Contracting

Health Disparities

By: Mariana S. Niell, MS, CGC, Hoag Hospital, Newport Beach, CA

The number of individuals speaking a language other than English at home has steadily increased since 1990. In 2000, 18% of individuals over the age of 5 spoke a language other than English. Of the “other” languages spoken in the home, Spanish is ranked number one over Chinese, French and German1.

Health care delivery relies heavily on accurate communication. As noted in a publication of the U.S. Department of Health and Human Services (USDHHS), “Quality Health Services for Hispanics: The Cultural Competency Component”2, thorough interaction between health care provider and a patient is not solely verbal, but relies on interpretation of personal, cultural, gender and age-based intricacies. Speaking the same language as a patient aids in the interaction; however, cultural cues are also important in establishing an effective relationship between provider and patient. As the number of Americans who speak languages other than English rises, healthcare providers will have to incorporate ways in which to better communicate with their patients in a culturally sensitive manner.

The Hispanic population is composed of individuals from various countries such as Mexico, Puerto Rico and Cuba. Each of these subcultures is distinctly unique from the others and from the U.S population in general. Although several factors, including genetics and environment contribute to the burden of illness experienced by a particular population, language and culture differences also play a significant role. Health disparities in the Hispanic population in the U.S. are evident in several areas. The rate of cervical cancer is 2.5 times higher in Hispanic women than in White women. Heart disease, obesity and diabetes are more common in Mexican American women as well. In addition, Hispanic individuals are 1.5 times more likely to develop diabetes than White individuals3.

Outlined in the USDHHS document2 are six methods that may be utilized to overcome language barriers in health care:

1. Bilingual/bicultural staff
2. Use of interpreters
3. Language skills training for staff
4. Internal language banks
5. Phone-based interpreter services
6. Written translators

In addition, since the interaction between health care provider and patient is complex and involves more than just verbal communication it may be reasonable to use cultural brokers. Cultural brokers have been weaved into healthcare delivery to ease cultural differences between provider and patient. According to “Bridging the Cultural Divide in Health Care settings: The essential role of cultural broker programs”4, expanding diversity in the United States increases differences in belief systems as they relate to health, illness, help-seeking behaviors and health care providers. In the health care setting, cultural brokers are intended to bridge the cultural gap between provider and patient to achieve appropriate and effective health plans.

Regardless of the availability of an interpreter or cultural broker, health care providers need to be familiar with certain aspects of the Hispanic culture. The lack of eye contact to signify respect, touch and the importance of family are aspects of the Hispanic culture that should be taken into account when interacting with a patient of Hispanic background. It is also just as important to not make any assumptions about the patient solely because they are Spanish speaking as each country of origin has its own unique and complex culture.

Resources:

1. US Census Brief - Language Use and English-Speaking Ability: 2000 (census.gov)
https://www.census.gov/library/publications/2003/dec/c2kbr-29.html

2. Office of Minority Health: Home page: https://minorityhealth.hhs.gov/

3. Bridging the Cultural Divide in Health Care settings: The essential role of cultural broker programs; Georgetown University. https://nccc.georgetown.edu/documents/Cultural_Broker_Guide_English.pdf

 

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