Managing Global Health Challenges: Cultural Competency and Health Disparities

Dr. Sonja Boone, the chief medical officer of Alegis Care, spoke to more than 20 students about cultural competency and health disparities in the United States in Annenberg Monday, February 8th, as part of Professor Michael Diamond’s “Managing Global Health Challenges” course.

Boone opened the lecture by breaking down the factors that influence doctor-patient relations, an important part of providing healthcare in a society where patients can be intimidated by medical culture.

“Trust is huge in creating that relationship that leads to compliance in the patient,” Boone said. “That leads to better interaction and communication between the physician and the patient.”

One way that doctors establish trust with their patients is through cultural competency. According to the National Quality Forum, cultural competency is the ability to give patients care that is sensitive and respectful of their backgrounds. Boone says this doesn’t mean caregivers should extensively study a wide variety of cultures: that can lead to stereotyping of patients. Instead, she advocates for communication.

“You want to talk to the patient, build rapport…you want to ask them ‘is it okay if I ask you some questions?’” said Boone. “You don’t just assume certain things.”

Culturally competent care is important both abroad and at home in the United States, according to Boone, because doctors need to make the most of their limited time with patients.

“If I have a handful of patients I need to take care of, I’m going to see a patient for about 15 minutes once a year,” said Boone. “That’s not a lot of opportunity to have a big impact on a patient’s health.”

For some Americans, the amount of time spent with health professionals is further shortened by health disparities in their communities. Health disparities are most often emphasized along racial lines, due to racial biases and the legacy of social policies like slavery and segregation. According to the Institute of Medicine’s 2002 Unequal Treatment Report, minorities tend to have decreased access to care, leading to worse health outcomes for nearly every disease or condition. However, Boone sees health disparities as a universal problem.

“[The issue of] Disparities is not just a matter of impacting minorities; it actually impacts everybody.” said Boone. “When you peel back the layers and really try to understand processes that are actually causing disparities, you find out that you can fix the process and everybody benefits from it.”

A 2009 study done by the Joint Center for Political and Economic Studies estimates that health disparities in the United States cost approximately $229.4 billion between 2003 and 2006. Emergency room bills and increases in chronic conditions comprise a lot of the cost, and are the result of individuals’ worsened conditions because they did not have regular access to preventative care when they were healthy or dealing with more minor ailments.

“You’re not getting the treatment that you need to improve your health and it’s episodic care [you are receiving], so you’re not getting preventative issues addressed at all,” said Boone.

Bringing better access to care and health education to the entire population could significantly reduce such expenses. Boone listed several organizations that are working to decrease health disparities throughout the United States, including the Health Resources and Services Administration, the Aetna Foundation and the Commission to End Health Care Disparities. She encouraged students to remember cultural competency and the problems of health disparities as they continue in their studies.

“I think we all have to think about what we can do,” said Boone. “You’d be surprised at what impact you can make.”

Boone was the first guest lecturer for Diamond’s class, which covers the effective overlap of biomedical technology with health policies at the local, national, and international levels for progress toward improved global health. From February 8th to 29th, weekly guest lectures in the class are open to the public.

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