Cultural Bias In Health Care

Directed Study - Public Health Practice:

Cultural Bias and Health Care Disparity:

Student: Bashar Nahab

Table of content

- What is Culture?

- What is Cultural bias?

- Interpersonal bias

- Structural (Systemic) bias

- Impact of cultural bias on healthcare outcome

-Cross cultural competency:

- Cultural humility

- Structural competency

-Review of evidence for healthcare disparities

-Patient – based approach:

Physician-Patient Communication Approach.

Physicians- Patient communication Models.

- Summary and Recommendations

Culture as described by Brislin [1], as the totality of learned behaviors of people that emerges from their interpersonal interactions.

Culture includes values, beliefs, aesthetic standards, linguistic expression, patterns of thinking, behavioral norms, and styles of communication, which a group of people have developed to assure thier survival in a particular environment [2].
When physicians initially hear the profile of a patient, they usually make associations and assumptions based on their previous experience. They may have a perception of the person before they meet with them. Our thoughts are based on our past experiences, individuals from cultures and certain image that comes to mind are certainly expected, that is defined as Interpersonal Bias. They may also be the result of unintentional biases [3] or perceptions we all have as a result of our lack of exposure and interpersonal skills when it comes to interacting with other cultures. Whether its conscious or not, whether it’s positive or negative, they are always a distortion of reality. On the other hand, barriers may not necessarily be the culture difference between physicians and patients, other barriers that limit the ability to form lasting doctor-patient relationship that is due to the shortage of primary care physicians, means of accessing healthcare services and the poor organization of the medical practice, this type of barrier known as structural or systemic bias [4].

The cultural bias is a prejudice in viewpoint suggesting a preference of a culture [5]. This will lead to conflicts between physicians, between physicians and staff, among the staff or the health care team and the patient, or patient's family. As a result cultural bias will have an adverse effect on productivity, morale, causes poor health outcomes. Cultural Heath disparity is a very complicated matter as it is very much related to so many factors. For example; Hispanics in New York City have so many reason to get disparity, such as language problems that might lead to poor job opportunities leading to poverty. Health insurance will be limited and health education will also be poor. So many diseases are prevalent in New York dues to the diversity of cultures [6]. Furthermore, although race is different from culture

but they are often two faces for the same coin, as certain race or ethnicity are contented with their cultures; African-Americans are less likely than non-Hispanic whites to be referred for cardiac catheterization for coronary artery disease [7], Hispanics with isolated long bone fractures were twice as likely as non-Hispanic whites to receive no pain medication in the emergency department, in a study from one US academic medical center [8] and that might be related to cultural and behavioral perception of pain. Despite an increase in the past decade in opioid use for pain-related diagnoses visits in US emergency departments, disparity in pain treatment between cultural groups have not decreased [9], compared to white patients, the odds ratios for black, Hispanic, or Asian patients to receive opioid treatment were 0.66, 0.67, and 0.79 respectively. The risk of an African-American developing end stage renal disease requiring dialysis is four times greater than a European-American [10]. Once on dialysis, African-American patients are only 70 percent as likely to be referred for evaluation for renal transplantation [11] African-Americans with hyperlipidemia, compared to non-Hispanic whites, are less likely to achieve target lipid levels, less likely to be using medication to control lipids, and less likely to be taking high efficacy statin drugs [12].Asian-Americans, compared to non-Hispanic whites, have lower rates of cancer screening (colorectal and breast), adjusting for access to care and socioeconomic status [13]. Foreign-born Asians, on survey, believed that cancer screening should be a response to symptoms and declined tests because of lack of symptoms. Minorities in the United States are less likely to seek mental health treatment when indicated, compared to White Americans; mental health providers (psychiatrists, psychologists and social workers) are less likely than general medical practitioners to be Hispanic, black, Asian, or Native American.
Whether on interpersonal, or systemic level, cultural bias and cultural disparities in our health care system does exist; due to the association with worse outcomes in many cases, actions must be sustained and comprehensive.

Shifting the definition toward cultural humility [14] as an alternative to “cultural bias” by making the provider engages in a regular self-evaluation and self critique, or through what is called as cultural competence [15]; which defined as the level of provider’s knowledge, attitude, and skills about cultural values, health related beliefs, disease incidence, prevalence, and treatment efficacy for diverse cultural group. Those models encompass under cross-cultural competence umbrella, both share the ultimate goals of preparing providers to manage sociocultural issues that emerge. On the other hand, Journals and magazines ranging from Social Science and Medicine to Psychology today have published articles describing structural competency [16 ] as a “new way “to combat the structural bias .structural compenetecy emphasizes recognition of the complex ways that matters such as rising income inequalities, decaying infrastructure, poor food-distribution networks and other economic factors lead to worse

health.