Why is Cultural Competency Why is Cultural Competency Important in the Practice of Important in the Practice of Medicine?Medicine?

Karen E. Schetzina, MD, MPH

Cultural Competency FrameworkCultural Competency Framework

Awareness

Knowledge

SkillsAttitudes

Behaviors

Definition of Health DisparitiesDefinition of Health Disparities

“ . . . [include] differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.”

U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000.

              

  

              

  

              

  

•Cardiac disease•Diabetes•Infant mortality•Hepatitis•Tuberculosis•HIV Infections/AIDS•Cancer screening and management•Immunizations

Minority Populations are Minority Populations are Disproportionately AffectedDisproportionately Affected

Disparities in Health CareDisparities in Health Care

The Kaiser Family Foundation (2002)National Survey of Physicians: Doctors on Disparities in Health Care

Institute of Medicine (2002)Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

The Commonwealth Fund (2002)Minority Americans Lag Behind Whites on Nearly Every Measure of Health Care Quality

Kaiser National Survey of Kaiser National Survey of PhysiciansPhysicians

“Disparities in the health care delivered to racial and ethnic minorities are real and are associated with worse outcomes in many cases, which is unacceptable.”-- Alan Nelson, retired physician, former president of the American Medical Association and chair of the committee that wrote the Institute of Medicine report, Unequal Treatment: Confronting Racial and Disparities in Health Care

IOM Report, 2002: Assessing the IOM Report, 2002: Assessing the Quality of Minority Health CareQuality of Minority Health Care

Racial Disparities in Care Do ExistRacial Disparities in Care Do Exist

Institute of Medicine Report, 2002The evidence is “overwhelming”Disparities exist even when insurance status, income, age, and severity of conditions are comparableMinorities are less likely than whites to receive needed servicesDisparities contribute to worse outcomes in many casesDifferences in treating heart disease, cancer, and HIV infection partly contribute to higher death rates for minorities

Source: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, March 2002.

Healthy People 2010:Healthy People 2010:Healthy People in Healthy CommunitiesHealthy People in Healthy Communities

Overarching goals:Increase quality and years of healthy life

Eliminate health disparities

74% 72% 70% 68% 66% 64%

12% 12% 12% 13% 13% 13%

1% 1% 1% 1% 1% 1%

4% 4% 5% 5% 6% 7%

11% 12% 14% 15% 16%10%

1995 2000 2005 2010 2015 2020

White African American American Indian Asian & Pacific Islander Hispanic

Changing U.S. PopulationChanging U.S. Population1995–20201995–2020

41% 37% 33% 30% 26% 24%

9%9%

9%9%

9%9%

1%1%

1%1%

1%1%

13%15%

16%18%

20% 21%

39% 41% 43% 44% 46%37%

1995 2000 2005 2010 2015 2020

White African American American Indian Asian & Pacific Islander Hispanic

California’s Population 1995–2020California’s Population 1995–2020Persons Aged 0-19Persons Aged 0-19

Health Care Issues Important for Health Care Issues Important for Reducing Ethnic Health DisparitiesReducing Ethnic Health Disparities

Increase availability of and access to insurance programs for all childrenAddress ethnic disparities in the health care workforce Racial and ethnic minority groups must be included in research and considered in the design of interventionsInterventions must be designed with all racial/ethnic groups in mindHealth care providers must be culturally competent

Cultural Competency FrameworkCultural Competency Framework

Awareness

Knowledge

SkillsAttitudes

Behaviors