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To Achieve Health Equity, We Must Make Culturally Relevant Care The Standard Of Care

Discussion in 'General Discussion' started by The Good Doctor, Apr 6, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    As a physician and businessperson who has dedicated his career to improving health equity, I consider news about vaccines going into arms bittersweet. An uncomfortable question remains: Whose arms are they going into?

    Data from the U.S. Department of Health and Human Services points to an inequitable rollout. White, non-Hispanic Americans are receiving more than their equitable portion of vaccines, while Black and Hispanic/Latinx Americans are receiving fewer shots compared with their share of the U.S. population.

    Why is this happening? Because the American health care system meets its diverse multicultural population with one-size-fits-all care. In other words, the standard of care, which leaves millions of Americans behind, is not culturally relevant care.

    As my colleague Abner Mason points out, “What this approach says to people is: ‘We don’t care what your journey is, how you got here, or what you think about health care. None of that matters. You’re all going to be treated the same.’”

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    When we treat people like this (and also make it difficult to access care in the first place), it’s not surprising that they don’t trust or engage with the system. It’s not surprising that despite millions of shots going into arms every day, vaccine hesitancy remains high in many communities, access remains low, and the pandemic is poised for another resurgence.

    If physicians and other clinicians want to improve health equity during the pandemic and beyond, we must work to ensure that culturally relevant care becomes the new standard of care. But how can we do this?

    Systemically, we face an uphill battle. The Biden administration has committed to improving health disparities as part of its COVID-19 response strategy, which aims to “protect those most at risk and advance equity.” But there’s a long way to go. Federal support matters—organizations like federally qualified health centers do a fantastic job of meeting patients’ culturally sensitive needs—but scaled local delivery is what moves the health equity needle.

    For now, much of the responsibility to build connections with underserved, diverse, and vaccine-hesitant populations falls on us, America’s clinicians. And culturally relevant care is one of the most effective tools to help us unite with patients and improve each other’s well-being.

    Culturally relevant care informs best practices for a patient visit. It dictates whether you stand or sit, what you say and how you say it, the breadth of knowledge you bring to the conversation, and more. Its success can be measured by whether you achieved a desired outcome, such as informed consent for a procedure or the administration of a vaccine. But whether the patient felt welcome, safe, understood, and comfortable putting their trust in you are less-discussed benchmarks.

    Here’s an example: In primary care settings, physicians often emphasize the importance of cervical cancer screening for female patients. For most women, this is a simple subject to discuss. But for trans men, such conversations require a high degree of cultural sensitivity and mutual understanding. Get it right, and you can build trust with a diverse American that ripples out into the local community. Neglect cultural sensitivity, and the opposite effect occurs.

    Here’s another example: In late April, a Muslim patient whose chart shows a long history of healthy blood pressure presents with hypertension. Cultural sensitivity in this scenario requires an awareness that Ramadan occurs in the spring, meaning your patient’s vitals may be affected by their religious observation of that holiday, which can include fasting. It’s important to acknowledge that a patient may have short-term elevated blood pressure before pursuing therapeutic strategies for a reading that amounts to a brief anomaly in their chart.

    This communicates something powerful to the patient: My clinician understands me. They respect my choices. They acknowledge what makes me who I am.

    Practicing culturally relevant care means we can account for the social determinants of health, barriers to access, and the emotional disconnect that results from the status quo, one-size-fits-all approach many patients have come to expect. It helps us reach into underserved communities and lift them up, which is essential during a pandemic that disproportionately affects low-income and diverse Americans.

    If we, as clinicians, can align around the fact that we exist to serve all patients, we must realize that culturally relevant care is more than a situational deviation from the norm. Rather, it must represent the new normal—the new standard of care.

    Vik Bakhru is a surgeon and health care executive.

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