Cultural Competence Is Key To Meeting Patients’ Needs: One Perspective From New York City – Health Affairs

The following is an example of the people whom our organization strives to help every day.

Ms. Santos got off the bus after working a 14-hour day as a housekeeper, when she noticed an unbearable pain in her abdomen. She continued to walk toward home, thinking it will go away soon. That evening, she noticed the pain worsening, decided to make some herbal tea in hopes of alleviating her symptoms, and then went to sleep.

The next day, the pain persisted when she woke up. The idea of going to a doctor passed through her mind but was quickly overshadowed with the fact that as a single mother providing for her two children, she needs the income from her 14-hour workday to meet her family’s basic expenses. She doesn’t have a designated primary care provider, and she was afraid of not being able to communicate with a provider who did not understand her cultural background and values. After all, she hasn’t seen a health care provider in the two decades she’s been in the United States.

As she made the decision to not seek care, she walked out of the house and into another 14-hour, labor-intensive workday with intensifying abdominal pains.

Cultural competence in health care is not merely a box to check. Rather, it is a foundational element of providing high-quality health care and a bedrock for meeting the needs of an increasingly diverse population of patients. Cultural competence becomes effective when those working for health care providers and health systems—from the sanitation staff to the chief medical officer—systematically consider how to integrate it into their approach in delivering care and their interactions with patients.

This understanding is nothing new. In research published in Health Affairs in 2005, the authors—from Harvard Medical School, Beth Israel Deaconess Medical Center, and Weill Medical College of Cornell University—wrote that cultural competence was “evolving from a marginal to a mainstream health care policy issue and as a potential strategy to improve quality and address disparities,” following their interviews with 37 experts in cultural competence from managed care, government, and academia. Cultural competence, they said, was emerging for three reasons:

  1. Clinicians are increasingly seeing patients with a broad range of perspectives regarding health, often influenced by their social or cultural backgrounds.
  2. Provider–patient communication has links to patient satisfaction, adherence to medical instructions, and health outcomes.
  3. The National Academy of Medicine (formerly the Institute of Medicine) published two reports—Crossing the Quality Chasm: A New Health System for the 21st Century and Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care—both of which focus on the role that patient-centered care and cultural competence plays in improving care quality.

More recent research published in PLOS ONE in 2015 focused on end-of-life conversations. Here, researchers from Stanford University School of Medicine found that doctors often struggled to talk to patients of a different ethnicity.

A Personal Experience

The health care system can be daunting for anyone, let alone for people who may lack the appropriate resources to navigate its complexities. From providers to paperwork, a simple trip to the doctor’s office can be confusing and intimidating for many patients. For those for whom language or cultural barriers exist, this presents even more layers of complexity and anxiety, creating systemic barriers to care for this population.

Throughout my career, I’ve set out to change the system at a community level to better meet the needs of those patients. As an executive director of a public mental health integration program within the New York City Department of Health and Mental Hygiene, I work to recruit, train, and deploy behavioral health clinicians across New York City—and ultimately help high-risk, vulnerable populations gain greater access to culturally competent care.

While there are tremendous challenges, there’s a very clear need to create new pathways and strategize on how we develop tomorrow’s clinical workforce, not just to address current or future shortages, but to do so with cultural humility in mind. We’re working to take cultural understanding to the next level, appreciating cultural differences in a way that helps us diversify our health care workforce and really connect with the people we serve.

As president of the Academy of Medical & Public Health Services, a public health not-for-profit organization in Brooklyn, New York, I work to integrate the mainstream health system with the community-based social support system through a workforce of community health workers who help coordinate care for high-risk, vulnerable immigrants, like Ms. Santos, who otherwise would not seek care. By having a workforce that hails from the same community as the people we serve, who look like that community, speak the same language, and understand its cultural values, we increase access to—and quality of—care simultaneously.

The United Health Foundation’s Diverse Scholars Initiative

Key to helping me on this path was my participation in the United Health Foundation’s Diverse Scholars Initiative. As part of the initiative, I received a scholarship from the Asian & Pacific Islander American Scholars to help me attend New York University (NYU) in a joint-degree neuroscience and public administration program with a specialization in health law and finance, through the NYU College of Arts and Sciences’ Center for Neural Science and the NYU Wagner Graduate School of Public Service. Through participation in the Diverse Scholars Initiative annual forum, I learned about complex health policy issues at a national level, which helped me to better understand the intricacies of our health care system in the United States and at the local level.

In 2019 the Diverse Scholars Initiative provided assistance for nearly 230 scholars across 40 states. Since the United Health Foundation launched the initiative in 2007, it has provided more than $20 million in assistance to students and funded nearly 2,600 scholarships to undergraduate and graduate students who are pursuing careers in primary care and who demonstrate a commitment to working in underserved communities.

One of the foundation’s core missions is to build healthier communities by helping to modernize and diversify the health care workforce to meet the needs of people from all backgrounds. That means investing in people, technology, and programs to keep up with the rapid pace of change in the industry.

Continuing to integrate cultural competency into the health care system requires an all-hands-on-deck approach. All stakeholders—from hospitals and health systems, to physician practices, to health insurers, to government agencies, to educational institutions, and beyond—must be willing to recognize the needs of people from all backgrounds and work to prioritize meeting those needs so as to optimize care. After all, the best care we can give someone is informed by who they are.