How to Advance Minority Health? A Diverse, Culturally Competent Health Care Workforce.

Apr 29, 2014, 9:00 AM

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Michelle L. Odlum, BSN, MPH, EdD, a postdoctoral research scientist at Columbia University School of Nursing, responds to the question, “Minority health is advanced by combating disparities and promoting diversity. How do these two goals overlap?” Odlum has more than ten years of experience as a disparities researcher. She is a recipient of an RWJF New Connections Junior Investigator award.

As a health disparities researcher, my health promotion and disease prevention efforts are rooted in sociocultural aspects of health. This approach is critical to improved outcomes. In fact, when socioeconomic factors are equalized, race, ethnicity, and culture remain contributing factors to adverse minority health. I have come to understand that the key to combating health disparities lies heavily in cultural understanding. A diverse, culturally competent health care workforce is essential to health equity.

The Office of Minority Health (OMH) at the U.S. Department of Health and Human Services identified cultural competency as integral to the elimination of health disparities. Aligning with the patient-centered care model, cultural competency promotes care that respects and responds to the cultural factors impacting health outcomes. These are not new concepts, as the term was coined more than 25 years ago. The question is: How can our health care sector effectively improve culturally competent patient-centered care? Two solutions have been proposed: a diverse health care workforce and cultural sensitivity training.

The need for a diverse health care workforce, representative of the cultural makeup of the United States, is the subject of ongoing conversation. A variety of organizations, including RWJF, have invested heavily in workforce diversity efforts. However, this is one half of the pie. Providers cannot be culturally compartmentalized in patient care. Cross-cultural care is essential, as diversity goes beyond the understanding of the practices and beliefs of racial and ethnic minorities. Diversity also includes faith, gender, age, sexual orientation, occupation, and other aspects of the human condition further enhanced by culture. Providers must be able to communicate openly, accept differences, understand similarities, and learn from cultural informants, thus reinforcing the patient-centered model of care.

The need for cross-cultural care should drive training programs and continuing education efforts. Effective cultural competency training is the other half of the pie. Cultural exploration in care during training programs allows for awareness and knowledge seeking, and presents trainees with diverse encounters for skill development. A variety of assessment tools and conceptual frameworks for cultural assessments exist; however, an evidence-based, systematic approach to skill development will be most effective for far-reaching outcomes. The question then becomes: How can the government facilitate and contribute to this pie?

The Affordable Care Act (ACA) offers multiple opportunities to further diversify the health care workforce. The ACA will invest in the training of culturally diverse health care paraprofessionals, such as home health aides. Money will be allocated for scholarships and loan forgiveness. Community health teams, an ACA investment, will allow providers to diversify care teams. The ACA has also committed to cultural competency curriculum development for the training of incumbent workers. A five-year rollout is scheduled for these initiatives.

OMH has released the enhanced National Culturally and Linguistically Appropriate Services Standards in Health and Health Care. I believe a combination of standards and individual and organizational-level incentives can facilitate change. Although promising, cautious optimism is required as we continue to roll out and evaluate efforts to improve our health care culture of inclusion.

See all the blog posts in this series.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.