Chapter6Lecturenotes-Tagged.pdf

Chapter 6:Cultural Competency and the Need to Eliminate Health DisparitiesLearning Objectives

After reading this chapter you should be able to

• Define health disparities.

• Provide an historical overview of health disparities.

• Discuss the relationship between health disparities and minority groups.

• Discuss immigration and cultural competency.

• Explain cultural competency as a contributing factor toward resolving health disparities.

• Understand role of culturally competent health professionals in closing the gap.

Health Disparities

“health disparity” term used in the US vs. “health inequity” or “health inequality” used outside the US.

In the United States health disparities are well documented among minority groups, rural and urban communities, gender, and economic status who tend to have poorer health, higher mortality and morbidity rates, and less access to quality healthcare services.

Health disparities- difference in health status among the population.

Contributing factors to health disparities: Socioeconomic status (SES) insurance coverage poverty race ethnicity language barriers disability educational level gender

Disparities are generally held to be population differences in (1) environmental exposures; (2) healthcare access, utilization, or quality; (3) health status; or (4) health outcomes

AN HISTORICAL OVERVIEW OF HEALTH DISPARITIES

The United States has a long history of health disparities among and across racial and ethnic populations.

This history of unequal access, quality, care, and treatment created an environment of less-than-optimal morbidity and mortality among the various minority groups.

The result of the historical health disparities in the United States produced poorer health, less access, health inequality, and a widening health status gap between the minority and majority populations.

These trends have raised alarm about the impact of a skewed distribution of societal resources on social and physical well-being.

Public health officials have called attention to this problem and pledged to reduce it.

Research in health disparities is generally considered to proceed in three generations: (1) the descriptive research describing relevant disparities, (2) research that addresses the underlying causes of these disparities, and(3) investigations designed to address and resolve these disparities.

(See e-book for highlights, p.78)

HEALTH DISPARITIES AND MINORITY GROUPS

African Americans and Hispanics tend to receive a lower quality of health care across a range of disease areas (including cancer, cardiovascular disease, diabetes, mental health, and other chronic and infectious diseases) and clinical services.

African Americans are more likely than Whites to receive fewer desirable services, such as amputation of all or part of a limb.

Disparities are found even when clinical factors, such as stage of disease presentation, comorbidities, age, and severity of disease, are taken into account.

Disparities are found across a range of clinical settings, including public and private hospitals, teaching and nonteaching hospitals.

Our text refers to Healthy People 2010, please take a look at Healthy People 2030.

IMMIGRATION AND CULTURAL COMPETENCY

Language barriersOf course, this is no fault of the patients- so what can be done to bridge this gap?

CULTURAL COMPETENCY AS A CONTRIBUTING FACTOR TOWARD HEALTH DISPARITIESThe goal of cultural competence is to create a healthcare system and workforce capable of delivering the highest quality care to every patient regardless of race, ethnicity, culture, or language proficiency.

Cultural competence in health care entails understanding the importance of social and cultural influences on patients’ health beliefs and behaviors; considering how these factors interact at multiple levels of the healthcare delivery system (e.g., at the level of structural processes of care or clinical decision-making); and, devising interventions that take these issues into account to ensure quality healthcare delivery to diverse patient populations.

A “culturally competent” healthcare system has been defined as one that acknowledges and incorporates—at all levels—the importance of culture, assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, expansion of cultural knowledge, and adaptation of services to meet culturally unique needs.

A new frameworkA new framework for cultural competence would include organizational, structural, and clinical interventions:

• Organizational cultural competence interventions are efforts to ensure the leadership and workforce of a healthcare delivery system are diverse and representative of its patient population—e.g., leadership and workforce diversity initiatives.

• Structural cultural competence interventions are initiatives to ensure the structural processes of care within a healthcare delivery system guarantee full access to quality health care for all of its patients—e.g., interpreter services, culturally and linguistically appropriate health education materials.

• Clinical cultural competence interventions are efforts to enhance provider knowledge of the relationship between sociocultural factors and health beliefs and to equip providers with the tools and skills to manage these factors appropriately with quality healthcare delivery as the gold standard—e.g., cross-cultural training.

THE ROLE OF CULTURALLY COMPETENT HEALTH PROFESSIONALS IN CLOSING THE GAPRaise awareness of the healthcare gap among broad sectors, including healthcare providers, their patients, payers, health plan purchasers, and society at large.

Racial/ethnic diversity in the workforce creates more trust and compliance with patients who have diverse backgrounds.

Spanish speaking patients are more comfortable and satisfied with Spanish speaking health care professionals.

The Institute of Medicine (IOM) says that both patients and providers can benefit from education.Patients can benefit from culturally appropriate education programs to improve their knowledge of how to access care and their ability to participate in clinical decision-making.

Healthcare professionals need tools to understand and manage the cultural and linguistic diversity of patients seen in today’s health systems and avoid allowing unconscious biases and stereotypes to affect their interactions with patients.

Cross-cultural curricula should be integrated early into the training of future healthcare providers, and practical, case-based, rigorously evaluated training should persist through practitioner continuing education programs.

Betancourt, J.R., Green, A.R., Carrillo, J.E., & Ananeh-Firemong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293–302.

Betancourt, J.R., Green, A.R., Carrillo, J.E., & Park, E.R. (2005). Cultural competence and health care disparities: Key perspectives and trends. Health Affairs, 24(2), 499–505.