|  Measures to improve cultural competence and ethnic diversity will help alleviate healthcare disparities and improve health care outcomes in these patient populations. Science and medicine are often used to support these perceptions (eg, phrenology), thereby convincing those in the socially more powerful, controlling group to accept the subjugation of others, to deny them access to care, and to practice brutality, enslavement, and other indignities. This dichotomy of views between minorities and the majority group points to the need for greater efforts to increase communication and awareness regarding health care disparities through cultural competency education. Thus, African Americans experience greater health care disparities than whites, even when data are adjusted for class, educational background, and health insurance. For immediate assistance, contact Customer Service: Private offices and facilities have been immune to the law, but measures are planned in state and local governments to overcome the limitations of the federal law. They also are at inordinate risk for developing such disease because of the high penetration of risk factors such as obesity, cigarette smoking, and improper diet. -, Chatterji P, Joo H, Lahiri K. Beware of being unaware: racial/ethnic disparities in chronic illness in the USA. Health is determined by many factors outside the traditional healthcare setting. The word “race” is derived from the Latin generatio (a begetting) and, according to anthropologist Elizabeth S. Watts,5 is a complex of semantic ambiguities. Her Theory of Cultural Care Diversity and Universality (1991) provides the foundation for providing culturally competent care for patients of all ages, as well as to families, groups, and communities (Ackley, 2011). Living in an increasingly multicultural society, nurses are regularly required to care for employees from a variety of cultural backgrounds. Dr. Williams is Clinical Professor of Medicine, UCLA School of Medicine, and President/CEO, The Minority Health Institute, Los Angeles, CA. In 2003, the Institute of Medicine (IOM) of the National Academy of Sciences released Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare.23 This report detailed the results of a long-term investigation commissioned by the US Congress on racial and ethnic differences in health care delivery, access to care, treatment outcomes, and other parameters. OMB-15 recognizes five races (American Indian and Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, White) and two ethnic groups (Hispanic or Latino, Not Hispanic or Latino). Health care environments attract a diversity of caregivers and patients. Online Journal of Issues in Nursing. Emphasis is placed on providing linguistic services and information to patients in their own languages via brochures, interpreters, and other means. It might be argued that most cases of racial discrimination are actually instances of social discrimination. There is not yet an even blend, and there may never be; homogenization does not come easily and perhaps should not be attempted. Abstract. Cruz-Flores S, Rabinstein A, Biller J, Elkind MS, Griffith P, Gorelick PB, Howard G, Leira EC, Morgenstern LB, Ovbiagele B, Peterson E, Rosamond W, Trimble B, Valderrama AL; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Epidemiology and Prevention; Council on Quality of Care and Outcomes Research. A patient from the Maya Indian town of Zinacantán in the highlands of Chiapas, Mexico, however, may not understand illness in the context of Western orthodox medicine, instead thinking of disease as a foreign process or spirit entering the body.3 A patient from Haiti who believes in voodoo medicine and has been treated for a cold with kerosene-soaked sugar cubes by a voodoo practitioner may not understand that he or she has developed serious renal disease because of this treatment and needs urgent medical attention to reverse it. Diversity in Healthcare “Today’s physicians, nurses, and dentists have too little resemblance to the diverse populations they serve, leaving many Americans feeling excluded by a system that seems distant and uncaring. Many of these theoreticians have been funded by the ultraconservative Pioneer Fund, which supports eugenics initiatives.16. Overall life expectancy improved during the 20th century for all groups but remains lowest for African Americans. 44. Get new journal Tables of Contents sent right to your email inbox, http://www.census.gov/prod/2006pubs/p60-231.pdf, http://www.omhrc.gov/assets/pdf/checked/finalreport.pdf, http://www.census.gov/main/www/cen2000.html, http://www.census.gov/population/www/projections/natsum.html, http://www.census.gov/main/www/cen1990.html, http://www.ahrq.gov/qual/nhdr06/nhdr06.htm, Articles in PubMed by Richard Allen Williams, MD, Articles in Google Scholar by Richard Allen Williams, MD, Other articles in this journal by Richard Allen Williams, MD. Sharma K, Grant D, Parikh R, et al. A study of cardiologist awareness by Nicole Lurie, MD, of the RAND Corporation, performed in conjunction with Duke University, the American College of Cardiology, the Association of Black Cardiologists, Louisiana State University, and the Society of Thoracic Surgeons, showed that only 34% of 344 cardiologists polled agreed that disparities exist overall in the US health care system.44 Only 12% felt that disparities exist in their own hospitals, and only 5% felt that they exist in the treatment of their own patients. 2016;138:354–361. Title VI of the Civil Rights Act of 1964 makes racial discrimination illegal in the United States.42 Health care practitioners must heed this law because it applies especially to discrimination in public accommodations, such as hospitals receiving federal funds. Given that most minority patients are treated by physicians from the majority group, these principles are extremely important. A framework for cultural competence in health care organizations. Sorlie PD, Backlund E, Johnson NJ, Rogot E: Mortality by Hispanic status in the United States. The common denominator in racial and ethnic bias is the bigoted perception, developed by one group about another group that differs in some way, that the bigoted group is somehow superior. The foremost step is for healthcare organizations to proactively commit to not only increasing the diversity of their workforces, but to investing in the continued cultural competence and education of their providers. -, Alegría M, Canino G, Ríos R, et al. Hispanic Americans are at particular risk for several diseases, such as diabetes mellitus, tuberculosis, hypertension, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), alcoholism, cirrhosis, cancer, and death from violence.31 The Hispanic Health and Nutrition Survey found hypertension to be lower in Hispanics than in comparable groups of whites and African Americans.32 Cardiovascular disease is surprisingly low among Hispanic Americans, despite the relatively high prevalence of risk factors such as obesity and diabetes. I have also had the honor of writing and editing several publications concerning humane health care delivery and the elimination of health care disparities. The most notorious example was the development of the pseudoscience of phrenology, invented by Franz Josef Gall.8 Through phrenology, medicine aided and abetted proponents of slavery by indicating that measurements of human skulls with calipers, pioneered by Retzius, demonstrated that whites had larger internal skull capacity and, therefore, larger brains and more innate intelligence than did blacks.9 The inference was that blacks were lower creatures and were deserving of being enslaved. Flores G, Abreu M, Olivar MA, Kastner B: Access barriers to health care for Latino children. Young 2016a - Young S, Guo KL. The controversy surrounding BiDil is one of the reasons that many African American patients have not received this life-saving drug. Only recently has there been a focus on the health of the Hispanic American community. US Department of Health and Human Services: 41. 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