Caring for Diverse Populations and Cultural Humility

00:01 We're gonna be discussing caring for diverse populations as as well as cultural humility now.

00:06 And this is a subject that's particularly important to me personally.

00:10 I've worked in my clinical practice in the same community health center for the past 20 years, and we are the largest safety net health care provider for our area.

00:21 In addition, I'm very interested in health disparities, because I think until we really address health disparities and provide culturally humble care to our patients, we're not gonna provide an optimal patient experience, and we also won't really get the outcomes we want to in terms of patient's taking physician's advice, adhering to treatment regimens, and incorporating lifestyle changes that really makes a difference, so we're gonna some spend time discussing some different definitions which aren't usually covered within the medical school curriculum but are important for patient care and USMLE as well.

00:56 And then we'll be talking about health disparities.

00:59 Going through some statistics.

01:01 How they really go from birth to grave.

01:04 And then finally, we will talk about implicit bias, something that we all share, and something that we can still do something about.

01:11 All right, so let's start with a definition, and you know, first, I think that when we think about health disparities, a lot of times we divide it by race and ethnicity.

01:20 And what does that exactly mean? It turns out that race as a fairly controversial subject overall, it doesn't have a precise definition.

01:30 But it generally means that people who share certain physical characteristics, doesn't get to the core of what it means to be a person, and how that impacts a person's health, and their attitudes and when they're in my clinic.

01:44 Ethnicity, I think it's a definition that brings a lot closer.

01:49 So we're talking about a social group that's characterized by a distinctive social and cultural tradition, maintained from generation to generation, a common history and origin and a sense of identification within the group.

02:01 The members have distinctive features in their way of life, shared experience and often a common genetic heritage.

02:07 These features may be reflected in their experience of health and disease.

02:11 So this is a definition I think that I can certainly relate to a lot better than race alone, because it's about values, and it's about practices.

02:21 It's about habits, and it's passed down from generation to generation.

02:25 And yes, there is probably some link to genetic heritage but not necessarily so.

02:30 So this is something that I feel like I can grab hold of, it's going to very much be a part of my clinical encounter and my patient's health care.

02:37 And it also reflects the definition of culture.

02:41 So there's a lot of definitions of culture out there.

02:44 There's a lot of definitions of race and ethnicity.

02:46 These I think are really strong ones, but it doesn't mean they're the only ones.

02:51 Culture can be defined as the shared values, beliefs and practices of a particular group of people which are transmitted from one generation to the next and are identified as patterns that guide the thinking and action of the group members, and that's called culture.

03:04 It really reflects I think what we just discussed and that's ethnicity, the two are often linked and very, very important to consider in health care.

03:12 Because when you don't, you wind up with health disparities.

03:17 And you know, one of the most severed disparities in the United States involves a life span.

03:23 So it's well recognized that African-Americans have a lower life expectancy than whites.

03:30 Back in 2004, the difference was 5.2 years, favoring whites.

03:35 But in 2014, the good news is at least that gap has shrunk to 3.4 years.

03:41 So this is the latest data.

03:43 So it's still a leg, it's still important to work on the base causes of these disparities, but at least it seems to be improving and the trend is getting better.

03:53 That's encouraging.

03:54 But it does start really early.

03:56 So this is looking at the rates of low birth weight infants less than 2,500 grams, and you can see that the overall rate in the United States in 2014 was 8%, but among Non-Hispanic black patients, it was 13.2%.

04:12 Among Puerto Ricans, 9.5%.

04:14 So as I said, these health disparities, they start at a very early age and they continue.

04:20 Continues in terms of the rates of childhood obesity which is what this graph is describing.

04:27 You could see the rates among Hispanic and Non-Hispanic blacks are higher than the rates of childhood obesity among Non-Hispanic whites and Non-Hispanic Asian populations.

04:39 And this continues into adulthood.

04:41 As you know, obesity during childhood is a strong risk factor for obesity during adulthood.

04:47 And then obesity during adulthood leads to higher rates of diabetes, hypertension, heart disease, all the things that cause early mortality.

04:56 I'm gonna take a minute just to highlight something that's really important.

05:01 It's becoming an increasingly important issue in the United States as awareness grows around transgender and transgender health issues.

05:13 And transgender health issues to me, it's difficult to separate from some of the social concerns that affect transgender people.

05:22 We're not talking about a small group of people.

05:24 If the estimated prevalence is 1%, and therefore, that means 25 million people worldwide are transgender.

05:32 So what are they at risk for? Transgender stats even itself is a higher risk for poverty which is one the strongest risk factors for poor health in a variety of different outcomes.

05:43 It's a higher risk factor for being a victim of violence or even murder.

05:47 Higher risk for sexual assault and being a sex worker, and being a victim of human trafficking, much higher rates among transgender people.

05:57 And for example, the talk about health risks and try to provide you some perspective.

06:01 The odds ratio for HIV infection amongst transgender individuals versus non-transgender is over 50 times.

06:09 So transgender individuals have over a 50 times higher risk for HIV infection.

06:15 Obviously, a very serious diagnosis compared with non-transgender.

06:19 So it's something to keep in mind as we evaluate patients, and especially as they're starting to evolve their ideas about their own gender identity.