Healthcare Disparities: Culture

One factor lacking in healthcare today is culturally competent care. Culturally competent care can be described as healthcare that incorporates a patient’s culture to improve communication, behavior, and accountability. Several national standards for culturally and linguistically appropriate services (CLAS) have been developed by the Office of Minority Health, Department of Health and Human Services. These services cover standards such as language assistance, leadership, and workforce development. In general, cultural competence is used to refer to ethnic and racial minority populations. According to ncbi.nlm.nih.gov, there are three main populations experiencing health disparities: LGBT populations, disabled individuals, and racial and ethnic minorities. It was found that these populations have higher morbidity and mortality rates from chronic diseases. According to georgetown.edu, a higher population of African Americans and Latinos reported suffering from at least one of seven main chronic conditions: cancer, heart disease, high blood pressure, obesity, asthma, diabetes, or depression. These chronic conditions rank among the most costly medical conditions in the U.S., and many minorities do not have a regular doctor or health insurance to rely on.

Some examples of cultural competence are linguistic competence and cultural trauma. Linguistic competence is when an individual does not speak English as their first language and requires the use of an augmentative communication system. This also applies to a person who is gender nonconforming or transgender. In the United States, there are more than 37 million adults whose primary language is not English. Of those, 18 million are reported to speak English less than “very well.” Elderly residents have a lower level of literacy, and it is found that it is more common for someone in their age range to lack a formal education. According to the 1992 National Adult Literacy Survey, 40 to 44 million Americans claim to lack the necessary “literacy skills for daily functioning.” Implementing health literacy is crucial to providing appropriate care within healthcare communities, such as nursing schools. Health literacy can lessen language barriers and differing beliefs, which can thus decrease the limited access certain populations have to healthcare. Multiple factors can lead to limited health literacy. For example, socioeconomic factors such as fewer resources and lack of a proper education increase the risk of experiencing worse healthcare outcomes.

Cultural trauma is the outcome of an assault from a dominant group on an individual’s culture, which can occur through force, threats, or oppressive policies. This kind of trauma can leave a lasting impact on health disparities, as culturally motivated violence can generate “health disparities that impact future generations.” For example, cultural traumas took the form of discriminatory U.S. housing practices, which included mortgage discrimination and blockbusting. This served as a barrier for African American communities, where health disparities and economic deprivation were common.

References:

Butler M, McCreedy E, Schwer N, Burgess D, Call K, Przedworski J, et al. Introduction [Internet]. www.ncbi.nlm.nih.gov. Agency for Healthcare Research and Quality (US); 2016. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361130/#:~:text=Culturally%20competent%20care%20is%20seen 

Health Policy Institute. Cultural Competence in Health Care: Is it important for people with chronic conditions? [Internet]. Health Policy Institute. GeorgeTown University; 2018. Available from: https://hpi.georgetown.edu/cultural/ 

Subica AM, Link BG. Cultural trauma as a fundamental cause of health disparities. Social Science & Medicine. 2022 Jan;292(114574):114574. 

mariecarrier. How Culture Impacts Care: What Nurses Need to Know [Internet]. tamiu. 2023. Available from: https://online.tamiu.edu/programs/nursing/rn-to-bsn/culture-impacts-care-nurses/ 

Agency for Healthcare Research and Quality. Improving Cultural Competence to Reduce Health Disparities for Priority Populations | Effective Health Care Program [Internet]. Ahrq.gov. 2014. Available from: https://effectivehealthcare.ahrq.gov/products/cultural-competence/research-protocol 

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