Diversity in Health Care

The focus of healthcare has been in a large part a standardization of procedures to achieve the best of outcomes and improve our delivery system. The improvements and breakthroughs have been many and what once used to kill us now can be cured (e.g., Ulcers number 3 killer in the 1960’s). However standardization is often in conflict with cultural diversity and leads to a myriad of inconsistencies that cause disparity.

The definition of diversity encompasses acceptance and respect. It means understanding that each individual is unique, and recognizing our individual differences. These can be along the dimensions of race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, religious beliefs, political beliefs, or other ideologies. It is the exploration of these differences in a safe, positive, and nurturing environment. It is about understanding each other and moving beyond simple tolerance to embracing and celebrating the rich dimensions of diversity contained within each individual.

However the two concepts can be viewed in conflict with each other standardization and diversity; they can work together to achieve a new standard that addresses cultural boundaries and diversity. Once knowing the issues we can start addressing this by teaching cultural competence and employing those with diverse cultural heritage.

The problems that need to be addressed to achieving cultural competence are;

Cultural Destructiveness: forced assimilation, subjugation, rights and privileges for dominant groups only.

Cultural Incapacity: racism, maintain stereotypes, unfair hiring practices.

Cultural Blindness: differences ignored, “treat everyone the same”, and only meet needs of dominant groups.

We can achieve a new level of standards by using this three approaches;

Cultural Pre-competence: explore cultural issues, are committed, assess needs of organization and individuals.

Cultural Competence: recognize individual and cultural differences, seek advice from diverse groups, and hire culturally unbiased staff.

Cultural proficiency: implement changes to improve services based upon cultural needs, do research and teach.

In recent history with the election of our first culturally diverse president and the appointment of a Latino supreme judge is showing us our view of diversity of culture is changing to a role of awareness, and acceptance. There have been many laws passed to address and give incentive to healthcare organization that practice cultural diversity and language barriers.

Title VI of the civil rights act of 1964, which states no person in the United States shall, on the grounds of race, color, or national origin be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.

Medicare reaches out to make bilingual services available to patients, by reimbursing hospitals for the cost of the provision of bilingual services to patients.

Medicaid regulations require Medicaid providers and participating agencies, including long-term care facilities, to render culturally and linguistically appropriate services.

The Hill-Burton Act, enacted by Congress in 1946, encouraged the construction and modernization of public and nonprofit community hospitals and health centers. In return for receiving these funds, recipients agreed to comply with a "community service obligation," one of which is a general principle of non-discrimination in the delivery of services. It also addresses language barriers.

The Emergency Medical Treatment and Active Labor Act, also known as the Patient Anti-dumping Act, requires hospitals that participate in the Medicare program that have emergency departments to treat all patients (including women in labor) in an emergency without regard to their ability to pay.

Finely with healthcare reform is in the forethoughts of our recent presidential administration, sweeping changes will emerge to improve other forms of disparity caused by greed. I am very hopeful concerning the changes taking place in our heath care delivery system. In time I believe we can overcome diversity with teaching, leading by example, and staying on focus with quality and favorable outcomes.

Reference:

The office of minority health:

http://www.omhrc.gov/templates/browse.aspx?lvl=2&lvlID=14

(Spector, Rachel E.. Cultural Diversity in Health & Illness, 6th Edition. Prentice Hall, 072003. 4).

Encyclopedia Britannica Online (Academic Addition)