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    A Model for Advancing Policy in Cultural Competency and Health Disparity

    As The US emerges from a long recession, managing the growing cost of healthcare remains an ongoing concern. The Affordable Health Act will eventually assure the availability of healthcare insurance coverage to over 30 million more Americans. This landmark legislation will improve access to a previously uninsured or underinsured group of Americans.

    Health and Healthcare disparities is broadly defined as worse baseline states of health and relatively worse clinical outcomes associated with certain diseases in certain population groups. The affected groups may be distinguished by race, ethnicity, culture, gender, religion and age. The costs to treat the diseases which result from Health and Healthcare disparities represent one of the recognized areas of unnecessary and arguably avoidable healthcare delivery costs. Specifically, in certain instances both prevention and more cost efficient management of chronic disease states can significantly reduce healthcare costs. A chronic disease is defined as a long lasting or recurrent medical condition.

    Some common examples include diabetes, hypertension, asthma and cardiovascular disease. Unfortunately, our current healthcare system may be better equipped to manage intermittent and episodic disease occurrences and not the demands of chronic medical conditions In a study published by Weidman et al from The Urban Institute,the authors estimated that in 2009, disparities among African Americans, Hispanics, and non-Hispanic whites will cost the health care system $23.9 billion dollars. Medicare alone will spend an extra $15.6 billion while private insurers will incur $5.1 billion in additional costs due to elevated rates of chronic illness among these groups of Americans. Over the 10-year period from 2009 through 2018, the authors estimated that the total cost of these disparities to be approximately $337 billion, including $220 billion for Medicare.

    In the same study, the authors estimated the total healthcare costs secondary to racial and ethnic health disparities in chronic disease treatment (diabetes, hypertension, stroke, renal disease, poor general health) in African Americans and Latino Americans residing in the Commonwealth of Pennsylvania to be $700 million. The Urban Institute. A study entitled The Economic Burden of Health inequalities in the United States by LaVeist et almeasured the economic burden of health disparities in the US using three measures: (1) direct medical costs of health inequalities (2) Indirect costs of health inequalities (3) Costs of premature death Their findings revealed:

    • The combined costs of health inequalities and premature death in the US among African Americans, Hispanics and Asian Americans were $1.24 trillion
    • Eliminating health disparities for minorities would have reduced direct medical expenditures by $229.4 billion for the years 2003-2006
    • Between 2003 and 2006, 30.6% of direct medical expenditures for African Americans, Asians, and Hispanics were excess costs due to health inequalities.

    Cultural competence (CC) refers to an ability to interact effectively with people of different cultures. CC comprises four components: (a) Awareness of one’s own cultural worldview, (b) Attitude towards cultural differences, (c) Knowledge of different cultural practices and worldviews, and (d) cross-cultural skills. Developing cultural competence results in an ability to understand, communicate with, and effectively interact with people across cultures. CC has been increasingly recognized as an important, overlooked and underappreciated factor in delivering healthcare to an increasingly diverse America. US census estimations project that by 2050, over 50% of Americans will be non-white. Over 50% of children will be nonwhite by 2025. It seems intuitive to that the interface between patient, healthcare system and healthcare provider is a critical point in the delivery of healthcare. To this end, The Office of Minority Health in the Department of Health and Human Services has issued mandates and recommendations to inform, guide and facilitate the creation of cultural and language appropriate services. (CLAS Culturally and Linguistically Appropriate Services). Implementation of these guidelines within systems and agencies and among individuals can enhance CC and ultimately improve clinical outcomes.. The Center for Health Improvement and Economic Development was one of several parties which advocated for statewide guidelines regarding the cultural competency CME (continuing medical education) requirements for initial licensure and relicensing of physicians in the Commonwealth of Pennsylvania. To accomplish this goal, we set forth to educate and inform the various stakeholders regarding the intrinsic value of CC as a critical determinant of improving healthcare outcomes and a direct result of a utilitarian argument of social justice in the United States. The Center also recognized the importance of making a compelling business case in the current economic climate Partnering with the Gateway Medical Society, the Pennsylvania State Legislative Black Caucus (PSLBC) under the leadership of State Representative Ronald G. Waters and the Center for Health Improvement and Economic Development-a townhall format meeting was organized and planned in Pittsburgh. Local legislators including State Representatives Jake Wheatley, Tom Preston and Daniel Frankel were in attendance.

    The townhall program: Working To Eliminate Healthcare Disparities in the Commonwealth of Pennsylvania was held in Pittsburgh. Attendees and participants included state policy makers, legislators, healthcare providers, healthcare administrators, social activists, business leaders and members of the general public. Robust debate occurred throughout the day and the exchange between audience members, legislators, policy makers and thought leaders underscored the recognized importance of the critical issue of Health Disparity and Cultural Competency. It is important to recognize the backdrop of the day’s events. The meeting took place two days after the initial steps of The Affordable Care Act were initiated with critical new consumer protections in the Patient’s Bill of Rights, including no pre-existing diseases for children, outlawing rescission and creating a path to allow adult children to remain on their parent’s insurance until age 26. The enthusiasm of the day culminated with a pledge from State Representative Ronald G Waters to support a resolution on CC to be submitted to the National Black Caucus of State Legislators- ultimately a path to introducing the legislation to all states and ultimately to the Congressional Black Caucus. The meeting emphasized the necessity and the benefit of identifying stakeholders, recognizing mutual agendas and seeking consensus in the path to generating support for public policy. Addressing CC in the healthcare environment through requirements for healthcare provider continuing education is one small step. Certainly, this requirement should be considered for other healthcare professionals, administrators and ancillary staff members. Greater awareness of the emerging diversity of America and understanding how to manage that diversity will significantly enhance the delivery of healthcare. The Pennsylvania State Legislative Black Caucus, The Center for Health Improvement and Economic Development and The Gateway Medical Society call upon other groups to join in our collaborative model to reduce Health Disparity and enhance healthcare delivery in The Commonwealth of Pennsylvania and beyond.

    The Legislative Black Caucus of Pennsylvania The PLBC was organized by House Majority Leader K. Leroy Irvis during the 1973-74 legislative session. K. Leroy Irvis saw the need for the caucus because he felt that legislators representing minority districts needed to speak with a united voice regarding the issues and concerns of their constituents. State Representative Ronald G. Waters was first elected to the House of Representatives in a special election in May 1999. He is chairman of the Health and Human Services Subcommittee on Health and serves on the Children and Youth, Health and Human Services, Judiciary, Liquor Control and Professional Licensure committees. He is also a member of the Philadelphia and the Southeast Pennsylvania delegations. Waters is also the chairman of the Pennsylvania Legislative Black Caucus, and chairman of Region 2 (which includes Pennsylvania and New York) of the National Black Caucus of State Legislators. About the Authors: Lee Kirksey MD is co-founder of The Center for Health Improvement and Economic Development, a public policy think tank. The organization is focused on the impact of social determinants on community health utilizing public private partnerships. His current research efforts include cultural competency and it impact on health disparities within surgery. He is author of The Wellness Revolution: Eliminating Disparities and Promoting Prevention…For All. Dr Kirksey is an Assistant Professor of Surgery in the University of Pennsylvania School of Medicine. Michele Jones, MSW, MHA serves as Manager of Partnership Development and Community Relations at Fox Cancer Center in Philadelphia. Having over 15 years management experience in health disparities, health education, public relations and development, Ms. Jones oversees prevention practices and partnership development. Through the years, she has worked in similar capacities at companies covering San Diego, New York as well as Pennsylvania. Through her work, she has become known as an innovator in the areas of health access, prevention and education, acquiring City Citations and Awards for both Community Outreach and Health Education. Jones is the founder of Jones Health Care Management Solutions and is currently a second-year Bioethics Student attending the University of Pennsylvania, School of Medicine.

    The Gateway Medical Society The Gateway Medical Society is a component of the National Medical Association. The National Medical Association objectives are to promote the science and art of medicine and the betterment of public health. Organized in 1895, the NMA Limits memberships to physicians licensed to practice medicine in any state or territory of the United States and the District of Columbia. Election of Membership may be obtained through Constituent Associations, through affiliation with societies consisting organized women physicians, Haitian physicians, and other minority physicians. The Gateway Medical Society is therefore a component society of its constituent association the Keystone State Medical Society of Pennsylvania.

    LaVeist TA, Gaskin DJ, Richard P, The Economic Burden of Health In equality in the US. Joint Center for political and Economic Studies.. Accessed Oct 10, 2010

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