Culturally competent care: The next step toward health equity

By Asif Dhar, M.D., US Life Sciences & Health Care leader, Deloitte Consulting LLP

Ethnicity, health literacy, race, socioeconomics, and myriad other factors can influence how people perceive their health conditions, when and where they seek care, and whether they follow treatment recommendations.

I recently had the honor of moderating a session at ViVE 2024¹ where a panel of health equity professionals described how they are using cultural competency on a daily basis to help make health care more accessible and equitable. Cultural competence in health care allows for a patient’s diverse beliefs, attitudes, values, behaviors, and preferred language to be included in the care they receive. This practice, which is intended to create a more personalized experience for the patient, requires clinicians, staff, community health workers, and others to be aligned with the patient’s cultural preferences.  

Nwando Anyaoku, M.D. is the chief health equity and clinical innovation officer at Providence Swedish Health Services. Shortly after moving to the U.S. from Nigeria, she said she was surprised to see how various segments of the population were treated when seeking care (see Rebuilding trust in health care). During the COVID-19 pandemic, she said it became clear to her that racism in the U.S. is a public health issue and that different populations experience health care differently. She explained that culturally competent care goes beyond breaking down language and cultural barriers and should also guarantee that all patients are treated with the same level of dignity. Providence Swedish is working to enhance its cultural competency by recruiting people from the communities it serves and training them to be cultural navigators. These navigators help to bridge the cultural gap between patients, clinicians, and the health system.

Sarita Mohanty, M.D., MPH, MBA, reflected on growing up in a community with limited diversity, where she said she often felt marginalized. As an internal medicine physician, Sarita said she witnessed older patients grappling with similar feelings of marginalization due to factors such as socioeconomic background, race, ethnicity, and in what neighborhood they live. Not only were these individuals contending with health issues, some of them had to deal with loneliness and isolation. Some of them struggled to afford their care or pay for basic necessities such as food and housing (see Addressing the drivers of health). Today, Sarita serves as the president and CEO of The SCAN Foundation, an independent public charity dedicated to championing bold and equitable solutions so older adults can age well in home and in the community.²

In a recent announcement, The SCAN Foundation revealed grants for California-based community organizations striving to enhance care for older adults, particularly those residing in rural areas and historically marginalized communities of color. These organizations aim to discern and address the most critical needs of these older populations, focusing on creating a meaningful impact and fostering inclusivity, Sarita said.

Health equity is not a zero-sum game, added Saranya Loehrer, M.D., MPH, “it’s about making health care work better for everyone, regardless of factors like geography, age, race, ethnicity or income.” Saranya grew up in rural Wisconsin as part of one of the only Indian families in town. She is the first chief health equity officer at Teladoc Health. She noted that the current U.S. health care system can often feel like it was not designed for the people who provide care or for the people who receive care (see Addressing health care's talent emergency). She explained that part of Teladoc’s cultural competency strategy is to recruit clinicians, coaches, and care team members who reflect the populations the company serves. This helps to ensure equitable access, experiences, and outcomes for all.

Can culturally competent care improve maternity mortality?

Jackie Ejuwa, PharmD, MHL, vice president of health transformation at Blue Shield of California, trained as a pharmacist in both sub-Saharan Africa and the United States. She noted that expectant Black women from African countries sometimes come to the U.S. to deliver their babies to reduce the risk of maternal and child mortality. The reality is that Black women are three times more likely than White women to die from a pregnancy-related issue in the U.S.; Indigenous American women are twice as likely to die from a pregnancy-related issue. More than 80% of pregnancy-related deaths in the U.S. are preventable.³ (See Maternal health inequities persist: Can digital tools be part of the solution?)

Nwando said that Providence Swedish recently launched a program to empower and improve the birthing experience for Black and Native American women and people from across the sex and gender identity spectrum. The program, she explained, recruits and trains Black and Indigenous people from the communities the health system serves. These employees act as cultural navigators, childbirth educators, and birth and postpartum doulas.⁴

Conclusion

Consider virtually any disease state—from diabetes to heart disease to mental health—and you are likely to see differences in prevention, early detection, access, and treatment quality based on factors such as ethnicity, gender, race, sexual orientation, and socioeconomics. Our research estimates that health inequities cost the US $320 billion a year (see U.S. health care can't afford health inequities).

The panelists who participated in the ViVE session are using data and emerging technologies to uncover opportunities to improve access, equity, and outcomes…and their programs appear to be having a powerful impact.

Several states have incorporated some form of cultural competency into their continuing education requirements for health care providers. Last year, for example, Illinois enacted legislation that mandates cultural competency training to help reduce the challenges that come patients face when trying to navigate the health care system. The new law goes into effect next January. Anyone working to make health care more accessible and equitable for everyone might feel like Sisyphus rolling the same boulder up a hill every day. But efforts to improve cultural competency could be an important step in reducing some of the inequities that have long been a part of the U.S. health systems. Stakeholders should look for ways to embed health equity into their core designs. It could be difficult to improve overall health outcomes if inequities remain.

Endnotes:

¹ ViVE 2024 conference, February 16-19, 2024
² Equity Community Organizing (ECO) Groups, The SCAN Foundation
³ Working together to reduce black maternal mortality, U.S. Centers for Disease Control and Prevention, April 3, 2023
⁴ Pregnancy and Childbirth at Swedish Providence