Feb 21 2014
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Faces of Public Health: Nadine Gracia, HHS Office of Minority Health

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Last year, the U.S. Department of Health and Human Services released updated national Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care to help health organizations improve care in diverse communities.

When the updated standards were released, Howard K. Koh, MD, MPH, the Assistant Secretary for Health in the U.S. Department of Health and Human Services (HHS), said “the enhanced CLAS Standards provide a platform for all persons to reach their full health potential.” Koh added that the updated CLAS Standards provide a framework for the delivery of culturally respectful and linguistically responsive care and services. By adopting the framework, health professionals will be better able to meet the needs of all individuals at all points of contact.

“As our nation becomes increasingly diverse, improving cultural and linguistic competency across public health and our health care system can be one of our most powerful levers for advancing health equity,” said Nadine Gracia, MD, MSCE, and Deputy Assistant Secretary for Minority Health and Director of the HHS Office of Minority Health.

NewPublicHealth recently spoke with Gracia about the updated standards and opportunities that efforts to increase health equity can bring to the health of individuals and communities.

NewPublicHealth: How does cultural respect help improve health in diverse communities?

Nadine Gracia: As we see the growing diversity of our country and the persistence of health disparities, really having everyone engaged in the discussion of health equity and the attainment of the highest level of health for all people is vital. Culture and cultural respect are really important when we talk about health equity as well as quality of care, and that’s because culture really influences health beliefs and practices. It influences one’s health-seeking behaviors and attitudes and the experience that someone may have in a health care setting.

So, it is essential that providers and health care delivery institutions understand the critical role that they play in providing culturally and linguistically appropriate services. We define those services as ones that are respectful of and responsive to an individual’s cultural health beliefs, their preferred languages, their health literacy levels and their communication needs. They are really applied by and employed by all members of an organization at every point of contact.

Culturally and linguistically appropriate services are essential when we talk about the health care encounter because they are increasingly recognized as being effective in improving the quality of services and increasing patient safety by preventing miscommunication; facilitating accurate assessment and diagnosis of a patient’s condition; and enabling everyone engaged in health services to truly develop an accurate and effective treatment plan.

NPH: What are some examples of culturally respectful engagement?

Gracia: To begin with, language definitely is important when we talk about providing high quality care. There is an example of a case where an individual went to the emergency room at a hospital in Florida, and said that he felt “intoxicado”—Spanish for not feeling well because of a food or beverage—and that was misinterpreted to mean intoxicated. There was a delay of care that resulted in a potentially preventable case of quadriplegia and a $71 million malpractice settlement.

It is important to provide culturally and linguistically appropriate care and services that address the language assistance needs that an individual may have by using qualified and trained interpreters. Linguistic assistance allows for an accurate understanding of what someone may be presenting with, and the development of the right diagnosis and treatment plan in order to prevent those types of complications and errors.

NPH: How do we introduce cultural respect as part of the health care system?

Gracia: One way is by raising awareness about the role of culture and language and how it can be tied to a lack of understanding of the influence of culture and language on health beliefs, practices, health seeking behaviors and the health care experience.

In 2000 the Office of Minority Health first released the CLAS Standards to provide a framework—a blueprint—to help health and health care organizations implement and provide culturally and linguistically appropriate services for our nation’s increasingly diverse communities. The updated standards reflect the growth in the literature of cultural linguistic competency over time, as well as the recognition of the persistence of health and health care disparities in our country.

For example, we've seen the Institute of Medicine, the Joint Commission and the National Committee on Quality Assurance all state that there is an importance to cultural and linguistic competency in the provision of health care. We know that it can be difficult for health care providers or health care institutions and delivery systems to develop strategies to address this. So these standards really serve as that blueprint, offering 15 core elements that will help an organization understand how to adopt and implement these strategies, and also to evaluate how the organization is doing with regard to providing culturally and linguistically appropriate services.

Examples include:

  • Recruit, promote and support a culturally and linguistically diverse governance, leadership and workforce that are responsive to the population in the service area.
  • Partner with the community to design, implement and evaluate policies, practices and services to ensure cultural and linguistic appropriateness.

NPH: Do you think the health delivery system can serve as an entry point for creating cultural respect for diverse communities in other aspects of society as well?

Gracia: With the growing diversity of our nation, it is vital that we understand that connection between culture and language and health equity so that truly all Americans have the opportunity to live a healthy life.

We, as a country and certainly as a world, are becoming more and more diverse. When we think about that diversity and talk about culture, it is race, ethnicity and language, but also disability status, spirituality, religion, sexual orientation, gender identity and socioeconomic status. In the changing landscape of the transformation of health care that we are currently experiencing through the Affordable Care Act, the urgency and the importance of cultural and linguistic competency is more paramount than ever.

The Office of Minority Health has created a website that lists the updated CLAS Standards and provides in-depth information on the importance of governance and leadership embracing cultural and linguistic competency and driving that in the mission and operations of organizations. The site also offers e-learning curricula to become more familiar with the principles and practice of cultural linguistic competency.

>> Bonus Content: View an RWJF infographic on the financial toll of health disparities.

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Tags: Barriers to care: language and literacy, Faces of Public Health, Health disparities, Language services