Page 46 - Cultural Competence in Health Education

24 Cultural Competence in Health Education and Health Promotion

INTRODUCTION
Carter - Pokras and Baquet (2002) suggest that “ a health disparity should be viewed as
a chain of events signified by a difference in: (1) environment, (2) access to, utilization

of, and quality of care, (3) health status, or (4) a particular health outcome that deserves
scrutiny ” (p. 427). The National Institutes of Health (NIH), in its Strategic Research
Plan to Reduce and Ultimately Eliminate Health Disparities (NIH, 2000), defi nes
health disparities as the “ differences in the incidence, prevalence, mortality and burden
of diseases and other adverse health conditions that exist among several population
groups in the United States ” (p. 4). Research on health disparities related to socioeco-
nomic status (SES) is also encompassed in this definition. The Institute of Medicine

(IOM), in a landmark report titled Unequal Treatment: Confronting Racial and Ethnic

Disparities in Health Care, documented and provided, for the very first time, evidence

that the playing field is not equal — that ethnic and racial minorities receive lower qual-
ity health care than white people do, even when insurance status, income, age, and
severity of conditions are comparable (Smedley, Strith, & Nelson, Committee on
Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Institute
of Medicine, 2002). The IOM has taken a leadership role in advancing research efforts
and polices to narrow these disparities and has partnered with private and public agen-
cies to improve the way that care is delivered to people of color, to develop more effec-
tive communication strategies and tools to help the provider community more
effectively interact with a broad range of patients, and to promote cultural competence
in training health care professionals and in treatment.
The reasons why we observe these disparities are not clearly understood and may
be due to such factors as individual choices, differences in disease processes, or sys-
temic barriers to care, or to any combination of these factors. The IOM has produced a
number of reports examining health care disparities and acknowledges that there are
many possible reasons for the observed disparities in health and health care, including:
language and cultural factors; distrust of the medical system among minority patients;
a lack of minority physicians in clinical practice, who may be more culturally sensi-
tized to the needs of minority patients; time limitations imposed by the pressures of
clinical practice; and conscious or unconscious biases, prejudices, or negative racial
and ethnic stereotypes that affect the ways in which health care providers deliver care
to different populations (National Academy of Sciences, 2005, p. 4). It is most easy to
identify a disparity in treatment for a particular condition when there is a clear clinical
standard for quality health care for that condition and there is proof that this standard
has not been met. Even when variations in individuals ’ disease state, severity of ill-
ness, and preferences are taken into account, there is a professional consensus that this
standard of care has been breached (National Academy of Sciences, 2005). In a brief
report targeted to health care administrators and managers, the IOM summarized the
conclusions of its report Unequal Treatment by restating that “ the sources of these dis-
parities are complex, are rooted in historic and contemporary inequities, and involve
many participants at several levels, including health systems, their administrative and

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