Preserving Culture in Population Health Strategies


If health systems, payers, and providers aim to positively impact social determinants of health, it is imperative they recognize the cultural differences in caring for minority populations. Nationwide, people of color represent 38% of all Americans, and yet these groups are overrepresented in the low-income and underinsured populations.

Research has shown that minority groups are more prone to poor health outcomes than other groups of people. For example, black, hispanic and native Americans have higher rates of heart disease, diabetes and other chronic conditions, than whites. Some minority groups live on average two to four years less than the majority, with gaps widening when education level is factored in.

There are a number of reasons why minority groups may be more at risk for certain conditions. However, one factor that applies across clinical diagnoses and minority groups is lower engagement. Minority groups are more likely to procrastinate care and harbor a sense of mistrust of health services.

This lack of engagement signifies a disconnect that needs to be addressed between often marginalized communities and the healthcare system. There can be a lack of cultural proficiency and sensitivity within the health community to differing social structures. Many minority patients have strong cultural and social values that may conflict with standard healthcare practices, but must be maneuvered, such as beliefs in spiritual healing or dietary practices. Additionally, barriers in language or poor relations in the past can hinder the patient-provider relationship, a key driver of health success.

With so many nuances in minority care, the challenge for providers in getting them to be more active in healthcare lies in protecting both health and culture simultaneously.

Cambridge Health Alliance in the Greater Boston area has found a way to bridge the gap between culture and health by training volunteers to provide health education in various cultural contexts. CHA’s Volunteer Health Advisors, representing a variety of countries and native languages, share critical information, lead forums and screenings, and guide healthcare access in their communities. This approach empowers minority groups to educate and hold each other accountable for engaging more fully in their healthcare.

But while education is the first step to better health, participation in decision-making is key to sustained health. Even if knowledgeable, minority groups often feel powerless in healthcare, as they are often underrepresented in the healthcare workforce, particularly in leadership roles. While this issue continues to be addressed, providers are left to decipher what’s best for vulnerable groups they may not identify with.

One solution to this challenge is simple: Ask them. In Seattle’s Chinatown-International District, diabetes, smoking, and hypertension are among the many health problems that lead to high rates of hospital visits for the area. With limited green space for exercise and poor air quality, the predominantly Asian-American community faces several social determinants of poor health that need to be addressed. Instead of trying to decipher fixes themselves, population health advocates meet with residents to determine which issues to tackle first and how to preserve their cultural needs in the process.

Groups like those in Cambridge and Seattle illuminate the path to success in engaging minority communities: increasing cultural awareness. Minority differences that contribute to health outcomes should be recognized and addressed, not suppressed. Population health strategies are not “one size fits all” formulas, and cultural needs should be considered just as much as social needs in the work to make our communities healthier.

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Topics: social determinants of health health disparities population health

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