Conversations in Cultural Competency

Why Being Black in America is Bad for Your Health

After more than a year of in-depth reporting in Baltimore, The Atlantic has published a long read that explores why, as a group, black Americans are significantly less healthy than white Americans. The piece follows a woman named Kairra, who is 27, black, very overweight, and suffers from a host of health problems that are usually associated with people three times her age. In Baltimore, as well as other segregated cities like Chicago and Philadelphia, the low-income, mostly black neighborhoods have a life expectancy that is 20 years lower than more affluent, whiter neighborhoods. The gap can be attributed to several factors, including violence, diet, environmental hazards, substance abuse, and stress.

Address the patient, speak clearly, avoid jargon, and check for comprehension

If you’re a healthcare provider who works with some of the 25 million limited English proficient (LEP) patients in the U.S., you know how important interpretation is to successful patient outcomes. Poor communication increases the chance of medical errors with any patient, and LEP individuals are especially vulnerable in this regard.

In this week's News Roundup:

• Creating Financial Success at a Small Rural Hospital
• Gender Bias Hinders Research in Chronic Disease
• The Business Case for Racial Equity

Creating Financial Success at a Small Rural Hospital

An in-depth piece from Politico Magazine explores how a small, rural hospital in Kansas has become an economic powerhouse by serving the local refugee/immigrant population and specializing in labor and delivery. Ben Anderson, the hospital's CEO, relies on community partnerships, infrastructure grants, and targeted recruiting. His recruiting model is especially interesting: He attracts young physicians who are interested in helping Third World populations. "You can do that work right here in Kansas," he says. Having a staff that actively seeks to work with diverse populations improves patient experience and outcomes.

• Health Equity Bill Introduced in Congress
• Medical Schools Must Do More to Combat Racism
• Experiment with Barbershop Clinics is Succeeding
  
  

Health Equity Bill Introduced in Congress

The Congressional Tri-Caucus, made up of the Congressional Asian Pacific American Caucus, Congressional Black Caucus, and Congressional Hispanic Caucus, has introduced the Health Equity and Accountability Act of 2018 (HEAA), a bill that attempts to address health disparities based on race and ethnicity. The authors note several reasons for these disparities, including language and cultural barriers to care.

To date, 1,656 organizations, 51 state hospital associations, and 11 municipal hospital associations have signed onto the American Hospital Association's (AHA) #123forEquity Pledge to eliminate healthcare disparities. That means every state, and nearly 30% of our nation's hospitals, are represented in the movement to improve health equity. But the road between pledging good intention and effecting actionable change can be poorly marked, and dotted with unseen obstacles. In this post we'll review the key tenets of the AHA's Equity of Care Campaign, rationale for participation, and key actions hospitals and health systems can start to focus on today.

Unconscious (or implicit) bias training is in the spotlight. From the #MeToo movement to the chorus of outrage over the unwarranted arrests of two black men at a Starbucks, companies are facing increasing public pressure to address the roots of discriminatory treatment.  But questions remain over whether bias training is an effective course of action, versus a perfunctory act taken to avoid bad press.

In this week's News Roundup:

• Near-Miss Mothers: For Every Woman Who Dies Post-Childbirth, Thousands More Come Close
• Surging Opioid Overdose Rate in Latinos Tied to Language Barriers
• More Transgender-Inclusive Healthcare is Essential

Near-Miss Mothers: For Every Woman Who Dies Post-Childbirth, Thousands More Come Close

The maternal mortality rates in the U.S. are grim, but the number of women who suffer postpartum complications that nearly cause death are even worse. For every woman who dies after childbirth, at least 70 come close. Some estimates put the number of women who suffer "severe maternal morbidity" at around 80,000 per year. A report by NPR/ProPublica finds that many of these complications are preventable, and there's a common theme that postpartum mothers don't feel their concerns are taken seriously by healthcare providers.

In this week's News Roundup:

• Unconscious Bias Training Can Ease Crisis in Black Maternal Mortality
• Stigmatizing Language in Medical Records Affects Patient Care
• Discrimination Causes Latinas to Be Less Satisfied with Contraception
• Documentary Explores Desegregation of Healthcare System

Unconscious Bias Training Can Ease Crisis in Black Maternal Mortality

We've reported extensively on the dismal maternal mortality rates in the U.S., and the crisis in black maternal mortality in particular. A new piece by NBC News follows the stories of two black mothers who experienced serious complications with their deliveries. Both women felt their medical teams were dismissive and brusque, and that their health problems may have been avoided with better communication. They are among the 32% of black women who feel they’ve been discriminated against in physicians’ offices. Unconscious (or implicit) bias on the part of healthcare providers has very real consequences for patient outcomes. Bias training may not be the complete solution, but it is part of the solution, and should become a standard practice in all medical schools and healthcare organizations.

In this week's News Roundup:

• How Empathy Keeps People Out of the Hospital
• Gender Bias Diminishes Women's Health Concerns
• University of Chicago Reopens Trauma Center
• Black Patients with Heart Failure Less Likely to See Cardiologists

How Empathy Keeps People Out of the Hospital

Growing evidence shows that more empathetic care can keep people healthier and reduce hospital visits. A new piece by NPR's Marketplace profiles Philadelphia's Penn Center for Community Health Workers, which pairs community health workers with patients who frequent hospitals due to chronic illness, poverty, or mental health problems. The community health workers visit patients at their homes and help them navigate their health issues. The Penn Center makes an effort to match its staff with patients who share a similar background, in order to inspire trust. A randomized, controlled study showed the Center reduced hospitalizations by 30%.

The most common objection

I've given hundreds of presentations on culturally-competent care to busy clinicians around the world. At the end of my talk, someone always asks the "time question." I know plenty of other clinicians are thinking it, but don’t want to appear insensitive. So I wait for a brave soul to say, “Dr. Green, you’re telling me that if I want to be culturally competent, I have to do all of these things on top of what I already have to cover? I have to ask my patients how they understand their condition? What their religious practices are? Whether they trust me? I’d love to—but I just don’t have time!”