Role of Cultural Proficiency in Eliminating Health Disparities Book

Foreword ix

Acknowledgments xi

Introduction xiii

List of Contributors xv

Chapter 1 Addressing Health Disparities in the 21st Century Rubens J. Pamies Phyllis A. Nsiah-Kumi 1

Overview of Health Disparities 1

Definition of Health Disparities 1

Models of Health Disparities 3

Factors Contributing to Health Disparities 5

Need for Relevant, Effective Interventions 7

Historical Perspectives of Health Disparities 8

Contemporary Disparities 9

Progress on Eliminating Disparities 14

Health Workforce Education 14

Cultural Competence and Trust 16

Communication and Disparities 16

Environmental Disparities 18

Solutions for the Reduction/Elimination of Health Disparities 18

Chapter 2 Race/Ethnicity, Trust, and Health Disparities: Trustworthiness, Ethics, and Action John R. Stone Annette Dula 37

Trust and Trustworthiness: Meanings, Distinctions, and Relevance 38

Addressing Trustworthiness: From Theory to Principles to Action Guides 43

What Health Professionals and Institutions Should Do 50

Chapter 3 Justness, Health Care, and Health Disparities Judith Lee Kissell 57

The Idea of Health Disparities 59

How Justness and Health Disparities Might Be Considered an Ethics Afterthought 60

The Turn Toward "Professionalism" 62

Justness from a New View 65

Chapter 4 The Role of Academic Medical Centers in the Elimination of Racial and Ethnic Health Disparities M. Roy Wilson Vanessa Gamble 73

Recruiting for Diversity 75

Cultural Competency Training 77

Health Disparities Research 80

Advocacy 82

Chapter 5 Nursing Perspectives in Addressing Health Disparities Valda Ford 87

"We just want to be treated like everybody else." 87

"Water, watereverywhere, but who's stopping to drink?" 88

"Never trust anybody over 30? Why, they're talking about me!" 88

"Oh, come on, Valda. You're being much too sensitive!" 89

The Role of Nurses in Promoting Cultural Competency 90

Demographic Challenges to Contemporary Nurses 91

Nurses Bridging the Gaps 92

Adding Insult to Injury 96

The Many Faces of Patient Vulnerability 97

The Ground Meat Parable, or "If I really listen I will understand." 98

Chapter 6 Full Circle: The Qualified Medical Interpreter in the Culturally Competent Healthcare System Janet E. Bonet 103

The Why and How of Language Access in Health Care 104

The Professional Interpreter: Beyond Bilingualism 106

Examples as Food for Thought 109

Chapter 7 Cultural Proficiency: Challenges for Health Professionals Richard L. O'Brien 117

Communication 118

Cultural Understanding 120

Trust 122

Actions by Others to Ensure Culturally and Linguistically Appropriate Care 123

Experiences of Minority Professionals 124

Chapter 8 Cultural Competency Research: Description of a Methodology. Part I Sade Kosoko-Lasaki Cynthia T. Cook 129

Background Information 130

Research Design 131

Appendix 8-A Community Assessment Instrument (Pre-Test) 137

Appendix 8-B Community Assessment Instrument (Post-Test) 146

Chapter 9 Cultural Competency Instrument: A Description of a Methodology. Part II Sade Kosoko-Lasaki Cynthia T. Cook 149

Background 150

Research Design 151

Appendix 9-A Cultural Competency Instrument (CCI) 156

Chapter 10 Statistical Models in Health Disparities Research Gleb Haynatzki Vera Haynatzka 159

Study Design 160

Health Disparities Measures 162

Statistical Models 170

Chapter 11 Addressing Health Disparities: The Hispanic Perspective Ann V. Millard Margaret A. Graham Nelda Mier Isidore Flores Genny Carrillo-Zuniga Esmeralda R. Sanchez 183

Access to Care 188

Immigration and Acculturation 189

Health across the Life Course 191

Chronic and Communicable Disease 194

Mental Health 199

Occupational and Environmental Health 200

Social and Behavioral Health 204

How to Address Health Disparities among Hispanics 206

Chapter 12 Health Disparities among Native American People of the United States Adeola O. Jaiyeola Wehnona Stabler 225

Historical Origins of Health Disparities in Native Americans 226

Federal Trust Relationship with Native American Tribes 227

Population and Socioeconomic Characteristics 228

Geographic Isolation and Cultural Barriers to Health Care 229

Mortality 230

Cardiovascular Diseases 233

Malignant Neoplasms 233

Unintentional Injuries 234

Diabetes Mellitus 235

Natality, Infant Mortality, and Maternal Health 236

Suicide 237

Substance Abuse 238

Sexually Transmitted Disease/HIV 238

Behavioral Health Risk Characteristics 239

Oral Health 239

Other Areas and Health Disparities 239

Population to Health Professionals Ratio 240

Indian Healthcare System 240

Addressing Health Disparities in American Indians 241

Chapter 13 Addressing Health Disparities in Immigrant Populations in the United States Patti Patterson Gordon Gong 247

Definitions of Immigrants, Foreign-Born Persons, Refugees, and Naturalized Citizens 248

The Numbers of Immigrants and Foreign-Born Persons in the United States 249

Health Disparities in Immigrant and Foreign-Born Populations 256

Access to Health Care among Immigrants 265

Policies and Practices Intended to Eliminate Health Disparities among Immigrants 266

Cultural Proficiency among Healthcare Providers and Researchers 267

Ethical, Legal, and Social Implications of Research with Immigrants as Subjects 271

Chapter 14 Minority Attitudes and Perception of Health Care: A Comparison of Comments from a Cultural Competency Questionnaire and Focus Group Discussion Cynthia T. Cook 281

Research Design 282

Results 284

Chapter 15 Health Disparities: The Nebraska Perspective Reverend Raponzil L. Drake Anthony Zhang Diane Lowe 311

Who Are the "Cornhuskers"? 311

Health Disparities in Nebraska 313

What Is Nebraska's Commitment Today? What Are We Doing? 316

Nebraska's Office of Minority Health and Health Disparities 317

State Financing for Nebraska's Public Health 318

Health Education of Racial/Ethnic Minorities 319

The Need for Public Health Leadership 320

Chapter 16 Cultural Proficiency and Health Disparity: The St. Louis, Missouri, Perspective Michael T. Railey 331

The Emergence and Growth of the City of St. Louis 332

Financial Development and Socioeconomic Disparities 333

Health Disparity in St. Louis: How Did It Happen? 333

The Genesis of Disparities 335

The Question of Racism 336

Education and Its Role in Healthcare Disparity in St. Louis 337

Cultural Proficiency in Clinical Medicine 337

The St. Louis Perspective: How Can We Make It Better? 339

Chapter 17 Health Disparities in the Pediatric Age Group Cristina Fernandez Cathy Hudson Karl S. Roth 343

Background 345

Literature Review 346

Pediatric Diversity 351

Education 352

Perceived Health Disparities 353

Healthcare Insurance 353

Chapter 18 Addressing Health Care in Communities Ethel Williams Frank T. Peak 357

The Community Approach 359

The Need for Community Empowerment 360

History 362

Community Solutions to Health Disparities 365

Chapter 19 The Relevance of Economics for Public Policies in Multidisciplinary Health Disparities Research Albert A. Okunade Chutima Suraratdecha 373

Economic Dimension of Health Disparities 375

Economic Status and Its Measurement 376

Income Distribution 377

Some Evidence on Economic Studies of Health Disparities 380

Some Policy Reflections 380

Chapter 20 Conclusion: Global and Domestic Health Disparities-Possible Solutions Cynthia T. Cook Richard L. O'Brien Sade Kosoko-Lasaki 385

About the Authors 391

About the Contributors 395

Index 413