______________________________________________ Intercultural Competence and Patient-Centered Care
Another feature of ICP is interdependency. Instead of working in an autonomous manner, each team member’s contributions are valued and maximized, which ultimately leads to synergy [29]. At the heart of this are two other key features: mutual trust/respect and communication [31]. In order to share responsibilities, the differing roles and expertise are respected. Experts have recommended that a structural or critical theoretical perspective be integrated into core competencies in healthcare education to teach students about implicit bias, racism, and health disparities [32]. This includes [32]: • Values/ethics: The ethical duty for health profes- sionals to partner and collaborate to advocate for the elimination of policies that promote the perpetuation of implicit bias, racism, and health disparities among marginalized populations. • Roles/responsibilities: One of the primary roles and responsibilities of health profes-sionals is to analyze how institutional and organizational factors promote racism and implicit bias and how these factors contrib- ute to health disparities. This analysis should extend to include one’s own position in this structure. • Interprofessional communication: Ongoing discussions of implicit bias, perspective taking, and counter- stereotypical dialogues should be woven into day-to-day practice with colleagues from diverse disciplines. • Teams/teamwork: Health professionals should develop meaningful contacts with marginalized communities in order to better understand whom they are serving. Adopting approaches from the fields of education, gender studies, sociology, psychology, and race/ethnic studies can help build curricula that represent a variety of disciplines [33]. Students can learn about and discuss implicit bias and its impact, not simply from a health outcomes perspective but holistically. Skills in problem-solving, communication, leader- ship, and teamwork should be included [33]. SOCIAL DETERMINANTS OF HEALTH Social determinants of health are the conditions in the environ- ments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. Healthy People 2030 groups social determinants of health into five categories [34]: • Economic stability
These factors have a major impact on people’s health, well- being, and quality of life. Examples of social determinants of health include [34]: • Safe housing, transportation, and neighborhoods • Racism, discrimination, and violence • Education, job opportunities, and income • Access to nutritious foods and physical activity oppor- tunities • Polluted air and water • Language and literacy skills Social determinants of health also contribute to wide health disparities and inequities. For example, people who lack access to grocery stores with healthy foods are less likely to have good nutrition, which raises the risk of heart disease, diabetes, and obesity and lowers life expectancy compared with those who have easier access to healthy foods [34]. Promoting healthy choices will not eliminate these and other health disparities. Instead, public health organizations and their partners must take action to improve the conditions in people’s environments. Healthcare providers play a role by identifying factors affecting the health of their patients, providing resources (when appropriate), and advocating for healthy environments. ECONOMIC STABILITY In the United States, 1 in 10 people live in poverty, and many people are unable afford healthy foods, health care, and hous- ing. People with steady employment are less likely to live in poverty and more likely to be healthy, but many people have trouble finding and keeping a job. People with disabilities, injuries, or chronic conditions (e.g., arthritis) may be especially limited in their ability to work. In addition, many people with steady work still do not earn enough to afford the things they need to stay healthy [34]. Employment programs, career counseling, and high-quality childcare opportunities can help more people find and keep jobs. In addition, policies to help people pay for food, housing, health care, and education can reduce poverty and improve health and well-being [34]. HEALTH CARE ACCESS AND QUALITY Many people in the United States are unable to access the healthcare services they need. About 1 in 10 people in the United States lack health insurance, and people without insurance are less likely to have a primary care provider and be able to afford the healthcare services and medications they need. Strategies to increase insurance coverage rates are critical for making sure more people get important healthcare services, including preventive care and treatment for chronic illnesses [34].
• Education access and quality • Health care access and quality • Social and community context • Neighborhood and built environment
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