June is Pride Month, a time to celebrate the LGBTQ+ community and to raise awareness of the challenges they face. Healthcare equity is the principle that everyone, regardless of their sexual orientation or gender identity, should have access to quality, affordable healthcare. Unfortunately, LGBTQ+ people face a number of barriers to healthcare, including:
-Discrimination: LGBTQ+ people are more likely to experience discrimination from healthcare providers, which can discourage them from seeking care.
-Invisibility: LGBTQ+ people are often invisible in healthcare, which can lead to providers not being aware of their unique needs.
-Cost: LGBTQ+ people are more likely to be uninsured or underinsured, which can make it difficult to afford healthcare.
We all play a role in promoting healthcare equity for the LGBTQ+ community:
-Learn about the challenges LGBTQ+ people face in accessing healthcare. There are many resources available online and in libraries.
-Be an ally. Stand up for LGBTQ+ rights and speak out against discrimination.
Support organizations that are working to improve healthcare for LGBTQ+ people. There are many organizations that are working to make a difference, such as the Human Rights Campaign and the National Center for Transgender Equality.
Cultural humility differs from cultural competence and is not about being an expert on all cultures. It is about being genuinely curious and open to learning about different cultures, and for those of us who are helpers, being willing to adapt your practice to meet the needs of our patients.
“Cultural humility involves entering a relationship with another person with the intention of honoring their beliefs, customs, and values. It entails an ongoing process of self-exploration and self-critique combined with a willingness to learn from others. Authors have contrasted cultural humility with the concept of cultural competence. Cultural competence is characterized as a skill that can be taught, trained, and achieved and is often described as a necessary and sufficient condition for working effectively with diverse patients. The underlying assumption of this approach is that the greater the knowledge one has about another culture, the greater the competence in practice. The concept of cultural humility, by contrast, de-emphasizes cultural knowledge and competency and places greater emphasis on lifelong nurturing of self-evaluation and critique, promotion of interpersonal sensitivity and openness, addressing power imbalances, and advancement of an appreciation of intracultural variation and individuality to avoid stereotyping. Cultural humility encourages an interpersonal stance that is curious and other-oriented.”
Cultural humility is a lifelong process of learning about and respecting the beliefs, values, and practices of others. It is an essential skill for healthcare providers, as it can help to ensure that all patients receive the care they need and deserve.
There are many benefits to practicing cultural humility in healthcare. For one, it can help to improve patient-provider communication. When providers understand the cultural context of their patients’ lives, they are better able to build rapport and trust. This can lead to better communication, which can ultimately lead to better health outcomes.
Cultural humility can also help to reduce health disparities. When providers are aware of the cultural factors that can influence health, they can take steps to address these factors and provide more equitable care. For example, providers may need to be aware of the cultural beliefs that influence how patients view health and illness, or the cultural barriers that may prevent patients from accessing care.
As I learn more about cultural humility, I reflect further on how it relates to the National Patient Safety Goal to Improve Health Care Equity. Effective July 1, 2023, The Joint Commission (TJC) Standard LD.04.03.08, which addresses health care disparities as a quality and safety priority, will be elevated to a new National Patient Safety Goal (NPSG), Goal 16: Improve health care equity.
The NPSG standard and 6 elements of performance (EPs) increases the focus on improving health care equity as a quality and safety priority, but the requirements for accredited organizations are not changing. While some of the original language from Standard LD.04.03.08 and its EPs were revised to focus on improving health care equity rather than reducing health care disparities, the intent behind the standard and associated EPs remains the same. Organizations will still be required to do the following:
-Identify an individual to lead activities to improve health care equity
-Assess the patient’s health-related social needs
-Analyze quality and safety data to identify disparities
-Develop an action plan to improve health care equity
-Take action when the organization does not meet the goals in its action plan
-Inform key stakeholders about progress to improve health care equity.
Cultural humility is an essential skill for all Americans, and especially those that are healthcare providers. By practicing cultural humility, we improve patient-provider communication, reduce health disparities, and provide more equitable care.
In addition to TJC, the government and professional organizations require culturally competent healthcare delivery. The national “standards issued by The U.S. Department of Health and Human Services’ (HHS) Office of Minority Health (OMH) respond to the need to ensure that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner. These standards for culturally and linguistically appropriate services (CLAS) are proposed as a means to correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all patients/consumers… § 440.262 = Access and cultural conditions: The State must have methods to promote access and delivery of services in a culturally competent manner to all beneficiaries, including those with limited English proficiency, diverse cultural and ethnic backgrounds, disabilities, and regardless of sex.”
Here are some tips for practicing cultural humility:
-Be aware of your own biases. Everyone has biases, but it is important to be aware of them so that they do not interfere with your care of other people.
-Ask questions. Don’t be afraid to respectfully ask about cultural beliefs and practices. This will help you to better understand them and to provide more personalized care. During a biopsychosocial assessment for health services, remember to ask “why” as you strive to understand the whole story.
-Be respectful. Even if you don’t understand a patient’s cultural beliefs, it is important to honor and be respectful of them. This means avoiding judgment and being open to learning more.
-Be flexible. Be willing to adapt your practice to meet the needs of others. This may mean providing services in multiple languages, or making accommodations for religious or dietary restrictions.
Together, we can create a world where everyone has access to quality, affordable healthcare, regardless of their sexual orientation or gender identity.
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Learn More:
Stubbe DE. Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients. Focus (Am Psychiatr Publ). 2020 Jan;18(1):49-51. doi: 10.1176/appi.focus.20190041. Epub 2020 Jan 24. PMID: 32047398; PMCID: PMC7011228.
The Joint Commission: https://www.jointcommission.org/standards/r3-report/r3-report-issue-38-national-patient-safety-goal-to-improve-health-care-equity/
The United States Department of Health and Human Services, OPHS Office of Minority Health: https://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf
Author: Theresa Drass
