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Cultural Competence in Health Care and its Contribution to Eliminating Racial/Ethnic Health Disparities How far have we come and where do we need to go ?. Dennis P. Andrulis, Ph.D., MPH Senior Research Scientist, Texas Health Institute, Austin TX
Cultural Competence in Health Care and its Contribution to Eliminating Racial/Ethnic Health DisparitiesHow far have we come and where do we need to go?
Dennis P. Andrulis, Ph.D., MPH
Senior Research Scientist, Texas Health Institute, Austin TX
Associate Professor, Health Management and Policy &
Center for Emergency Preparedness
University of Texas School of Public Health
NIMHD/NIH Seminar Series ● Bethesda, MD ● August 25, 2011
“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.”
–Cross et al., 1989.
Source: M, Beach. Patient-centeredness and cultural competence: their relationship and role in reducing health disparities. Commonwealth Fund 2006
Source: Goode T. et al. The Evidence Base for Cultural and Linguistic Competency in Health Care, 2006.
Dark Blue : legislation requiring (WA, CA, NJ, NM, CT) or strongly recommending (MD) cultural competence training, which was signed into law.
Purple : legislation which has been referred to committee and is currently under consideration.
Royal Blue : legislation which died in committee or was vetoed.Cultural Competence:State Level Legislation2000-2011
Source: Think Cultural Health, 2011
Provide the framework for all health organizations to best serve the nation’s diverse communities
Set of mandates, guidelines and recommendations intended to inform practices related to cultural and linguistic competency in health care for patient care, language services and organizationsHHS Office of Minority HealthProgress in Promoting National Guidance and Standards – cont’d.
Over three dozen provisions in ACA on
race, ethnicity, cultural competence,
language assistance and diversity.
Over three dozen general provisions with
potentially major implications for
racially/ethnically diverse populations
Expansion of Medicaid eligibility to 133% FPL
Small business (<25 employees) tax credits
State-based health insurance exchanges
Support for Community Health Centers
Support for nurse-managed health centers, teaching centers & school-based clinics
Community health teams
Primary care extension programs
Pilots on regional emergency & trauma care
Childhood obesity demonstration projects
National diabetes prevention program
Education campaign for breast cancer
Community transformation grants
Non-profit hospital community needs assessment requirement
National Strategy for Quality Improvement
Developing & evaluating quality measures
Linking Medicare payments to quality outcomes
Pediatric Accountable Care Organizations
Reduction in Medicare & Medicaid Disproportionate Share Hospital (DSH) Payments
Great breadth of opportunities in ACA to reduce disparities and improve health equity.
Federal agencies, generally assigned leading responsibility for advancing and implementing these provisions.
Many provisions related to equity, cultural competence and language assistance have received appropriations and offer opportunities for community based organizations, county agencies and states to pursue funding.
However, important provisions, with a strong evidence base for need have not received appropriations as yet and may require state, county and community organizations to take innovative approaches to achieve their objectives.
Research and knowledge regarding incidence and prevalence of disparities-related conditions has matured as has documentation and tracking of rates and outcomes.
But knowledge gaps remain as to why disparities in outcomes have remained resistant to significant, consistent positive change in closing gaps.
Cultural competence initiatives and research seen as potentially significant strategies for reducing disparities
Fig. 1 The Current Health Care SystemThe medical care system functions as a funnel because individual illness is an outcome of, and final common pathway for, society’s ills.
–J. Horowitz. The New England Journal of Medicine. Vol. 329, Number 2: 1993, pg 131
Still very short on documenting clinically what, specifically, constitutes a cultural competence intervention, what works, when and how.
Little guidance to organizations for integrating cultural competence into actions to improve health care processes and outcomes.
Relationship and importance of community engagement in providing culturally competent care increasingly acknowledged, but indeterminate.