Cultural Humility in Healthcare ________________________________________________________________
Court decision legalizing same-sex marriage, LGBTQ individu- als were not able to marry in most states. There are more than 5.5 million LGBTQ individuals living in the U.S. The LGBT community face barriers to fair and equal access to employment, housing, healthcare, and public accommodation. There are several nondiscrimination laws on federal, state, and local levels that protect people from discrimi- nation based on such factors as age, sex, and national origin. However, until 2020, federal law did not protect individuals from discrimination based on sexual orientation or gender identity (Pew Research Center, 2024b). The Pew Research Center conducted a national public opinion study on the state of the LGBTQ community in 2025. The survey included interviews with 3,959 self-identified LGBTQ adults aged 18 and older on the experiences of LGBTQ Ameri- cans. The report was made possible with support from the Trusts and from the People & Voices Initiative (Pew Research Center, 2025). Major findings from the survey include the following (Pew Research Center, 2025): • 61% of LGBTQ adults say there is at least a fair amount of acceptance for people who are gay or lesbian. About half (52%) say the same for people who are bisexual. Far fewer say there’s a great deal or fair amount of acceptance for people who are nonbinary (14%) or transgender (13%). Most adults say there is more acceptance today compared with 10 years ago for these groups. • Majorities of gay or lesbian adults (73%) and transgender adults (68%) say they have been subject to slurs or jokes because of their sexual identity. • Discrimination adversely impacted the mental and economic well-being of many LGBTQ Americans, including one in two participants who reported moderate or significant negative psychological impacts. • 70% of transgender adults say they have feared for their personal safety at some point. About half of gay or lesbian adults (52%) and 28% of bisexual adults say the same. • • Transgender adults are more likely than others to say they have been treated poorly by health care professionals (42% vs. 24% of gay or lesbian adults and 16% of bisexual adults). The complexity of individual diversity is inclusive of not just racial and ethnic identity but also of variables such as socio- economic class, disability, and LGBTQ status. While these facets of diversity are not exhaustive, they do represent some important categories of diversity. Healthcare professionals must consider the unique array of diverse identities that are represented within each individual encountered in each thera- peutic relationship. The complexity embodied within each
patient affects the way that the patient understands and views the healthcare professional and the professional relationship, just as the complexity of the healthcare provider’s diversity dimensions affects the way that the healthcare professional understands and views each patient. It is impossible to pro- vide information that allows healthcare professionals to gain knowledge about categories of people and how they behave or view the world, because not only is the variation within individual ethnicities and races endless, but the variation within each individual also is endless. Instead, healthcare professionals should aim to understand the societal landscape that privileges and oppresses individuals. The experiences of oppression experienced by various diverse groups are likely to provide them with a unique perspective on both the larger society and on the relationship with healthcare professionals.
OPPRESSION, PRIVILEGE, AND MARGINALIZATION
Understanding the concepts of oppression, privilege, and mar- ginalization is essential for practicing with cultural humility. There are various aspects of individual identities that oppress or privilege people and their marginalization or empowerment. Oppression can be defined as an “unjust or cruel exercise of authority or power” (Merriam-Webster, 2025). This can be a person or group that knowingly or unknowingly abuses a specific group. Oppression is a pervasive system. It has its foundation in history and is maintained via individual and institutional systematic discrimination, personal bias, bigotry, and social prejudice. Oppression leads to a condition of privi- lege for the person or the group that is the oppressor(s). See the National Conference for Community and Justice (NCCJ, 2025). Privilege is a central concept within the healthcare professions. The concept of White privilege and male privilege was clearly articulated and widely disseminated through McIntosh’s work in the 1980s. McIntosh articulated White male privilege as “an invisible package of unearned assets which he can count on cashing in each day, but about which he was ‘meant’ to remain oblivious. White privilege is like an invisible weightless knapsack of special provisions, assurance, tools, maps, guides, codebooks, passports, visas, clothes, compass, emergency gear, and blank checks” (McIntosh, 1998, p. 1). Privileging is “a process where chances or odds of being offered an opportunity are altered or skewed to the advantage of members of certain groups” (Minarik, 2017, p. 55). Essentially, privilege functions by providing some groups of individuals (e.g., White, male, heterosexual, abled, middle class) with preferred treatment in the form of special opportunities and advantages, while with- holding that preference from other individuals (e.g., African American, female, LGBTQ, disabled). Privilege can include many advantages including being given the benefit of the doubt and feeling a sense of belongingness (Minarik, 2017).
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