Solutions to Bridging the Cross-Cultural Divide in Healthcare Program Development Sudler & Hennessey AnneMarie Armani, M.D. Senior Medical Director, Imprint Science Daria Blackwell Consultant, Sudler Multicultural Education Ruben Gutierrez Director, Sudler Multicultural Education Three Steps to Achieving Cultural Competence for Physicians 1. Understand the medical differences affecting diverse populations in terms of disease prevalence, influence of environmental factors such as diet, and physiologic response to therapeutics. 2. Appreciate the cultural and ethnic differences in behavior toward disease management that may be contrary to the Western system of medicine, and the role of intangible factors such as belief, religion, and philosophy, which will help facilitate patient connection and communication. 3. Increase awareness of disparate personal perspectives in management of different patient populations and embrace tools that will assist healthcare professionals in dealing with people of ethnic and cultural backgrounds different from their own. Despite a concerted effort in recent years by the government, medical institutions, and insurance companies to put programs in place to help eliminate healthcare disparities in minority and ethnic populations, no major improvement seems to have taken root, especially among Latinos. There is a need to instill cross-cultural healthcare competence, which involves educating healthcare providers and patients of diverse cultural and ethnic backgrounds. Through improving physician-patient communications and interactions and by discovering ways to make existing tools more accessible to the medical community, a major opportunity exists to help narrow the healthcare gap. The United States is not so much a melting pot as a mosaic of different ethnicities, cultures, and beliefs. This makeup presents challenges, as well as opportunities. The most important of these is to provide quality healthcare to people of diverse cultural beliefs and genetic backgrounds. As racial and ethnic populations and communities continue to grow, it is essential that the healthcare community be embraced as a crucial partner in providing quality care and products to underserved populations. Developing Intercultural Competency With this in mind, providers of healthcare education should start to take a multicultural approach to helping physicians and other medical professionals to develop intercultural competence. This model should also include the goal of improving patient-physician interactions and adherence to prescribed management decisions. Reminding people — particularly physicians — that the United States is the fifth-largest Spanish-speaking country in the world is not enough. Showing them how their community’s cultural constitution affects their practice through enlightening, intercultural CME activities is much more powerful. This approach should also seek to aid patients, through interaction with their doctors, in acquiring what might be called “health culture competence.” Overcoming Obstacles Many clinical scenarios exist in which cultural differences create obstacles to optimal healthcare delivery. For instance, healthcare providers may unknowingly introduce their belief systems into the healthcare process. Fortunately, this is behavior that can be modified. Creating an experiential exercise that physicians can take part in and learn from is perhaps the best eye-opener to managing disparity in behavior. In addition, understanding biological predisposition to certain diseases and response to therapeutics, environmental influence on disease prevalence, and physiologic response to treatment must all be communicated to healthcare providers. Although language, socioeconomic status, and access to health insurance are significant barriers, studies have confirmed that there are other factors that require consideration. Genetics, environment, education, customs, philosophy, behavior, diet, immigration/Westernization, religion, and fatalism also contribute to disparities in care. It is also important to avoid stereotyping and over generalization, and to recognize the heterogeneity that exists within all population groups. Studies have shown that physicians are not comfortable with the level of their preparedness to deliver cross-cultural care because of a lack of training in these specific areas, and therein lies the educational opportunity. The point is to integrate the resources for physicians and patients so that they seamlessly complement each other. Focus on the Patients On the patient side, providing patient-education materials at each point in the intervention continuum helps improve adherence. Targeted awareness programs via managed-care initiatives, community-based programs that tackle the importance of healthy behaviors, and family and caregiver resources are all part of the equation for helping to improve the delivery of healthcare in the United States. Sudler & hennessey, New York, is a global healthcare marketing and communications organization with offices around the world; the network includes two global communications agencies Sudler & Hennessey and Sentrix Global Health Communications, as well as specialized divisions in medical education, market research and strategic planning, branding, publication strategies, sales training, and digital solutions. For more information, visit sudler.com. August 2006 VIEW on Medical Education

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