The Importance of Culturally Competent Care: Needed Now More Than Ever
Find NP Schools
The Covid-19 pandemic has tested our healthcare system, touching every community in our country and shining a very bright light on socioeconomic and health disparities. While healthcare inequality is nothing new—in fact, I took three courses on the topic throughout my nursing education—the pandemic has exacerbated and awakened this monster, showing publicly the structural inequalities that prevent everyone from receiving the right care in the right way. Now more than ever, nurse practitioners must deeply understand, provide, and advocate for culturally competent care.
This article provides an overview of health disparities in the United States, introduces the concept of culturally competent care, and encourages all nurses and nurse practitioners to continue to practice and support a better, more inclusive health system.
Health Disparities in the United States
A health disparity is a term used in healthcare referring to a higher burden of illness, injury, disability, or mortality experienced by one group relative to another. It’s typically most apparent when comparing differences between a group’s health insurance coverage, access to care, and the quality of care received.
Most commonly, health disparities are thought of among racial and ethnic groups, but it also applies to sexual orientation, gender identity, age, disability, socioeconomic status, geographic location, and any other characteristic that has been historically linked to discrimination or exclusion.
It’s important to note that health and healthcare disparities are those differences that are not explainable by variations in needs or preferences, but instead are closely linked with social, economic, and environmental disadvantages.
Another common term you’ll hear is social determinants of health. The Centers for Disease Control (CDC) defines these as the conditions in which people live, learn, work, and play, and they have more impact on your health than you might expect.
From public health expert Robyn Correll, here are a few striking examples of well-known health disparities in the United States:
- Infant mortality: Babies born to Black women in the United States die at more than double the rate of babies born to white women.
- Dementia: Black people also have the highest risk for dementia, and are twice as likely to develop Alzheimer’s disease than whites in the United States.
- Cancer: Individuals with less education and lower incomes are more likely to get cancer and to die from it compared to more affluent individuals, and this gap appears to be widening.
- Obesity: Even after controlling for family income, rates of obesity in Black women and Mexican-American men are significantly higher than in other races or ethnic groups.
- Smoking: Native American/Alaska Native men and women have disproportionately higher rates of smoking. Those individuals living below the federal poverty level and those who are unemployed also have higher rates of smoking compared to the general population.
- Binge drinking: Younger, non-Hispanic white men are more likely than other groups to binge drink (5+ drinks in a two-hour period).
The Uneven Impact of Covid-19
Covid-19 has revealed “striking” socioeconomic and health care equalities in the United States, according to recent study by the Infectious Diseases Society of America and the HIV Medicine Association.
Covid-19 has disproportionately affected minorities and underserved communities like those in correctional facilities, rural and immigrant populations, people with disabilities,and individuals experiencing homelessness.
Only 40 of our 50 states are reporting Covid-19 deaths by race and ethnicity, so data is incomplete. However, some available statistics indicate:
- The mortality rate for African Americans is 2.4 times as high as the rate for whites
- Latinx individuals are twice as likely to die than whites
- Black and American Indian/Alaska Native populations have a hospitalization rate 4.5 times that of whites
- The Navajo Nation and Hopi Reservation have reported one of the highest per capita case rates with over 2,500 per 100,000 people
Specifically, African Americans, Latinx, and Native American communities face unique challenges:
- Disproportionately impacted by structural racism
- More likely to be uninsured
- Experience higher rates of pre-existing and underlying health conditions
- More likely to be low wage frontline workers
Why Do These Healthcare Disparities Exist?
The root causes are complex but they’re often related to income inequality, as well as systemic discrimination and exclusion.
Healthcare in the United States is expensive, costing about twice as much here than in other, comparable high-income countries. We pay more for services, treatments, and medications, and as the income gap widens, poorer Americans just can’t afford to cover the basic costs of healthcare anymore. And, as is often the case, delayed care means more expensive treatments down the road.
Racism, sexism, ableism, classism, and homophobia perpetuate inequalities and these forces can be so deeply ingrained that people may not even realize they’re happening. Camara Phyllis Jones, and American epidemiologist and civil rights activist, wrote the famous story, The Gardener’s Tale, to illustrate the effects of these systemic social drivers:
Imagine, two flower boxes: One with new, nutrient-rich soil and another with poor, rocky soil. Seeds planted in the nutrient-rich soil will flourish, while seeds in the poorer soil will struggle. As the flowers go to seed, the next generation will drop into the same soil, experiencing similar struggles or success. As this happens year after year, one box of flowers will always be more vibrant than the other due to the original condition of the soil. When people are separated and given different resources to start with, that is going to have an impact for generations to come.
What is Culturally Competent Care?
In the worlds of Dr. Larry Purnell, PhD, RN, FAAN, author of Transcultural Health Care: “Cultural competence is developing an awareness of one’s own existence, sensations, thoughts, and environment without letting it have an undue influence on those from other backgrounds; demonstrating knowledge and understanding of the client’s culture; accepting and respecting cultural differences; adapting care to be congruent with the client’s culture.”
Cultural competence refers to understanding and respecting the values and attitudes of others with the goal of optimizing the healthcare experience for patients with cross-cultural backgrounds.
Ultimately, culturally competent care aims to reduce health disparities and provide the highest quality care for patients regardless of their race, gender, ethnic background, language spoken, and/or religious or cultural beliefs.
Cultural competence means learning about cultural differences, recognizing how they may impact healthcare decisions, and being able to modify your care to align with that patient’s culture. This type of care has been led and advocated for by the nursing profession for decades.
Jane Lauderdale, PhD, RN, FAAN summarized the importance of having a culturally competent practice framework: “Cultural competence is not about race or gender or morality; it’s about patient outcomes; it’s about openness and acceptance—with every patient, every day.”
Why Culturally Competent Care Matters
Culturally competent care is important because as healthcare providers, we have taken an oath to do no harm. Our job is to serve, heal, and improve other’s quality of life regardless of their race, gender, religion, or ethnic background.
It matters because diversity isn’t going away. Actually, America is getting more and more diverse, soon becoming a minority-majority nation. According to an article from NPR, the most recent census found that all racial and ethnic minorities are growing faster than non-Hispanic whites, and Asian and mixed-race people are the two fastest-growing segments.
Furthermore, a study by the National Academy of Sciences found that while non-Hispanic whites remain the single largest group, the nation is actively experiencing a major historic shift in the diversity of its population. Over the coming decades, America’s Hispanic, Asian, and multiracial populations will more than double. Sometime after 2040, no racial or ethnic group will make up the majority, bringing a wave of new values, preferences, and meanings that individuals bring to the healthcare system.
Finally, it matters because it’s expensive to ignore. Addressing health care disparities improves health broadly and increases the overall quality of care and population health for all. The W.K. Kellogg Foundation estimates that disparities amount to approximately $93 billion in excess medical care costs and $42 billion in lost productivity every single year.
Build Your NP Cultural Competence
In the context of the Covid-19 pandemic, now more than ever, nurses and nurse practitioners must strive for cultural competence in order to combat the increasing health disparities.
Start with awareness. Seek to learn and understand the composition of your community. Who in your area may be particularly susceptible and in desperate need for culturally sensitive healthcare? Educate yourself and share what you learn with co-workers. Approach your learning with openness and positivity, and refrain from criticism.
Avoid making assumptions. If something is different or unusual, just ask. Asking with a kind, open tone will actually help you build trust and rapport with your patients. Be mindful of your body language and facial expression, listen actively as patients share their culture with you, and thank them for their honesty.
Always do what you can to overcome language barriers. Seek out a translator or translation technology immediately to ensure you and the patient can adequately understand each other. This will also promote trust, build rapport, and foster a positive relationship between you and the patient.
Want to learn more and become an advocate for culturally competent care? Check out the Transcultural Nursing Society, who offer a certification for both registered nurses and advanced practice nurses.
You may also wish to join and/or support a diversity nursing association:
- American Assembly for Men in Nursing (AAMN)
- Asian American/Pacific Islander Nurses Association, Inc. (AAPINA)
- Black Nurses Rock (BNR)
- National Alaska Native American Indian Nurses Association, Inc. (NANAINA)
- National Association of Hispanic Nurses, Inc. (NAHN)
- National Association of Indian Nurses of America (NAINA)
- National Black Nurses Association (NBNA)
- National Coalition of Ethnic Minority Nurse Associations (NCEMNA)
- National Indian Nurse Practitioners Association of America (NINPAA)
- Philippine Nurses Association of America, Inc. (PNAA)
Melissa DeCapua, DNPWriter
Dr. Melissa DeCapua is a nurse practitioner working at Microsoft on organizational behavior and culture change. She began her career in psychiatry and fine arts, and these skills fuel her passion for user experience (UX): building programs, conducting qualitative research, and designing services. By night, she continues to advocate for nurses through lobbying efforts, blogging, and volunteering. For more about Melissa, check out her website and follow her on LinkedIn and Twitter.