In the late 1970s and 1980s, the concept of cross-cultural medicine emerged from recognition and advocacy surrounding cultural and linguistic barriers to health care. In the early 1990s, increased emphasis on health care disparities expanded the focus of cultural competency programs and trainings beyond immigrant populations and interpersonal aspects of cross-cultural health care. New focal areas included health care systems and all racial and ethnic minority populations experiencing health care disparities. With the aim of improving access and reducing health care disparities, cultural appropriateness was framed as addressing cultural barriers to care and dimensions of provider quality. Views of cultural competence (CC) have continued to evolve along with understanding of the structural sources of health disparities. New terms such as “structural competence” have been proposed for provider training to emphasize structural aspects of health inequalities. On the other hand, interventions to improve cultural competence of the health care system may reflect nuanced conceptualization of the multilevel sources of disparities, transcending the origins of the term “cultural competence” in cross-cultural medical encounters.
Past systematic reviews have found an association between self-reported racism and illness among people of minority groups. Perceptions of discrimination based on race/ethnicity are also associated with worse patient-reported experiences of care. Past reviews have also found evidence of racism by health care providers toward minorities, although little is known about the extent of provider racism or how to measure it. Personally mediated racism includes underlying (often unacknowledged) prejudices among clinicians that cause them to treat others differently, with clinical consequences, according to race/ethnicity. Individual level racism can also manifest as omissions such as lack of services or failure to convey a welcoming environment.
In many instances, discrimination against minorities is exacerbated by and rooted in socioeconomic issues. Minorities are more likely to lack health insurance coverage and they are disproportionately covered by public programs like Medicaid, where reports of insurance-based discrimination (being treated unfairly by health care providers based on enrollment in public insurance or a lack of insurance) are higher. Those who report insurance-based discrimination also report restricted and delayed access to care. (author chapter introduction) #P4HEwebinarApril2024