February 11

Beyond Cultural Awareness: A Unified Approach to Better Outcomes and Reduced Health Disparities


Olivia Carter-Pokras, Ph.D.
Olivia Carter-Pokras, Ph.D.

What are health disparities? They are, according to Dr. Carter-Pokras, who has spent three decades in the study of health disparities, differences in health outcomes that we can measure, that we have the tools to address, and that ethically, we are obligated to address. We know that disparities do exist across all dimensions of access and quality of health care, across many clinical conditions, and many subpopulations.

The Annual report on National Healthcare Disparities in 2012 noted no changes in rates of poor communication, and no improvement in areas like diabetes care and maternal and child health and thus a need to accelerate progress. National developments, such as Healthy People 2020 and new CLAS standards have precipitated local developments, and rapid embracement by legislators. A number of states have passed cultural competency training mandates — though it is often the case that such mandates are unfunded.

Another issue is that cultural competency research and training is at work separately from health literacy training and research — and Carter-Pokras wonders why. Each has common interests but they are not on the same bus, or at the same conferences. In the October 2012 issue of the Journal of Health Communication, Carter-Pokras and her fellow authors note that “competencies have been developed for cultural competence training (Lie et al., 2008), and health literacy competencies are being developed. But educational research in each field is being conducted independently despite overlapping constructs and common desired patient outcomes.” Health literacy is often “housed” in quality improvement, and cultural and linguistic competency are aligned under patient satisfaction, when they are instead complimentary. “What better place to begin than a collaborative of health literacy and cultural competence educators working together to share tools, training strategies, and resources for the common goal of health disparities reduction, improved research agendas, and outcomes?”

So, we need to educate medical students in cultural competency and health literacy together — but how? Carter-Pokras and others have created a new “Primer: Cultural Competency and Health Literacy: A Guide to Teaching Health Professionals and Students” from the University of Maryland School of Public Health and the Maryland Department of Mental Health and Hygiene, released in May. Its stated intent is to be a resource guide to help “students and health care professionals learn how to reduce health disparities and improve health outcomes through culturally sensitive and effective communication across health disciplines.” The Primer is free and easily accessible as a download. There are six instruction modules, and learning objectives are arranged by type of competency: knowledge, attitudes and skills. Contents come from credible sources and to the extent possible, the resources in The Primer are evidence-based, though Carter-Pokras cautioned that very little research has been done—there are as few as seven studies that look at outcomes. “Moving upstream from health services research to health professions education as another solution is a logical, positive response to the call to action.”


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