Globalization and international migration result in greater diversity in Western populations, such as the United States. The health status of black, indigenous, and people of color (BIPOC) is often disproportionate or inequitable to the majority racial and ethnic group. These individuals have limited access to healthcare, some due to their undocumented status.
Patient-provider cultural differences are one root cause of why BIPOC patients are treated differently. 63% of US adults have experienced some form of discrimination during a clinical encounter with a healthcare provider, with the majority of individuals experiencing more than once (Nong, 2020). However, African Americans and Hispanics tend to experience it more than their Caucasian counterparts, and the discrimination type is race-based (Nong, 2020). Specifically, BIPOC patients’ various social characteristics may lead to victimization through provider-initiated implicit and explicit bias.
In a 2003 landmark report, the Institute of Medicine recommends health care providers acknowledge and respect the diverse preferences, concerns, and values of others as elements of patient-centered care – a fact that in nearly two decades hasn’t changed. The organization recommends healthcare providers understand how the patients’ cultural differences directly influence health outcomes. The healthcare provider’s ability to recognize and self-correct prejudice, bias, stereotyping, and discriminatory practices can consequently enhance the provider-patient relationship during clinical experiences with BIPOC patients.
Research indicates that a patient’s cultural makeup can profoundly affect a patient’s health status (Hines-Martin, 2019). Individuals in marginalized communities face disadvantages in receiving quality healthcare due to systemic, organizational, provider, and personal barriers due to their BIPOC status. When these individuals do present to health care institutions, they are often acutely ill, have unfamiliar conditions, and may not have the ability to communicate adequately with others.
BIPOC face poor health outcomes due to social inequities affecting health care, information, and education. Lower health outcomes arise when this patient population succumbs to healthcare inequalities and/or becomes dissatisfied with care. These systemic, organizational, and provider, and personal barriers and the social determinants for health result in greater health disparities, dissatisfaction with healthcare experiences, and healthcare avoidance for BIPOC populations. For diverse people, equity-centered care improves treatment adherence and contributes to health promotion and preventive health measures.
The shift towards equitable care is challenging. Health care professionals identify a need for greater guidance on how to improve their clinical appropriateness in meeting the cultural health needs of diverse patients’ care. Partially, the concern with clinical appropriateness is due to the difficulty in appraising and applying evidence-based culturally-specific interventions to improve health outcomes.
Healthcare providers, especially front-line workers, often feel unprepared with limited control over patient interactions. Healthcare providers are experiencing challenges nationally concerning administering equity-centered care. Across the country, there is limited to no preparation for addressing health inequity as a byproduct of social injustice in many health science programs.
A healthcare provider’s ability to provide culturally appropriates and equity-centered care promotes health equity and positions the health care provider as a change agent, empowering BIPOCs to reduce health disparities actively. A needed skill for healthcare providers is to create a systematic process for patients with diverse backgrounds to receive culturally responsive healthcare services. Of course, this process requires initial and ongoing cultural development training for healthcare providers.
Reference
Hines-Martin, V., Starks, S., Hermann, C., Smith, M., & Chatman, J.M. (2019). Understanding culture in context: An important next step for patient emotional well-being and nursing. Nursing Clinics of North America, 54(4), 609–623. doi.org/10.1016/j.cnur.2019.08.005
Institute of Medicine. (2003). Unequal treatment: confronting racial and ethnic disparities in health care. The National Academies Press.
Nong, P., Raj, M., Creary, M., Kardia, S.L.R., Platt, J.E. (2020). Patient-reported experiences of discrimination in the US health care system. JAMA Network Open, 3(12), e2029650. doi.org/10.1001/jamanetworkopen.2020.29650
