Population-Based Health Policy: Minorities/Cultural Issues

Minorities, including Native American, Hispanic, Asian, Latinos, and African American populations, are less likely to have a regular source of care. However, racial and ethnic differences in access to healthcare are not always due to differences in financial resources and insurance coverage. A majority of minorities receive fewer services when compared with whites who have the same level of health coverage and income. Cultural differences may exist in patients’ beliefs in regard to the value of medical care and approaches toward seeking treatment for their symptoms.¹

Communication is a critical aspect in healthcare delivery and must be facilitated by healthcare providers in order to enhance efficiency and performance. Good communication between healthcare providers and patients is imperative for sharing information. However, ineffective communication between patients and healthcare providers of differing races, cultures, and languages results in a reduced chance of rapport building.

Disparity/Quality of Care

Health disparity is a type of difference in health that is closely associated with social or economic disadvantage. Health disparity can have adverse effects on people who possess greater social or economic obstacles to health. These barriers originate from characteristics historically associated with discrimination or exclusion, such as ethnicity, religion, socioeconomic status, gender, mental health, sexual orientation, geographic location, cognitive, sensory, and physical disability. It is imperative to have a healthcare system that is based on equity and fairness that provides affordable, accessible, and high-quality care, which gives everyone to have the opportunity to achieve full health potential and no one is disadvantaged due to their social position or any other socially determined circumstances.²

The Affordable Care Act (ACA) has a significant role in providing a critical foundation for addressing racial and ethnic health disparities. ACA is designed to improve access to healthcare for communities of color. ACA mandates to expand Medicaid, eliminate denials and charging premiums for individuals with pre-existing conditions, increase funding for community health centers, and promote culturally and linguistically appropriate services.³

In 2012, almost half of Medicare beneficiaries had annual incomes below $22,500 and the median average among marginalized population was significantly lower than white individuals. While the top 10% of minorities, including black and Hispanic populations, had incomes above $43,900 and $44,550, respectively, the top 10% of white beneficiaries had incomes above $70,000 in 2012. Despite having college degree among black and Hispanic individuals, their incomes were $29,200 and $34,800, respectively, compared with white beneficiaries who had incomes of $41,400. It is indicated that 92% of Medicare beneficiaries had some savings, such as retirements account holdings and other financial assets: 95% among white individuals, 80% among black, and 81% among Hispanic populations. In 2012, 78% of Medicare beneficiaries had some home equity; however, the share was 61% and 60%, respectively, among black and Hispanic beneficiaries. Among individuals who had some home equity in 2012, almost half had less than $93,850 in home equity. The median home equity was $53,650 and $67,700, respectively, among black and Hispanic beneficiaries compared with white population who had $100,200 in home equity in 2012.

All of these findings are significant. The analysis acknowledges substantial disparities in income, savings, and home equity among Medicare beneficiaries by race and ethnicity. It is essential to understand the economic realities of the Medicare population, which provides an important context for arranging and assessing Medicare, Social Security, Medicaid, and any other policy proposals that could strengthen or weaken the economic security of older Americans in the marginalized population.⁴

Cultural Issues/Languages

Culture is the combination patterns of human behavior that include language; thoughts; communications; actions; customs; beliefs; values; and institutions of racial, ethnic, religious, or social groups. It is imperative for healthcare professionals and organizations to have the capacity to act effectively within the cultural beliefs, behaviors, and needs presented by patients and their communities.² It is essential to initiate a process of promoting cultural safety and deal with cultural differences and conflicts. The aim of cultural safety is to create an environment in which members of different groups feel safe to express and discuss their identity.

One of the most important barriers associated with providing healthcare to Hispanic, Asian, and Latinos populations is language barriers between healthcare providers and patients. In most circumstances, sick individuals who are unable to speak or understand English, rely on young children to interpret. This problem will continue until healthcare organizations recruit bilingual healthcare professionals to enhance quality of healthcare.⁵ In addition, it is important to have medical interpreters at healthcare facilities. Medical interpreters will help to have a better patient-practitioner relationships and communications, which will ultimately increase patients’ likelihood of receiving and accepting appropriate medical care.

Studies indicate that when patients interact with clinical members who share a common race, ethnicity, or language, there is a higher chance of rapport building. Conversing in the same language can instill and strengthen the needed cultural values and act as a bridge linking these populations to healthcare society, which will lead to a greater interpersonal care, better medical comprehension, and higher chance of keeping follow-up appointments.⁶ It is imperative to increase teaching second language courses, which act as a bridge linking new immigrants to society. Older generations with limited English proficiency in these populations find it very difficult to adjust to a foreign culture and understand Western medicine.⁷

Social Determinants of Health

The social determinants of health are the circumstances in which individuals are born, grow up, live, work, age, and the systems that are in place to deal with ailment. All of these circumstances are shaped by ample sets of forces that include economics, social policies, and politics.²

Scientists usually identify 5 determinants of health: biology and genetics, individual behavior, social environment, physical environment, and health services. Examples of such determinants of health include gender, age, alcohol consumption, drug usage, unprotected sex, smoking, discrimination, income level, where individuals live, access to quality healthcare, and having or not having health insurance.² For instance, alcohol abuse is prevalent in the American Indian community. Domestic violence, sexual abuse, and assaulting of women are other issues surrounding the American Indian population. Most women are hesitant to admit that they are victims of abuse and therefore the crisis continues. Their experiences of discrimination in the healthcare setting is the main precursor to their participation in traditional healing as an alternative to working with Western medicine healthcare professionals. The initiation of traditional remedies in indigenous people is mostly associated with their unmet needs by Western medicine. They follow the main tenets of ritual and traditional healing in order to address imbalances in the body, mind, and spirit. They use traditional practice to maintain the facets of their respective Native cultures and acknowledge their heritage.⁸

Creating Social Justice

Minorities have lower quality indicators. It is essential to address social determinants of health in order to challenge inequality and disparities to ensure better health for all. It is important to create social justice that promotes equity, diversity, and professionalism among all participants in the system. Social justice will ensure integration, respect of cultural and religious practices, and act against injustices and inequalities. People with different race, gender, age, disability status, socioeconomic status, and geographic location deserve to be treated with dignity and achieve health equity.

The goal is to acknowledge, respect, and explore cultural identities and challenge the assumption and work towards an equitable and sustainable life on this planet. Leaders with their multicultural attitudes can create environments that are genderblind and colorblind.

References

1. Bodenheimer T, Grumbach K. (2012). Understanding health policy: A clinical approach (6th ed.). New York: McGraw Hill Medical.

2. Centers for Disease Control and Prevention. (2014). Definitions. In Social Determinants of Health. Retrieved from http://www.cdc.gov/socialdeterminants/Definitions.html

3. Families USA. (2010). How the Affordable Care Act helps communities of color. Retrieved from http://familiesusa.org/product/how-affordable-care-act-helps-communities-color

4. Jacobson G, Huang J, Neuman T, Smith K. (2013). Wide disparities in the income and assets of people on Medicare by race and ethnicity: Now and in the future. Kaiser Family Foundation. Retrieved from http://kff.org/medicare/report/wide-disparities-in-the-income-and-assets-of-people-on-medicare-by-race-and-ethnicity-now-and-in-the-future/

5. Sherrill W, Crew L, Mayo R, Mayo W, Rogers B, Haynes D. (2005). Educational and health services innovation to improve care for rural Hispanic communities in the US. Education for Health, 18(3), 356-367.

6. Spector RE. (2013). Cultural diversity in health and illness. (8th ed.). Upper Saddle River, NJ: Pearson.

7. Asian American Health Initiative. (2005). Together to build a healthy community. Retrieved from http://www.aahiinfo.org/english/asianAmericans.php

8. Moghaddam J, Momper S, Fong T. (2013). Discrimination and participation in traditional healing for American Indians and Alaska Natives. Journal of Community Health, 38(6), 1115-1123.