HLTH-2301-002

Cultural Diversity Healthcare

Faegheh Hazaveh
Homework, Chapter 2.
1. Clearly, disparities in health status have existed among groups in the
United States for a long time. Why do you think the nation has been so
slow in addressing them?
Awareness of and the need to address disparities in health care has taken an
unconscionably long time to come. There are many reasons for this slow
movement of nation towards recognizing the importance of disparities in our
health care system. First, the federal government itself has been slow to
adopt and enforce rules and regulations. When the population of minorities
started to grow rapidly in the last decades and when faced with healthcare
system crises as a result of pressure from groups formed in states, the
federal government in mid-1980s began to require that federally funded
research should address the minorities and other segment of population.
Second, most private health care organizations, who were concerned with
increased cost in their business if they wanted to change their data collection
methods to include data for minorities, African American or other races into
their system. These private organizations did not see any benefit to address
disparities. Third, there was not enough research done on the subject that
could shed light on the huge cost the nation is incurring as a result of
increasing disparities in healthcare system. For example employers were not
aware of disparities in health care attributable to race, ethnicity, and
socioeconomic status of their employees. Hence, instigation of change in
attitudes toward disparities came from advocacy groups and other
organizations that prompted government regulations and from frontline
health care providers. I feel these are collectively the main reason why the
nation has been slow in addressing disparities that has existed for so long in
our nation.
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2. There were many federal agencies mentioned in this chapter. What

role does the federal government play in disparities reduction? Could
the individual states do the work to address disparities without the
federal government? Why or why not?
As mentioned in above the major initial effort to address disparities
started from states. For example a task force was created by California
Department of Health in 1996 which was formed at the request of an
advocacy group when California decided to set up state-supported health
plans through which all Medicaid persons would receive their care. The
state would identify minorities through enrollment and then the plan
would address their cultural needs. Other states then followed more or
less the same procedures in starting the data collection on their minority
population. States therefore can address the disparities. Even though
sates can look to address disparities within their own states, the federal
governments effort however is needed not only to coordinate what is
being done at state level but also to provide funding when required and to
resolve any disputes that may arise in interpreting disparity at national
level. The federal government clearly considers the evaluation of a
patients quality of care by race and ethnicity as a necessary step toward
quality improvement or it wouldnt have mandated that all federally
funded health programs and population surveys collect these data.
Promotion of health equity requires awareness of the social determinants,
culture, and environments affecting racial, ethnic and linguistic minorities.
Policy and institutional changes are needed by the federal to help ensure
a commitment to health equity for minority communities in the nation. As
we can see this problem should be addressed both at the state level as
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well as the federal government level to be effective solution to address

the problem.

3. Much of the US health care is in the hands of the private sector. Could
the private sector address disparities issues better than state or
federal government? Why or why not?
The disparities that are visible across racial and ethnic populations in the
United States are the subject of national attention and goal setting
because health care disparities are seen to be a nationwide economic and
quality-of-care problem. Lets examine what has been completed so far.
The federal government has taken measure steps toward addressing the
existence health inequities through the stimulus funding provided so far.
The private sector has provided important leadership to some extent. For
example, both the Robert Wood Johnson Foundation's Commission to Build
a Healthier America and the Kellogg Foundation's ongoing focus on health
inequities and racial healing has led to major efforts to reduce health
inequities. Similarly, The California Endowment is emphasizing the
importance of place and the need for investing in communities with
minorities. The initiatives of the Kaiser Family Foundation and the
MacArthur Research Network on Socioeconomic Status and Health have
contributed significant steps to reduce health inequities. Also many
toolkits were developed by Robert Wood Jonson Foundation and the
Commonwealth Fund to help health care organizations on how to collect
racial and other ethnic information on their system. I conclude therefore
that not one particular group, public or private could address the problem
alone, rather a team work effort both by the government and the private
sector as shown above can take lead in reducing disparities in our health
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care system. The government can address the funding issues and
mandates and the private sector can participate in research and guidance
for the healthcare organizations in interpreting the mandates and control
and monitoring of reports provided by the health care organizations.
Sources:
1. Divers and Cultural Competence in Health Care (Chapter 2) Janice L.Dreachslin, M.
Jean Gilbert, Beverly Malone. Jossey-Bass