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Health Disparities/ Cultural Competence Curriculum. Clinical Addiction Research and Education Unit Section of General Internal Medicine Boston University Schools of Medicine and Public Health Supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) R25 AA013822.

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health disparities cultural competence curriculum

Health Disparities/Cultural Competence Curriculum

Clinical Addiction Research and Education Unit

Section of General Internal Medicine

Boston University Schools of Medicine and Public Health

Supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) R25 AA013822

health disparities cultural competence curriculum objectives
Health Disparities/Cultural Competence Curriculum Objectives
  • To assure cross-cultural efficacy when screening for alcohol problems and assessing alcohol problem severity
  • To encourage providers to approach patients with an understanding of and respect for the patient’s needs and cultural values
  • To improve provider sensitivity to cultural characteristics including race, ethnicity, cultural identity and societal factors that may effect the patient-provider interaction
  • To increase the awareness of current health disparities regarding alcohol (prevalence, morbidity, treatment)
cross cultural efficacy
Cross Cultural Efficacy
  • Why is assuring cross cultural efficacy important?
institute of medicine report
Institute of Medicine Report
  • Assessed the extent of racial and ethnic disparities in healthcare
  • Reviewed >100 studies assessing quality of healthcare for various racial and ethnic minority groups
  • Even when insurance, income, and medical profiles are the same as whites, minorities often receive fewer tests and less sophisticated treatment for their ailments
alcohol related health disparities
Alcohol-Related Health Disparities

Compared with whites:

  • Hispanic men have higher rates of alcohol-related problems, intimate partner violence, cirrhosis mortality
  • Black men have higher rates of intimate partner violence and cirrhosis mortality
potential sources for disparities in care
Potential Sources for Disparities in Care
  • System-Level Factors: funding for mental health and substance abuse treatment, linguistic abilities of care providers
  • Patient-level factors: patient beliefs and preferences, trust and spirituality, stress and coping behaviors, explanatory model
  • Physician-level factors: the clinical encounter, default decision making, emphasis on prior expectations based on age, gender, race or ethnicity; bias, prejudice, stereotyping

Disparities:An integrated model

  • Social, Economic and Cultural Influences
  • Financial Incentives
  • Institutional Design
  • Legal Environment
  • Cultural Influences

Medical History

Patient Input

Subject to ambiguity

And misunderstanding

Racially and Culturally







Physical Examination

Diagnostic Test Results

  • Normative Values and Stereotyping
  • Conscious
  • Unconscious
  • Prejudice
  • Conscious
  • Unconscious
cultural competence
Cultural Competence

Integrationvalues a variety of cultures, integrates aspects of other cultures in own

Adaptation skilled in communicating across differences and can take on other’s view

Acceptancerecognizes and values differences

Minimizationtrivializes difference; similarities means “like me”

Defensethreatened by perceived differences

Where are you on this spectrum?

Denialthere is no difference

  • A social construct, varying by location, associated with certain physical attributes
  • Some shared ancestry and common gene pools but:

genetic variation depends on geographic dispersal and varies MORE WITHIN most common racial groups THAN BETWEEN groups

minorities view of the healthcare system
Minorities View of the Healthcare System

Health Quality Survey Commonwealth Fund 2002

  • Minorities report belief that:
    • They are more likely to be treated with disrespect
    • They would receive better care if not black
    • Staying healthy is luck
  • Minorities report a greater difficulty communicating with physicians
historical relationship to the healthcare system
Historical Relationship to the Healthcare System

Tuskegee as an event and metaphor

  • 63% of AA and 38% of whites believed MDs often prescribe meds to experiment without consent
  • 25% of AA and 8% of Whites believe MD had given them experimental treatment without consent
  • 45% of AA and 35% of Whites believed MDs would expose them to unnecessary risk
  • 2 x as many AA as Whites felt they could not freely question their doctors
bridging the gap
Bridging the Gap

RESPECT- a framework that can assure effective cross cultural communication


Explanatory model

Sociocultural context



Concern and fears


  • Respect - a demonstrable attitude
  • Explanatory Model - what is the patient’s point of view regarding his/her alcohol use
  • Sociocultural context - in what context does his/her drinking occur
  • Power - share the power in the patient-provider interaction
  • Empathy - make sure the patient feels understood
  • Concerns and fears - elicit patient’s fears regarding alcohol use
  • Trust - provider’s goal to deliver appropriate, effective healthcare most easily achieved when there is a therapeutic alliance and shared objectives between provider and patient