Cities large and small have become home to the great growth in cultural diversity of the United States. According to US Census Bureau projections, by 2050, only 50% of the US population will self-identify as "white."
With this growth has come greater attention and concern about the health and health care of an increasingly racially and ethnically diverse society where language, literacy and culture may affect health care access, quality and outcomes. Hospitals, community health centers, clinics and health plans have realized the importance of addressing disparities. Research has begun to offer promise in redressing these inequities through new programs that work with patients, communities, and providers in identifying and applying promising models of care. In particular, over the past several years, innovations in health care provider training for patients of diverse heritage, recognizing the role of interpreters in the health care encounter, understanding the influence of an individual’s community and perceptions of the health care system and many other factors have taken on increasing relevance and importance. Accompanying this heightened attention has been a substantial growth in research, papers, conferences, centers, task forces, and other venues to present information related to cultural competence and disparity reduction.
Drexel University’s Center for Health Equality (CHE) was established to serve as major resource for addressing inequities in health and health care. By developing new information and strategies, and creating constructive partnerships with communities, government, health care providers and other academic centers, CHE will work to improve the health and well-being of the city, the state, and the nation. Its related activities will focus on three major areas: health disparities, cultural competence and health literacy.
What is Health Disparity? | What is Cultural Competence? | What is Health Literacy?
What is Health Disparity?
The National Institutes of Health (NIH) defines health disparities as “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.” Examples of health disparities include: differences in access to care, health outcomes, health care services delivery and disease patterns in relation to race, ethnicity, gender, social class, geography or sexual orientation.
Of particular concern, as noted on a United States Dept. of Health and Human Services (USDHHS) Fact Sheet, “There are continuing disparities in the burden of illness and death experienced by African Americans, Hispanic Americans, Asian Americans/Pacific Islanders, and American Indians/Alaska Natives, as compared to the U.S. population as a whole. Statistical reviews of the disproportionate toll of certain diseases on racial and ethnic populations highlight the need for prevention, treatment and resources toward reducing the loss of life.” (HHS Fact Sheet, “Minority Health Disparities at a Glance”) Government initiatives, such as Healthy People 2010, seek to eliminate racial and ethnic health disparities in such areas as cancer, cardiovascular disease, HIV/AIDS and diabetes.
What is Cultural Competence?
“Cultural competence is a set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations. It reflects the ability to acquire and use knowledge of the health-related beliefs, attitudes, practices, and communication patterns of clients and their families to improve services, strengthen programs, increase community participation, and close the gaps in health status among diverse population groups.
"Cultural competence also focuses its attention on population-specific issues including:
• health-related beliefs and cultural values(the socioeconomic perspective)
• disease prevalence (the epidemiological perspective)
• and treatment efficacy (the outcome perspective).”
(Cross et al., 1989 and Lavizzo-Mourey and Mackenzie, 1996, as cited in Cultural Competence: A Journey, Bureau of Primary Health Care. Health Resources and Services Administration, US Department of Health and Human Services, n.d.)
Recommendations related to the development of standards for culturally and linguistically appropriate services (CLAS) promulgated by the U.S. Department of Health and Human Services Office of Minority Health have helped guide efforts in this area. The March 2001 final report, National Standards for Culturally and Linguistically Appropriate Services in Health Care, identifies a set of priority actions aimed at improving access and quality of health care for racially and ethnically diverse populations. As they pertain to cultural competence activities, they include:
• Tracking CLAS standards implementation and adoption
• Creating an Internet-based clearinghouse of CLAS implementation to facilitate the ability of health care organizations to learn from and build on the experiences of other organizations and to assist researchers and policymakers
• Supporting the development and dissemination of resources and technical assistance through conferences and training
• Guiding providers as they work to implement cultural competence in their settings by providing information resources and identifying potential sources of funding for these efforts
• Linking cultural competence to patient satisfaction and outcomes
What is Health Literacy?
“Health literacy is defined as the ability to read, understand, and act on health information. People of any age, income, race, or background can find it challenging to understand health information.” (Pfizer Clear Health Communication)
Many patients face great difficulty in understanding health information and navigating the health care system. These difficulties, as identified by a growing number of reports, including the 2004 publication by the Institute of Medicine, Health Literacy: A Prescription to End Confusion, have focused increasing attention on the importance of addressing health literacy. Practitioners and their health care settings have recently begun to recognize its importance and its implications for patient safety, medical error and overall quality of care. Health care organizations have also started to recognize their multiple responsibilities for addressing language, literacy and culture, including providing training, encouraging the use of multidisciplinary staff, integrating health literacy into quality of care measures and objectives, conducting outreach into the community, and posting appropriate signage. Recommendations for improving health literacy generally and for racially/ethnically diverse populations, including those with limited English Proficiency, have highlighted the need for greater research on innovations in patient-provider interactions and their health care settings.