu(punkt)edu

View full CV at: http://www.nursing.vcu.edu/people/ahns/NancyLMcCain.htm

Abstract summary:

Psychoneuroimmunology (PNI) provides an inherently holistic approach for integrating the person-environment transactions of the stress process with the psychosocial, spiritual, biobehavioral, and pathophysiological processes involved in numerous stress-disease relationships (McCain et al., 2005). Given compelling research supporting multidimensional interactions between psychological and physiological dimensions of health, PNI provides a promising foundation for enhancing health-promoting patient interactions. This plenary session will focus on the foundational knowledge of PNI and its implications for health-promoting patient interactions, building on a schema for promoting altruism ⇒ promoting happiness ⇒ promoting health.

Psychoneuroimmunology: An integrating paradigm

  • "PNI is concerned with the mechanisms of multidimensional neuroendocrine-immune system interactions, including the influence of psychosocial factors on immunological function and thus health status" (McCain et al., 2005, p. 320). PNI mechanisms may induce immunosuppressive effects and negative health consequences.

Promoting altruism ⇒ Promoting happiness

  • "Promoting mind-body health should be the responsibility for all health care providers….Not only are the effects beneficial for those being provided care, but studies have shown that people experience greater job satisfaction and happiness when they are altruistic or give to others" (Love & Femia, 2011, p. 454).
  • There appear to be psychological benefits to helping others. "Well-being" is characterized by feeling hopeful, happy, and good about oneself, as well as energetic and connected to others (Post, 2005).

Promoting happiness ⇒ Promoting health: The PNI connection

  • "A holistic approach to care is often described as one addressing physical, psychological, spiritual and social needs….Evidence to support this approach can be found in the field of psychoneuroimmunology" (Buckley, 2002, p. 505).
  • A number of PNI-based strategies for stress management (including relaxation, imagery, biofeedback, meditation, tai chi, and yoga) have generally been associated with positive immunological function and health status.  
  • Approaches for health-promoting patient interactions clearly are indicated, including empowerment strategies, supporting engagement and meaning, and creating holistic care environments.

Buckley, J. (2002). International Journal of Palliative Nursing, 8, 505-508.
Love, K., & Femia, E. (2011). Geriatric Nursing, 32, 453-454.
McCain, N.L., Gray, D.P., Walter, J.M., & Robins, J. (2005). Advances in Nursing Science, 28, 320-332.
Post, S.G. (2005). EXPLORE, 1, 360-364.

Reducing Stress Through Cultural Competent Health Services


AUSL Reggio Emilia (ITA)


Date/Place of birth: 08/02/1954, Reggio Emilia, Italy
Nationality: Italian
Marital status: married

University degree in Political Science, University of Bologna, Italy
PhD in Sociology, University of Leicester, UK
Doctoral thesis: “Professions, Legitimacy and Change”
Master in Promotion and governance of Health Research, University of Modena and Reggio Emilia

Following his research Doctorate in Sociology, Antonio Chiarenza’s research interests have focused on health promotion, migrant health and community health since he joined the Local Health Authority of Reggio Emilia in Italy, where he is responsible for research and innovation. He leads the international WHO-HPH Task Force on Migrant-Friendly and Culturally Competent Healthcare and the Coordinating Centre of the Regional HPH Network of Emilia-Romagna.


  • 2002–2005: Coordinator for Italy of the EU project "Migrant-Friendly Hospitals": DG-Sanco
  • 2002-ongoing: Responsible for the coordinating centre of the regional Health Promoting Hospitals  network of Emilia- Romagna
  • 2005-ongoing: Leader of the Task Force on Migrant-friendly & Culturally Competent Health Care of the international network WHO-Health Promoting Hospitals
  • 2007-2011: Coordinator of the Working Group "Health care for migrants and ways of improving it" within the COST project HOME "Health and Social Care for Migrants and Ethnic Minorities in Europe"
  • 2008-2011. Coordinator for Italy of the EU project "NowHereland - Health Care in NowHereland - Improving Services for Undocumented Migrants in the EU"
  • 2012-ongoing: Coordinator of working group "Health system’s issues" within the COST action ADAPT “Adapting European Health Systems to Diversity”


  1. Chiarenza A. & Simonelli F. (2003). “Alleanze per la salute: il contributo della Rete HPH alle politiche sanitarie nelle regioni Emilia-Romagna e Toscana”. In T. Saccheri (a cura di) Prima che … promozione della salute e responsabilità istituzionali, Società e salute, anno II, n. 3,  Milano: F. Angeli, pp. 65-78
  2. Chiarenza, A. (2005). “Il progetto Migrant-friendly Hospital. Un’iniziativa di promozione della salute degli immigrati e delle minoranze etniche” in “Manuale di sociologia della salute: spendibilità” Vol. 3, F. Angeli, Milano, pp. 214-230
  3. Chiarenza A., (2005).Improving interpreting in clinical communication in Primary Health Care for all – A synthesis of emerging themes – Orangeville: Ontario, pp. 18-21
  4. Chiarenza A. (2006). Servizi sanitari culturalmente competenti” in Janus, N° 21, Roma: Zadig, pp.: 63-70
  5. Chiarenza A., (2007). Il ruolo dei servizi sanitari nello sviluppo della Health Literacy in M. Ingrosso (a cura di) Fra reti e relazioni: percorsi nella comunicazione della salute, Società e Salute, Anno VI – n. 1, Milano: F. Angeli, pp. 205-209
  6. Chiarenza A., (2007). Servizi sanitari Migrant-friendly ed aperti alle diverse culture: l’esperienza dell’azienda USL di Reggio Emilia.  Lavoro e Salute. n 1. pp. 3-7
  7. Chiarenza, A. (2007). Strategie per lo sviluppo di servizi sanitari “migrant-friendly” e culturalmente competenti in Mara Tognetti Bordogna (a cura di) Arrivare non basta: complessità e fatica della migrazione, Milano: F. Angeli, pp. 306-317
  8. Chiarenza, A. (2008). "Towards the development of health systems sensitive to social and cultural diversity" in Health and Migration in the EU: conference proceedings, Ministry of Health, Portugal - pp.167-176
  9. Chiarenza, A. (2008) “Una Task Force a livello europeo” in Salute e Territorio, N. 169, pp. 237-43
  10. Bischoff A., Chiarenza, A. & Loutan, L. (2009). Migrant-friendly hospitals: a European initiative in an age of increasing mobility. World Hospitals and Health services, Vol. 45 No. 3, pp.10-12
  11. Chiarenza, A. (2012). Developments in the concept of cultural competence. In: Ingleby, D., Chiarenza, A., Devillé, W. and Kotsioni, I. (eds.), Inequalities in health care for migrants and ethnic minorities. Antwerp: Garant.. pp. 66-81

Since 2002, Antonio Chiarenza has presented papers on the issues of health promotion and access to health care for migrants at national and international conferences

He is member of the scientific committee of the international HPH conference
He is a reviewer of the scientific journal “Health Policy”

Dr. Antonio Chiarenza
Via Fornaciari, 5
42100 Reggio Emilia, Italy
Tel.: +390522434177
Mobile: +39 3283607272
e-mail : antonio.chiarenza(at)ausl.re(punkt)it

Abstract summary:

One of out of every 33 persons in the world today is a migrant, however the percentage of migrants varies greatly from country to country. In the WHO European region the total number of migrants is estimated to be 75 million, 8,4% of the population. Despite the fact that most migrants are healthy when they first arrive in their host country, they risk suffering from poorer health compared to that of the average population. These migrant groups are more vulnerable, due to their lower socio-economic status, social exclusion, discrimination and poor living conditions; in general all these factors impact on the health and mental health of migrants. This vulnerability can only be further exacerbated by a lack of access to health services and to quality of care. Examples of this include not only language and cultural barriers in patient-doctor communication but also lower levels of health literacy among migrants, especially where the appropriate use of health care systems is concerned. Specific challenges for migrants include understanding explanations of treatments and ensuring fully informed consent, taking an active role in the care process, and accessing health education, health promotion and disease prevention programmes.

In order to ensure interactions are effective with diverse patients, health providers and services need to learn about their patients’ ideas and experiences, socio-cultural characteristics, living conditions, health literacy and language proficiency, and recognise the interrelationship between these factors in the context of health care.  People are so diverse that developing competence for health care professions based solely on cultural knowledge, or simplified ideas about the health-related beliefs of specific ethnic groups, does not allow for understanding individual diversity. It is important to look beyond culture to examine its intersections with gender, class, race, ethnicity, age and other social distinctions. As shown in the Migrant-friendly Hospital approach, integrating interpreting services, patient information and education strategies and staff intercultural competence in the policy and management system is a key to successful responsiveness to migrant needs. This approach has been taken over and further developed by the HPH Task Force on Migrant-Friendly and Culturally Competent Health Care.

This presentation looks at the work undertaken to date by the Task Force MFCCH to develop effective strategies and tools for reducing inequity in healthcare for migrants and other vulnerable groups. It proposes a new approach at both individual and organisational levels, based on the idea of encouraging staff to focus on the uniqueness of the individual, recognising and valuing all differences and ensuring equity of treatment for all as the major strategy to reduce disparity in health care.