Implicit Bias/Health Disparities
what is culture?
The totality of socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human work and thought.
how much of the US population is foreign born?
13%
what do you ask to elicit patient's explanatory model of illness?
What do you think you have? What do you think caused it? What have you done to treat it?
what is involved in religion?
interface between religion and health, role of religious community in health provision, fatalism versus personal control/power, etc
how do you know you are a culturally competent provider?
-Ability to interview and assess patients based on a psychological, social, biological, cultural, political, and spiritual model. -Ability to communicate effectively and use interpreters -Ability to diagnose with an understanding of cultural differences in pathology, avoiding under-diagnosis and over-diagnosis. -Ability to formulate treatment plans that are culturally sensitive to the patient and the family's concept of health and illnesses.
what is race?
A local geographic or global human population distinguished as a more or less distinct group by genetically transmitted physical characteristics •refers to a person's physical characteristics, such as bone structure and skin, hair, or eye color
what is CLAS?
Culturally and Linguistically Appropriate Services •US Department of Health and Human Services, Office of Minority Health •National Standards - "...are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations..."
what can we do about implicit bias?
Educate Yourself •Take the Implicit Association Test (IAT) at implicit.harvard.eduto learn of your unconscious beliefs. Study history and look for the connections between the past and the current realities of inequality. Take Action •Seek people who run counter to stereotypic views, increase contact with groups of people outside of your own demographics, and try to think of things from the perspective of others. Be Accountable •When confronted with bias, take the time to examine your actions or beliefs. Think of how you would explicitly justify them to other people.
what are causes of health disparities?
Inadequate Access to Health Care •Barriers to care can result from economic, geographic, linguistic, cultural and health care financing issues.Even when minorities have similar levels of access to care, health insurance and education, the quality and intensity of health care they receive are often poor. Substandard Quality of Care •Lower quality care has many causes, including patient-provider miscommunication, provider discrimination, stereotyping or prejudice. Quality of care is usually rated on the four measures of effectiveness, patient safety, timeliness and patient centeredness.
what is the LEARN guideline for cross-cultural communication?
Listen with empathy to patient's perspective of problem (from their sociocultural context) Explain your perception and concerns. Acknowledge & discuss differences and similarities Recommend treatment and course of action (Pharmacological, psychological, social, spiritual, educational) Negotiate treatment plan (collaboration with patient & other health care team members) •-can combine treatment remedies
what is social location?
One's position in society relative to others oRace & Ethnicity oGender oAge oImmigration Status oLanguage oNeighborhood of Residence oNumber of Generations in US oEducation oIncome oOccupation oReligion oSexual Orientation oPrior experiences with racism
what is ethnicity?
Quality or affiliation of a sizable group of people sharing a common and distinctive racial, national, religious, linguistic, or cultural heritage
what is involved in health beliefs?
causation of wellness and illness, level of self-determination, western medicine, complementary and alternative medicine, priority of health care, acute vs chronic disease practices. pain reactions, rtc
what categories are included in cultural norms?
communication style, education/language, time orientation, nutrition, family and community relationships, health beliefs, religion, and ethnicity
what is involved in education and language?
formal and informal, literacy level, language(s), spoken, etc
what is involved in communication style?
oral versus written, eye contact, facial expressiveness, direct vs indirect, questioning versus accepting, touch practices, etc
what does nutrition involve?
role of food in health and illness. perception of body size and health, availability of traditional foods, food practices and intolerances, etc
what is involved in nutrition?
traditional family units, marks pf childhood, adolescence, adulthood, and old age, gender differences/roles, dominance patterns, child rearing practices, values, etc
what are some challenges that recent immigrants face?
•Alterations in social status •Changes in occupation •Changes in daily routines •Isolation/lack of social support •Change of family hierarchy: younger adapt quicker •Sense of purposelessness •Lack of feeling of belonging
what is implicit bias?
•Attitudes or stereotypes that affect our understanding, actions or decisions in an unconscious manner. •Activated involuntarily, without awareness or intentional control. •Not always aligned with explicit beliefs. •Either positive or negative. •Everyone is susceptible.
what are 6 strategies to combat implicit bias?
•Consciously commit yourself to egalitarianism. •Recognize that unconscious bias is no more "the real you" than your conscious values. You are both the unconscious and the conscious. •Acknowledge differences, rather than pretend that you are ignoring them. •Seek out friendship with people from different groups. •Consciously identify what qualities and goals you might have in common. •When you encounter examples of unambiguous bias, speak out against them.
why is implicit bias important?
•Implicit biases have real-world effects across domains -Employment -Education -Criminal justice -Housing -Health care Implicit biases are malleable
what is Healthy People 2020?
•National health objectives designed to oidentify the most significant preventable threats to health oestablish national goals to reduce these threats •Four Overarching Goals Goal 1: Increase quality and years of healthy life Goal 2: Eliminate health disparities Goal 3: Create social/physical environments that promote good health Goal 4: Promote quality of life across life span
what is affinity bias?
•The preference for people like ourselves •Also called ingroup bias •Not only have greater trust for people like ourselves -Hold group in positive regard -Engage in more cooperation -Have more empathy for the situations they are in
languages spoken at home?
English only = 78.5% Lang. other than English spoken at home = 21.5% Speak English less than "very well" = 8.6%
what are health disparities?
"...racial or ethnic differences in the quality of healthcare that are not due to access-related factorsor clinical needs, preferences, and appropriateness of intervention "...differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States." •Despite continued advances in health care and technology, racial and ethnic minorities continue to have higher rates of disease, disability and premature death than non-minorities." •"African Americans, Hispanics/Latinos, American Indians and Alaska Natives, Asian Americans, Native Hawaiians and Pacific Islanders have higher rates of infant mortality, cardiovascular disease, diabetes, HIV infection/AIDS, cancer and lower rates of immunizations and cancer screening."
what is cultural competency?
"...the knowledge and interpersonal skills that allow providers to understand, appreciate, and work with individuals from cultures other than their own. It involves an awareness and acceptance of cultural differences, self-awareness, knowledge of the patient's culture, and adaptation of skills."
what is involved in time orientation?
present focused or future focused, perception of time
what is involved in ethnicity?
considerations for diagnosis and/or treatment
