Chapter e3: Exploring Cultural Diversity and Equity in Healthcare

KEY CONCEPTS

• Healthcare providers should strive toward cultural competency and equity in the context of social determinants of health and community history to improve care and access unique resources for patients and communities from diverse cultures and backgrounds.

• Changes in demographics in the United States, health disparities, patient safety, and healthcare workforce shortages are among the reasons for needing cultural and linguistic competency skills and for promoting diversity and equity in healthcare.

• A variety of models recognize cultural competency as a process, not an achievement.

• Legal and regulatory issues surrounding cultural competency include understanding and interpreting accreditation standards for healthcare organizations and Title VI of the Civil Rights Act.

• Patients may enter the healthcare setting with a different explanation of their illnesses than what is found in the Western biomedical model (WBM).

• Cultural values and beliefs influence decisions and attitudes about healthcare, including race, ethnicity, age, gender, sexual orientation, and religious beliefs.

• Developing communication skills to interact with diverse populations involves recognizing personal styles and cultural values of communication as well as barriers to patient understanding.

• Linguistic competency encompasses understanding the capacity of organizations and providers to communicate well with diverse populations such as patients with limited English proficiency (LEP), low literacy, or hearing impairments.

• Before practitioners can understand other cultures, they should strive to understand the personal and organizational values and beliefs.

• Skills for working with patients from diverse cultures include being able to listen to the patient’s perception of health, acknowledging differences, being respectful, and negotiating treatment options.

BEYOND THE BOOK

Select any one of the patients from diverse backgrounds from the cases introduced in the first section of this chapter. What are the factors that influence their health that are based on genetics? Individual and family choices? Community influences? Larger city and policy structures?

For more in-depth discussions, consider these activities and questions:

1. Use Healthy People 2030 (https://health.gov/healthypeople/objectives-and-data/browse-objectives) to identify Social Determinants of Health found in the cases.

2. Describe what you think would be the acculturation of each patient. What is the host culture? What is the home culture?

3. Explore values and beliefs found in resources provided in the chapter: Based on the information provided, what social identity and acculturation characteristics are involved? Look up information about healthcare beliefs and values based on how the patient self-identifies with religion and race or ethnicity.

4. Discuss what you would describe to be your own “cultural competency” to work with each of the patients. Which models do you prefer?

5. If approached by one of the patients, providers may argue that “we can’t solve everything in healthcare. I only have so much time during a visit.” How might you respond to those statements? What changes can be made at a provider level, clinic/hospital level, and at a larger system-wide level to improve care across cultures?