Cultural Competence: An Overview _____________________________________________________________
• Lack of feedback • Feeling behind with work • Lack of guidance • Long hours • Overcrowding • High-crises environments • Mentally taxing tasks • Juggling competing tasks
• 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
ROLE OF INTERPROFESSIONAL COLLABORATION AND PRACTICE The study of implicit bias is appropriately interdisciplinary, representing social psychology, medicine, health psychology, neuroscience, counseling, mental health, gerontology, gen- der/sexuality studies, religious studies, and disability studies [28]. Therefore, implicit bias empirical research and curricula training development lends itself well to interprofessional collaboration and practice (ICP). The main characteristics of IPC allow for implicit and explicit biases to be addressed by the interprofessional team. One of the core features of IPC is sharing—professionals from differ- ent disciplines share their philosophies, values, perspectives, data, and strategies for planning of interventions [29]. IPC also involves the sharing of roles, responsibilities, decision making, and power [30]. Everyone on the team employs their expertise, knowledge, and skills, working collectively on a shared, patient- centered goal or outcome [30; 31]. Another feature of IPC 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. This includes [32]: • Values/ethics: The ethical duty for health professionals 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 professionals is to analyze how institutional and organizational factors promote racism and implicit bias and how these factors contribute to health disparities. This analysis should extend to include one’s own position in this structure.
• Education access and quality • Health care access and quality • Social and community context • Neighborhood and built environment
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 opportunities • 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].
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