The Emergence of Cultural Competency and Connectivity to Health Literacy/Language Access IOM Roundtable on Health Literacy October 19, 2015 Guadalupe Pacheco, MSW 1

Themes of Presentation Definition and Key Concepts of Cultural Competency Trends/Drivers facilitating the integration of Cultural Competence, Health Literacy, and Language Access Services ✓ Demographics, Health Disparities/Costs/ Legislative Authorities/Accreditation Bodies/Literature Summary 2

The ability of an organization and/or individual within the health care delivery system that provides effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs of the patient. The ability of an organization and/or individual within the health care delivery system that provides effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs of the patient. *Source: Adapted from the National CLAS Standards, DHHS/OMH, 2013 Cultural Competence--Definition 3

Key Concepts of Cultural Competency Health beliefs—lens of the patient, punishment from god, bad behavior, curses, issues death, fatalism Addressing the communication needs of the patient, language preference and addressing health literacy issues –questioning of physicians (authority figures) Providing Patient-Center Care—equitable care Developing a workforce that is inclusive of the demographics of the community Sources: The Future of Diversity and Inclusion in Health Services and Policy Research: A Report on the Academy Health Workforce Diversity 2025 Roundtable, September, 2015; Systems Change for Greater Cultural Competence in The Pennsylvania Disability Service and Support Sector, A Report to the Pennsylvania Developmental Disabilities Council, 2011; Healthcare Risk Control, ECRI, Vol,2, July

U.S. Population Trends *Sources: U.S. Census Bureau, Population Reference Bureau,

America's estimated 2.5 million gay seniors are twice as likely to live alone, four times less likely to have adult children to help them, and far more fearful of discrimination from health care workers. Older adults may not be aware of the services recommended for their age group or may not know that the services are covered by Medicare. Young people from racial and ethnic minority groups in the United States suffer disproportionately from a number of preventable diseases and health problems. American Indians and Alaska Natives have a lower life expectancy than other Americans perhaps due to economic adversity and poor social conditions. Disparities in America *Source: CDC/Kaiser Health Facts,

Drivers of Health Care Costs Combined cost of health inequalities and premature death in the U.S. is $1.24 trillion. Eliminating health disparities for minorities would have reduced direct medical care expenditures by $229.4 billion in Source: LaVeist, Gaskin, Richard,

Limited English- Proficient Populations Approximately 35 million U.S. residents are foreign born; Approximately 55 million people (19.7% of the U.S. population) speak a language other than English at home; and More than 25 million people (8.7% of the U.S. population) speak English less than "very well" and are considered LEP. Source: U.S. Census 2013, ACS 8

Legislative Authorities/Policies/Accreditation Bodies Issuance of HHS National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (2000/2013) HHS Office of Civil Rights Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition against National Origin Discrimination Affecting LEP Persons (2000/2003) Patient Protection and Affordable Care Act of 2010 The Joint Commission/National Committee for Quality Assurance At least five states have passed legislation mandating some form of cultural competency requirements into their health care delivery systems* *Source: HHS OMH Think Cultural Health,

CLAS Awareness: State Level Cultural Competency Legislation *Source: Think Cultural Health,

CLAS Awareness: : Publications/Citations * Reported citations are approximated based on Web of Science® analysis reporting. 11

Summary Addressing the needs of the patient from their lens (cultural beliefs/practices, language, health literacy) are crucial in delivery culturally appropriate care—person- centered care/equitable care. Demographics, health disparities, costs, legislative authorities/policies, accreditation bodies and literature are drivers for the delivery of cultural competent care. 12

Contact Information: Guadalupe Pacheco, President/CEO Pacheco Consulting Group, LLC 1516 U Street, NW Washington, DC (202) (202) (fax) Power-point:©Copyright 2015 All Rights Reserved, Guadalupe Pacheco 13