Health Status
Differences and disparities exist in the daily lives of everyone in the United States. They especially relate to socio-economic class, race, language fluency, and culture, and these disparities affect access to quality health care and the outcomes of that health care. One of the best ways to improve the disparities in health care is for physicians to learn cross-cultural skills and apply them to clinical encounters.
The recently released report, Health United States, 2008 (National Center for Health Statistics Health, United States, 2008 With Chartbook; Hyattsville, MD: 2009. See: http://www.cdc.gov/nchs/data/hus/hus08.pdf) documents the health status of the US population with special emphasis on young adults, 18-29. The document shows trends for the population based on race/ethnicity, poverty, children living with single parents, and health-risk factors. Disparities in health status are emphasized.
The 2003 study by the Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care defines health care disparities as “racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences and appropriateness of intervention.” See: http://www.nap.edu/catalog.php?record_id=10260#toc for a full text online.
An Integrated Model of Healthcare Disparities (taken from: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, page 127). A patient’s health status depends greatly on the demographics of the patient, the community, the physician, and the health care system. Understanding these demographics will affect both your approach to and management of an individual patient. The United States is a demographically diverse country. In the most recent community survey done by the U.S. Census, more than a quarter of the population described themselves as non-white, and a full 12.4% of the U.S. population is foreign-born. Despite the prevalence of English, there is no official national language in the U.S. (though many groups lobby each year to change this). According to the census almost 20% of people in the U.S. speak a language other than English, and only half of those feel that they speak English very well.
Physicians have both a professional and ethical responsibility to provide the best possible care to individuals, to do no harm, to respect the individual’s autonomy, and to be just in the distribution of their skills and utilization of resources. Communication is critical to a physician’s ability to carry out these responsibilities and depends on the ability of one individual to acquire and transmit information in a way that is understandable by both parties. Language fluency is critical to this interchange. But, if an individual has limited English fluency and the physician is not fluent in the patient’s first language, then communication breaks down and health care is potentially compromised. The ethical and professional responsibility to provide the best possible care has become a legal duty to provide language services for patients with limited English proficiency.
The Emergency Medical Treatment and Active Labor Act [EMTALA], the Hill-Burton Act, Medicare, and Medicaid, all require in various ways that language services are to be provided to each patient. Title VI of the Civil Rights Act of 1964 states, “No person in the United States shall, on ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” Because many, if not most, hospitals receive federal money, the law applies to the medical profession. For more on initiatives, laws and policies see Policies, Initiatives and Laws.
Numerous organizations in the U.S., both governmental and private, maintain registries to follow and understand the status and trends of health among different populations. In addition, many hospitals and universities monitor the epidemiology of the areas they serve, to better prepare care providers for their clinical and service responsibilities.
Health Information for Specific Groups:
Common Health Problems in Selected Minority, Ethnic & Cultural Groups,
Office of Minority Health – Data/Statistics:
http://www.omhrc.gov/templates/browse.aspx?lvl=1&lvlid=2
For further information:
Agency for Healthcare Research and Quality
http://www.ahrq.gov/
Kaiser Family Foundation
http://www.kff.org/
The Centers for Disease Control and Prevention (CDC)
http://cdc.gov
National Center for Health Statistics
http://www.cdc.gov/nchs/
Morbidity and Mortality Weekly Report (MMWR)
http://www.cdc.gov/mmwr/
Resources:
Board on Health Sciences Policy, Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities. National Academies Press; c2003.
http://www.nap.edu/catalog.php?record_id=10260#toNational Healthcare Disparities Report, 2006.
http://www.ahrq.gov/qual/nhdr06/nhdr06.htm
U.S. Census Bureau. 2005 American Community Survey.
http://www.census.gov/acs/www/
