1. © 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective Chapter 16

2. © 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  The Emergence and Growth of the City of St. Louis  St Louis was the 8 th largest City in US, now is the 50 th,  Health disparities  Indicators like life expectancy, infant mortality, maternal mortality, HIV, AIDS, STD : bad outcomes  Multiple ethnicity: Founded in 1764 1803 Trade Center 1847 Laws against Blacks education 1875 High School education for Black children Currently still controversies about quality of education in minority population

3. © 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  Health Disparity in St. Louis: How Did It Happen?  The Genesis of Disparities AA are largest group in St. Louis. Poor health outcomes: lifestyle factors, AA identity theory  Multiples theories: Defective gen hypothesis Ghetto miasma hypothesis Social factors : income, education, occupation, family status, coping with stess

4. © 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  Financial Disparities CEO $ 3.13 millions vs. Average worker $37.900

5. © 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  The question of Racism American theory : all men were created equal 1015-9 mayor interracial disturbances 1991 TV documentary with several disparities seen. Association of racism and disparate health care outcomes

6. © 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective Dred Scott Emancipation Proclamation Black H.S. RiotWW II DesegregationRace Docume ntary 1857186318851917194119521991

7. © 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  Education and its role on healthcare disparities in St. Louis Public School Board : very little progress toward excellence in education for all Poorly outcomes Poor leadership? Poor health literacy

8. © 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  Cultural Proficiency in Clinical Medicine Cultural competency: success of outcome Cultural competency interview requires patience, make pt comfortable, knowledge, attitude, skill to assure that their interpretation of circumstances and their beliefs system will be accepted and respected

9. © 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  The St. Louis Perspective: How Can We Make It Better? Challenge how to educate professionals and provide them with skills, attitude, and knowledge to provide culturally competent care Medical Schools leadership, change attitude needed and better understanding of health disparities Current practitioners should strive to understand their own weaknesses of cultural proficiency Increase admission of minorities in Medical Schools Capitalizing the presence of AHEC Local medical societies take ownership of programs in Health disparities to educate professionals

10. © 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective

11. © 2010 Jones and Bartlett Publishers, LLC Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective  Summary Commitment from the City and the government Government as a Stakeholder Weakly teaching, programming, health education, emergency preparedness, and dissemination of other important health information for the public Need of resources Community has resources Multidisciplinary team effort