Demographic changes in states across the country and greater recognition of gaps in access to health services. Combined with increased attention on the influence of race, culture and language in quality of healthcare in different states has made us all more aware of the importance of promoting equity and reducing disparities in health care among states. As a result of this heightened recognition, we are seeing encouraging efforts that span a spectrum of priorities from cultural competence training and use of interpreters to organizational adaptation and transformation. These efforts to address longstanding disparities in care access, quality and outcomes are urgently needed, particularly given the reality that non-white populations are expected to comprise more than half the country by 2050.
Adding to the urgency and prominence is the passage of the Affordable Care Act (ACA). Its focus broadly and directly on addressing the needs of diverse individuals and their communities – and efforts to improve health equity – demonstrates the crossing of a threshold, where now new obligation and opportunity present the possibility of positive change not seen in at least a generation.
Assuring that race, culture and language of patients and communities are core to quality care is not a side issue. With growing diversity comes growth in a diverse workforce whose ability to access and use health care services efficiently and effectively can reduce morbidity and, in turn, can work to control the costs of health services as well as improve productivity and reduce absenteeism.
As a result of these efforts, we can expect measurable improvements. For example, a 2004 Harvard study published in the journal Pediatrics found that health care settings that emphasized cultural competence policies and practices such as providing staff training, cultural and language appropriate materials, diverse staff recruitment and related evaluation measures reported greater adherence to drug treatment for asthma and greater parental satisfaction with care for children enrolled in Medicaid.
Bringing health care professionals and others together is part of the process of learning about such findings as well as new ways to reduce disparities and improve health and health care. As a living example, since 1998 we have convened national conferences on quality care for culturally diverse populations, where participants hear from policymakers, researchers, practitioners and other leaders in disparities and cultural and linguistic competence, as well as network and seek to apply cutting edge work to their settings (www.diversityrx.org). The event provides a marketplace of ideas and lessons learned singularly focused on working to improve the health of its diverse residents.
Our 2013 conference offered the opportunity to hear from 200 presenters and discuss topics ranging from the issuance of new enhanced standards for Culturally and Linguistically Appropriate Services (www.thinkculturalhealth.gov) to how America’s Health Rankings® state-level data can help to identify and inform deliberations to reduce disparities.
But, at the end of the day, we must recognize that efforts to improve the health of diverse individuals and communities are not an “us or them” matter. Developing and maintaining a healthy workforce that serves all regardless of race or culture is at the heart of creating a healthy society for all.
Blog Author
Dennis Andrulis, PhD
Dennis Andrulis, Ph.D. is a Senior Research Scientist at the Texas Health Institute, a non profit policy research organization, and is an Associate Professor at the University of Texas School of Public Health. In his current roles and previous positions as Research Dean at the Drexel University School of Public Health and Director of its Center for Health Equality, Dennis has led the development of numerous initiatives on racial and ethnic disparities and cultural competence, working at the community level, for states, and nationally.
His recent work includes the development of assessment tools on emergency preparedness for primary care sites with a special emphasis on addressing the challenges of engaging racially and ethnically diverse communities; analyzing Republican and Democratic presidential candidate health reform platforms, related legislation and the enactment of the Patient Protection and Affordable Care Act, creation of a cultural competence self-assessment tool for health care organizations; and serving as co-founder of a national conference series on quality health care for culturally diverse populations, now in its 12th year.
He developed a compendium and analysis of national data sources on the nation’s 100 largest cities and their surrounding areas, entitled The Social and Health Landscape of Urban and Suburban America; assisting in the implementation of a HRSA CAP grant for Nassau County, NY focusing on program evaluation and integrating cultural competence into the intervention strategies and the overall program; and assisting the Health Research and Education Trust in creating a cultural competence curriculum for health care leaders.
Dr. Andrulis was part of the core faculty for the NIH award to the Arthur Ashe Institute and Downstate Medical Center to address cardiovascular disparities, and was charged with the responsibility of curriculum development. He also has participated in and/or chaired numerous national committees and advisory groups addressing disparities, communication and cultural competence, including efforts convened by the Joint Commission, the National Institute for Child Health Quality, The American Medical Association and the National Quality Forum and Pfizer (health literacy).
He has a Ph.D. in Educational Psychology from the University of Texas at Austin and a Masters of Public Health from the University of North Carolina at Chapel Hill.