1. By: Stephanie McLaren Culture, Ethnicity, and Health Dr. Perez

2.  Whether in access, quality care, or insurance coverage, one of the many factors causing inequalities in healthcare status in the United States.  Persistent gaps between health status of minorities compared to non-minorities.  Despite the advances in health care, minorities are still facing disease, disability, and premature death in comparison to non- minorities

3.  Most important causes of ill health, since poverty may result in:  Poor nutrition  Overcrowded living conditions  Inadequate clothing  Low levels of education  Housing sited in areas with greater environmental dangers (i.e. Toxic chemicals)  Exposure to physical and psychological violence  Psychological stress  Drug and alcohol abuse

4.  The number of minorities are increasing at a rapid rate.  Race is still a factor in determining whether an individual receives care, receives high quality care, and in determining health outcomes.  Persistent barriers between patients, health care providers, and the healthcare system exists.

5.  Inadequate access to care  Barriers to care can result from economic, geographic, linguistic, cultural, and health care financing issues.  The quality and intensity of care can still be poor even with individuals having similar levels of access to care, insurance, and education  Substandard Quality of care  Lower quality care can be caused by patient- provider miscommunication, provider discrimination, stereotyping, and prejudice.

6. -Effectiveness -Patient Safety -Timeliness -Patient Centeredness

7.  Raising patient and provider awareness of racial/ethnic disparities in health care  Expanding health insurance coverage  Improving the capacity and number of providers in underserved communities  Increasing the knowledge base on causes and interventions to reduce disparities

8.  Develop interventions to examine the:  Level of training health care providers receive in offering culturally and linguistically appropriate services.  Increased use of electronic medical records to decrease medical errors and improve coordination of care  Increased use of financial incentives to promote high quality health care

9.  The framework focuses on recommendations in achieving:  Organizational cultural competence  Systemic cultural competence  Clinical cultural competence

10.  Programs that promote minority involvement in leadership positions  Organizations that will make it a priority to hire and promote minorities in the health care workforce  Seek out community representatives that will be involved in health care organization’s planning and quality improvement meetings

11.  On-site interpreters should be present at health care settings where there is a large proportions of patients who have limited English proficiency (LEP).  Appropriate level of health literacy, language proficiency, and cultural norms for the population being served should be reflected in information given to patients by health care providers

12.  Researchers should focus on identifying tools that result in medical errors due to lack of systemic cultural competence (i.e. taking prescriptions incorrectly).  The federal government should enforce Title VI requirements mandating the provision of interpreters in health care settings

13.  Cross-cultural training should be required amongst health care providers  Culturally and linguistically appropriate patient survey methods should be included in quality improvement efforts  Programs should be implemented to get patients more involved in the clinical encounter

14.  Betancourt, Joseph R., MD. “Cultural Competence in health care: Emerging Frameworks and Practical Approaches”. The Commonwealth Fund. http://www.hawaii.edu/hivandaids/Disparity/Cultural_ Competence_in_Health_Care__Emerging_Frameworks _and_Practical_Approaches.pdf. (October 2002). http://www.hawaii.edu/hivandaids/Disparity/Cultural_ Competence_in_Health_Care__Emerging_Frameworks _and_Practical_Approaches.pdf  National Partnership for Action. “Health Care Disparities”. U.S. Department of Health & Human Services. http://www.omhrc.gov/npa/templates/browse.aspx?lvl= 1&lvlid=13. (1 April 2009). http://www.omhrc.gov/npa/templates/browse.aspx?lvl= 1&lvlid=13