Why is Cultural Competency Important in the Practice of Medicine? Karen E. Schetzina, MD, MPH

Cultural Competency Framework Awareness Knowledge SkillsAttitudes Behaviors

Definition of Health Disparities “... [include] differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.” U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd ed. Washington, DC: U.S. Government Printing Office, November 2000.

Cardiac disease Diabetes Infant mortality Hepatitis Tuberculosis HIV Infections/AIDS Cancer screening and management Immunizations Minority Populations are Disproportionately Affected

Disparities in Health Care The Kaiser Family Foundation (2002) National Survey of Physicians: Doctors on Disparities in Health Care Institute of Medicine (2002) Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care The Commonwealth Fund (2002) Minority Americans Lag Behind Whites on Nearly Every Measure of Health Care Quality

Kaiser National Survey of Physicians

“Disparities in the health care delivered to racial and ethnic minorities are real and are associated with worse outcomes in many cases, which is unacceptable.”-- Alan Nelson, retired physician, former president of the American Medical Association and chair of the committee that wrote the Institute of Medicine report, Unequal Treatment: Confronting Racial and Disparities in Health Care IOM Report, 2002: Assessing the Quality of Minority Health Care

Racial Disparities in Care Do Exist Institute of Medicine Report, 2002 The evidence is “overwhelming” Disparities exist even when insurance status, income, age, and severity of conditions are comparable Minorities are less likely than whites to receive needed services Disparities contribute to worse outcomes in many cases Differences in treating heart disease, cancer, and HIV infection partly contribute to higher death rates for minorities Source: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, March 2002.

Healthy People 2010: Healthy People in Healthy Communities Overarching goals: Increase quality and years of healthy life Eliminate health disparities

Changing U.S. Population 1995–2020

California’s Population 1995–2020 Persons Aged 0-19

Health Care Issues Important for Reducing Ethnic Health Disparities Increase availability of and access to insurance programs for all children Address ethnic disparities in the health care workforce Racial and ethnic minority groups must be included in research and considered in the design of interventions Interventions must be designed with all racial/ethnic groups in mind Health care providers must be culturally competent

Cultural Competency Framework Awareness Knowledg e SkillsAttitudes Behaviors