Academic journal article Health Care Financing Review

Approaches to Eliminating Sociocultural Disparities in Health

Academic journal article Health Care Financing Review

Approaches to Eliminating Sociocultural Disparities in Health

Article excerpt

INTRODUCTION

Over the past decade, there has been a growing amount of attention focused on demonstrating or documenting the prevalence of racial, ethnic, and socioeconomic disparities in health status, utilization, and outcomes. These sociocultural disparities are most commonly described in groups who have experienced and often continue to experience political, social, and economic discrimination. These populations have diverse health beliefs and values, differing prevalence of diseases, and may respond differently to therapies (Lavizzo-Mourey and Mackenzie, 1996).

While researchers have made significant advances in assessing sociocultural disparities, they have not made such advances in conducting, evaluating, sustaining, and disseminating programs to address them. They have either been unable to improve many aspects of the health care and the health of diverse populations, or unable to demonstrate and communicate the success of many of their efforts. Research, clinician, policy, and community groups have often failed to work together, though many are currently adopting novel strategies to attack the serious and troubling gap in health outcomes. We will review existing approaches to reducing disparities and barriers to their evaluation. We will then provide recommendations for developing, implementing, and evaluating programs to assess the root causes of, and eliminate, disparities. We gathered this information from a review of published and unpublished documents, and informal interviews with providers, program and policy leaders, and researchers around the United States.

OVERVIEW OF SELECTED APPROACHES

There are a variety of ways to characterize the many programs that have been implemented to address sociocultural disparities in health status, utilization, and outcomes. For this overview, we have grouped them into three broad categories: (1) those targeted at health providers, (2) those focused on individual patients and communities, and (3) those that address health systems and policies more broadly. These categories naturally overlap, and many initiatives approach these problems by adopting more than one strategy. In this section, we will outline programs that represent each approach. This does not imply that those interventions have been shown to reduce disparities--the vast majority have not been adequately evaluated for their effects on health.

Health Provider-Targeted Programs

Until recently, health providers received little formal training on how to deliver culturally and linguistically competent care, and little assistance in working with diverse populations. While many race-based health assumptions have been proven inaccurate, informal advice and myths based on stereotypes may be common in the medical school educational process, and this "silent curriculum" may influence many health care providers (Ricks, 1998). Efforts to help clinicians better understand and improve the care and health of their increasingly diverse patient populations occur in three general areas: (1) formal clinician training; (2) clinician resources such as published literature and internet websites, and (3) partnerships with interpreters.

Cultural and Linguistic Competency Training

Surveys in the early 1990s showed that very few U.S. medical schools had integrated cultural competency training into their curriculum (Lum and Korenman, 1994). Although more recent surveys indicate that a growing number of schools are including courses specifically on "multicultural medicine," cultural issues are more often incorporated into general medical coursework. The American Medical Association (AMA) has adopted policies that encourage, but do not require, medical schools to offer electives in culturally competent health care and educational programs about cultural issues (American Medical Association, 1999).

Several professional organizations and medical specialty groups provide cultural competency training to clinicians who have already completed their medical education. …

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