FEBRUARY 9, 2022

Health Equity

What elements do you consider when you think of a person’s culture? Race, ethnicity, and religion typically are top of mind. However, culture is also shaped by geography, gender identity, values and beliefs, language, family structure and lived experiences. Considering cultural influences and further introducing cultural humility into healthcare can help advance health equity.

Failing to identify, respect, and understand the influence of cultural beliefs, values and/or experiences during the care delivery journey can lead to poor health outcomes and exacerbate health inequities. Biases, language and access barriers, inability to pay for healthcare, and mistrust of healthcare providers and systems may negatively impact the health of individuals and their communities.

Starting with culturally competent care

Traditional approaches to cultural competency integrate information about individuals into culturally appropriate interactions, treatments, protocols, and standards. Delivering culturally competent care includes efforts like connecting individuals with healthcare providers who have a similar culture or incorporating culture into the clinical environment, such as diverse images of people, flags representing the community’s cultures, and culturally reflective brochures and waiting room literature.

While this traditional approach to culturally competent care incorporates many aspects of a person’s culture, it has inherent biases. First, it draws from traits and experiences at the group level, rather than acknowledging individuality. Second, it generally positions certain traits (often white and heterosexual) as the “norm” and others as alternatives, rather than seeing them as equal, parallel traits. Finally, it suggests that there is an endpoint where one is totally culturally competent.

Providing equitable care through demonstrating cultural humility

Cultural humility has emerged as a more effective approach to reducing cultural biases within the healthcare system. All people must be seen as individuals, with their own varying characteristics that make up their culture. This leads to respect of the individual, instead of viewing them as part of a larger group and eliminating long-standing inequities. It encourages curiosity and life-long learning about the complexity of identities.

Cultural humility requires a shift in approach for some healthcare providers. They must learn to mitigate their own biases through ongoing, honest self-reflection and self-critique. Examining our own identities, histories, assumptions, and defaults can help us understand and empathize with others’ unique combination of cultural influences, preferences, and identities.

Demonstrating cultural humility can create an environment to hold meaningful conversations not only about the joys of an individual’s culture, but the pain and misunderstandings associated with it as well. A more thorough understanding of each individual can lead to better health outcomes.

Integrating cultural humility into daily practice

So how can we demonstrate cultural humility in healthcare effectively? There are several elements to incorporate.

One key element is the elimination of the provider-over-patient power imbalance, to instead establish an equal partnership between a person and their practitioner. It requires providers to learn from their patients, without judgement, assumptions, or comparison. The goal is to understand and acknowledge others’ experiences as truths. Further, they must apply these learnings to support people to be as healthy as possible.

Another element related to this balance is a practitioner’s willingness to humble themselves to establish trust and improve the wellbeing of those they work with. Where cultural competence implies that someone has learned a lot about a culture, cultural humility acknowledges that they will never be the authority on someone else’s culture or life. We all are the experts when it comes to our own health needs, beliefs, and capabilities.

Third, providers must be continuously learning, so they can identify and put aside their own biases. These may include examining or challenging deeply held beliefs in favor of openly considering and being curious about others’ beliefs, values, experiences, and other aspects of their culture.

Fourth is a conscious effort to avoid an approach to care where providers decide, based on their own beliefs, what is best for others. The best outcomes occur through mutually beneficial partnerships that leave people feeling heard, understood, and validated. People are more than just their diagnosis, so two people with the same diagnosis most often benefit from different treatments or approaches.

Healthcare providers embracing cultural humility create the opportunity to truly hear, acknowledge, celebrate, and serve the individual. This enhanced relationship opens the gateway to improved health outcomes while advancing health equity.