1. "21st Century Medicine: A Case for Healthcare Diversity & Cultural Competency" Presented By Sonja Boone, M.D. Director of Physician Health & Healthcare Disparities American Medical Association Presented To: Diversity Rx Conference Seventh National Conference on Quality Health Care for Culturally Diverse Populations October 19th, 2010

2. Agenda Learning Objectives Health Disparities & Patient Populations What Is Diversity & Cultural Competency? Efforts to Eliminate Disparities: The Commission to End Health Care Disparities Summary and Discussion

3. Learning Objectives

4. Explain the different meanings of diversity, cultural competency and disparities; Describe the impact and scope of health care disparities; Detail the importance of healthcare workforce diversity; and Outline various provider-based tools for skill- building in cultural competency and national efforts to eliminate healthcare disparities.

5. US Demographics

6. America’s Changing Demographics

7. Increasingly Diverse Community Largest Growth in Latino Population Source: 1980, 1990 & 2000 - US Census; 2008 – Thirdwave 2003, Claritas 2003 1313 Population in the City of Chicago & PSA by Race/Ethnicity, 1980-2008* 0 200 400 600 800 1,000 1,200 1,400 198019902000Forecast 2008* Population (Thousands) White African- American Hispanic Asian

8. Health Care Disparities

9. What is a healthcare disparity? Disparities in health care describes the gap identified in the health outcomes of Minorities when compared with non-Minorities; because of long-standing racial bias and unequal care, minorities experience poorer outcomes in every health category and often have less access to care.* *Source: 2002 IOM Report-Unequal Treatment

10. Why Is It Important to Address Disparities? This is one of the nation’s most serious health problems Disparities are costly By 2050, nearly 50% of Americans will be Minority

11. Factors That Contribute to Disparities Language Barriers Cultural Barriers Literacy Levels Provider Bias Unequal Treatment

12. Leadership Demographics Cultural Competence Commitment to Diversity Organization Processes Culture More Factors That Contribute to Disparities

13. Patient Factors That Contribute to Disparities Mistrust of Providers Socially, Negative Racial Experience Within and Outside Healthcare Age Discrimination Experienced Routinely by Elderly Patients Real and/or Perceived Mistreatment by Providers

14. Provider Factors That Contribute to Disparities Minorities such as Latinos, African Americans and Native Americans are underrepresented in healthcare, representing… Less than 6% of Doctors Less than 9% of Nurses Less than 30% of the Workforce Less than 7% of Managers

15. Provider Factors Continued… Prejudice and Bias Misperceptions by Providers of Patient Stamina Cultural and Communication Barriers

16. The Role of CME It is the responsibility of all medical professionals to deliver care that is always of the highest caliber to all patients. Education of all physicians—throughout their training and through continuing medical education (CME) credits should have goals -to increase their awareness of disparities and, -to increase skills in delivering care to diverse patients “It is imperative that there be a simultaneous process of self- reflection (realistic and ongoing self-appraisal) and commitment to a lifelong learning process. In this way, trainees are…flexible and humble enough to say that they do not know when they truly do not know and to search for and access resources that might enhance immeasurably the care of the patient as well as their future clinical practice.” Tervalon and Murray-Garcia

17. Percentage of Patients Who Felt They Were Looked Down Upon/Treated With Disrespect by Their Doctors Source: J. Blanchard and N. Lurie, “R.E.S.P.E.C.T.: Patient Reports of Disrespect in the Health Care, Setting and It’s Impact on Care”, Journal of Family Practice. 53(Sep.2004):721

18. What is Diversity?

19. Diversity… Encompasses all of the ways that human beings are both similar and different with respect to: Race, gender, age, sexual orientation, religious and cultural beliefs, living with a disability, language, and socio-economic status & veteran status “Any collective mixture characterized by similarities and differences” -AIMD

20. Why Is Diversity Important?

21. It is a business imperative that is operationalized It’s a community responsibility It’s a moral issue It’s a legal issue There is a strong business case: Source of patients/market share-reflecting patients served To address workforce shortages Improve capabilities—more input/perspectives into what works Community relations improved

22. What is Cultural Competency?

23. Cultural Competency Is… Delivery of care that is both sensitive to and respectful of the patient's cultural background and health beliefs.

24. Diversity/Cultural Competency link to Disparities To eliminate disparities, diversity initiatives for healthcare staff and education for providers must take place to foster better communication Organizational culture shifts towards inclusion and cultural competency usually must take place for an organization to become more diverse and culturally competent in delivering care Diversity & Cultural Competency must be elevated to the level of Patient Safety and Quality in hospitals Diversity Goals must be incorporated into the Mission & Business Goals of the Medical School

25. Efforts to End Healthcare Disparities

26. Organizations Working to Eliminate Disparities I. Institute of Medicine, Multiple Reports II. Joint Commission Reports III. Commission to End Health Care Disparities IV. Toolkits and Products

27. Institute of Medicine Recommendations to Enhance Healthcare Diversity I. Pipeline - Mission/Admission/Training II. Accreditation Body's to Formulate and Enforce Standards that Increase Minorities in Healthcare III. Institutional Climate that Values Diversity IV.Institutional Objectives should be Consistent with Community Benefit Goal of Increasing Workforce Diversity

28. Commission to End Health Care Disparities

29. CEHCD: Disparities Addressed Products of the Commission Workforce & Physician Awareness Committees: - Speaker’s Bureau Slides - Cultural Competency/Disparities Training Workshop - Doctors Back to School-AMA Minority Affairs Consortium Program developed in 1999, adopted by CEHCD resulting in up to 17,000 students reached in 2 years - Position Papers

30. Summary

31. I. Disparities are rooted in the system of healthcare leading to a complex scope of issues to be addressed (cultural, organizational, process). -Dedicated efforts to end disparities must start with the leadership -Dedicated Clinical Research on the topic is imperative II. Minority patients are often in more than one protected group, compounding possible negative encounters with the healthcare system and providers. More research may uncover solutions to disparity in treatment of other populations such as the elderly. III. Discussion Points

32. Question and Answer Discussion

33. Information/Other Sources: American Medical Association website: www.ama-assn.org Commission to End Health Care Disparities website: www.ama-assn.org/go/end disparities The National Healthcare Disparities Report http://www.ahrq.gov/qual/nhdr03/nhdrsum03.htm Office Of Minority Health http://www.cultureandhealth.org/develop/ccdevelop/ccdevelop.asp Closing the Gap -http://www.healthgap.omhrc.gov

34. "21st Century Medicine: A Case for Healthcare Diversity & Cultural Competency" Presented By Sonja Boone, M.D. Director of Physician Health & Healthcare Disparities American Medical Association Presented To: Diversity Rx Conference Seventh National Conference on Quality Health Care for Culturally Diverse Populations October 19th, 2010