Culturally Competent Care Delivery Is Critical for Reducing Health Inequities

Racial and ethnic disparities that have existed in US health care for centuries were pushed into the spotlight by the COVID-19 pandemic, revealing to clinicians the importance of accounting for cultural factors when providing patient care.

Indeed, culture is at the heart of many utilization, prioritization, and prevention patterns that we see in various patient populations. Broadly speaking, clinicians understand culture plays an important role in prescription adherence, behavior modification, patient satisfaction, and the way different cultural groups utilize the US health care system.

What many clinicians lack, however, are the right tools that provide practical and tangible ways of embedding cultural beliefs and preferences into their work at the point of care. It is not enough for clinicians to merely be aware of cultural differences and practice medicine with cultural humility—though it is certainly a start.

In addition, clinicians need a way to incorporate culturally competent care delivery into their day-to-day practice of medicine which will provide steps they can take at the point of care that are likely to improve outcomes for Black individuals, Indigenous American individuals, Latino individuals, LGBTQ+ individuals, older adults, and young adults, among other cultural groups.

Because the typical clinician-patient encounter lasts around 10 minutes, it is critical for clinicians to use that short amount of time to create more trust and respect. Most clinicians understand intuitively that for care plans to be successful, there must be a close relationship of trust and mutual understanding shared by both parties.

Without question, practicing culturally competent care delivery is a topic of depth and complexity that merits extensive time and scrutiny from clinicians, but following are a few steps they can take to get on the right path.

#1 Assess and Address Social Determinants of Health

The World Health Organization (WHO) defines social determinants of health (SDoH) as “the conditions in which people are born, grow, live, work, and age,” which are “shaped by the distribution of money, power, and resources at global, national, and local levels.” SDoH such as access to secure housing, healthy food, and medical care play a significant role in determining health outcomes. In short, your zip code matters.

To account for SDoH, clinicians need to first survey patients to understand the challenges they face, then analyze that data for common trends among various patient populations, and, finally, connect patients with community-based organizations that can help them address those challenges.

#2 Understand the Difference Between “Health Equity” and “Health Equality”

For many years, we’ve talked about the importance of “equality” in medicine, but it’s important to understand exactly what that means. Health equality means everyone receives the same standard of care, such as prescribing the same treatment for 2 patients with hypertension. However, those 2 patients who received the same treatment may experience vastly different outcomes, because one could afford their prescribed medications and one couldn’t.

That’s where health equity comes into play. Health equity means accounting for where each patient is in their own health journey and providing individualized care that brings both patients to the same level of health. To bring about greater health equity, clinicians must understand the cultural and SDoH factors that create unequal conditions in the first place, such as access to transportation, health literacy, or available employment opportunities.

#3 Mind Your Language

When we refer to “language” in medicine, it’s about more than whether we’re speaking to patients in Spanish or English, for example. Language is also about communicating in a way that makes information understandable for patients at all levels of education. It’s also important to communicate with patients in their preferred language and ensure clinicians have access to Cultural Linguistic Appropriate Services such as language assistance/interpretation services.

From a medical standpoint, we’re good at communicating in English at a sixth or seventh grade level, but what about our translations of medical literature into other languages? Additionally, different cultural groups may have different preferences for how they absorb information. Many indigenous cultures have historically relied on storytellers or their elders to share stories and generational experiences. How can we incorporate that into medicine to improve our communication with this group?

Our job is to find a way to do that and look beyond the boxes we need to check for any given patient encounter. Even if we discuss important health information with a patient, it doesn’t mean anything unless the patient is able to translate that knowledge into actions that improve health.

The bottom line is being a good clinician requires far more than just delivering strong medical care. It is critical that clinicians endeavor to understand the social and cultural constructs within which they practice medicine.