Smith Final Paper A (2)

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Smith 1 Jane Smith Professor Tooley English 111 27 March 2023 Cultural Humility: A Workable Way to End Racism in Healthcare She sits up on the bed at the post-surgical care center. Her surgeon, a kind and attentive man, advises her of what her aftercare treatment plan will be. He describes the physical therapy regimen to her, informs her when she will be able to return to work, and advises her on the medications she will be taking. After the doctor leaves, the woman is stunned. She cannot believe she has only been prescribed acetaminophen for her post-operative pain. Indeed, a procedure such as this would warrant something more potent than just acetaminophen. The patient recalls her best friend had the same procedure and was given more potent pain medication to help with the long recovery process. She thinks about all her pain ahead of her and fears the painful physical therapy process. She wonders why her friend would be prescribed a different medication for recovery. The answer is simple but uncomfortable to hear. The patient is black, and her friend is white. Biases in the field of medicine and public health are long-standing and prevalent. The story described above shows one of the many biases people of color are faced with when they are in treatment for any painful ailment. It is long held and incorrect assumption that Black people experience less pain than White people (Hoffman et al. 4297). Of course, some diagnoses have a more measurable effect on those with certain skin tones; one example is sickle cell anemia. But diagnosis does not equal pain. And though people with black skin have had to silently bear the physical pain of the burden of historical injustices, does not mean that they were impervious to

Smith 2 the pain. It means they were not allowed to speak up and address the pain. The misguided belief that Black people do not feel pain like White people still stands tall among many other subtle, and not-so-subtle assumptions regarding people of color and medicine. These beliefs and biases are symptoms of the disease of racism in the healthcare profession. With all this modern medicine and a wellspring of knowledge, it may surprise some that racism is still commonly experienced in healthcare. But it does exist, and it greatly influences the people of color and their prognoses (Racism and health). Racism is a system. It is built upon a scaffolding of societal norms, assumptions, life lessons and public policies. The system of healthcare is not exempt from the system and structure of racism. Through education and cultural humility, racism can be lessened. It is not just a matter of feelings, or people not feeling heard or respected. Lives are on the line, people die every day because of racism in the healthcare setting. It is time something was done about it. Just as in the financial, professional, and educational settings, people from marginalized communities experience inequity. People of color are marginalized in the United States, and that marginalization has a profound impact on the quality of healthcare experienced (O’Reilly). People who are seen as the “other” are not treated with appropriate respect and dignity. People of color are far too familiar with the biases of White physicians and others in the medical field because it is present in every interaction at medical facilities. This otherization of people of color leads to what Dr. Arline T. Geronimus describes as “weathering.” Weathering is the idea that people who are oppressed through the institution of cultural racism have diminished and poorer prognoses. Weathering has acute and chronic effects on the bodies of people of color. For instance, in the short term, a Hispanic woman may not be believed when she reports that she has been experiencing painful ovulation. And in the long

Smith 3 term, a middle-aged Black man who has mistrust of the system of medical care does not go in to his schedule prostate exam which leads to his colon cancer being undiagnosed, leading to his premature demise. Stressors from both acute and chronic health concerns have profound effects on the bodies of people of color. When stress is prolonged, and the medical establishment does not take care to gain trust, bodies deteriorate, and people die much earlier than they should. Racism is not a one-way-street. Non-white healthcare professionals and students experience racism from their superiors and their patients (Bell). When a person of color enters the healthcare field as a professional, they become a part of the structure that historically has been very unjust to people who look like them. In schools of public health and medicine, racist ideologies are often deeply rooted into those systems. It is hard to combat those beliefs, particularly when aggressions come from supervisors, management, and patients. Dealing with regular work-pressures atop racism leads to poor quality of care (National Commission to Address Racism in Nursing). It is not just the patients and professionals that bear the burden of the institute of racism. When things go wrong medically with a loved one, the whole family suffers. Returning to the concern of “weathering,” and how it affects the family and community of the ill person of color. Perhaps the ill person is the head of household and earns much of the money. If the head of household cannot work and maintain a steady income, the whole family suffers. The community also suffers when the grocery store loses profit, the child cannot go to daycare, or the stories of the past generations are lost prematurely. Linda Villarosa illuminates the fact that Black Americans “live sicker and die quicker.” Early death leads to a loss in talent in the marketplace, the variety of the community, and a deepening mistrust of the medical establishment.

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Smith 4 Racism has an effect across diagnoses. Race and ethnicity are correlated with a higher rate of death relating to Covid-19 infections (Gross et al. 4). People of color have higher rates of heart disease, stroke, and high blood pressure than their white counterparts. It would be easy to jump on the bandwagon and believe that it is not a race issue, but a class issue. But when access to care and other socioeconomic factors are controlled and accounted for, health disparities as they relate to race and ethnicity persist. The color of one’s skin continues to be the predictor of the quality of healthcare received (Smedley et al. 5). So, this is not just the people in the poor neighborhoods; it is the teachers, banking officials, religious leaders, artists, and all other people integral to communities everywhere. Patients of color know they experience racism; medical professionals know they experience racism; what seems to be missing is the awareness of the medical establishment to do something about it. It takes awareness to begin to combat structural and systematic racism, but most people do not believe that inequalities or racism exists anymore (Kwate 851). Individuals do not expect themselves to be racist. They do not see it in their own actions or words. But racism still runs rampant in healthcare settings. Something bust be done to address it, more than is currently being done. So, what is already in motion? Diversity Equity and Inclusion, a training that is created to provide framework for organizations or institutions to deal with fair treatment internally, does not pass muster ( Cultural Humility: People, Principles and Practices ). Diversity Equity and Inclusion training does not work well as it creates and fosters tension within the white workers and members of the organization. Rather than create a sense of curiosity and respect, it otherizes and makes White people feel like they do not belong. Additionally, it does not meet the task of

Smith 5 truly promoting voices of people of color, and it does not allow for the nuance that truly exists within all individuals. What Diversity Equity and Inclusion training does well is to promote what is called cultural competence. Cultural competence is the ability of people to knowledgeably interact with people from different cultures (Khan). On the outside, cultural competence sounds like a wonderful solution. Knowledgeable interaction sounds like a great place to start, and perhaps it is. But it barely scratches the surface about who the patient sitting in front of their provider really is. What cultural competence does is put people in boxes while they are being observed from the outside. It does not consider the entirety of the person, nor does it allow for the patient to have a say in how they identify or wish to be addressed. The Center for Disease Control and Prevention has created a set of health equity guidelines that outline principals for inclusive communication (CDC Health equity guiding principles for inclusive communication. ). included in this list are using terms which with people most identify, considering equity in planning healthcare for individuals, and exploring other resources that could benefit the patient and the institution. The CDC is moving towards the right frame of mind. But it still lacks the attention to patient and patient background that is needed for equity in healthcare. To begin to bridge the gap between what is happening and what is needed, an understanding of intersectionality must occur. Intersectionality simply means that a person is more than just what boxes they appear to fall into, and that it is the entirety of their personal categories are what make a person unique. Intersectionality shows that a person is more than just their gender, race, background, personal geography, or friend group; they are a melting pot of all

Smith 6 these things together as a unit. Full understanding of person is what is needed for patient care. But how is that possible? It is certainly easier said than done. Instead of shaking up a system that is already in place, perhaps what is right would be a consideration in a shift of awareness that would allow the healthcare provider to be ok with the fact that they do not know everything. This moves into the area of what is called “cultural humility,” and it is the answer to the problem of racism in healthcare. Cultural humility is a concept coined by Melanie Tervalon and Jan Murray-Garcia in 1996. Cultural humility goes past the concept of intersectionality and Diversity Equity and Inclusion training. Cultural humility considers the entirety of intersectionality and adds to it the core understanding that it is okay to not completely understand your patient. As discussed earlier, being unwell in the medical system goes far past being low socioeconomic status, or a person of color, or being far from a medical establishment. It also has to do with how the medical professionals see patients within the system. Cultural humility advocates for full involvement in the health of the patient. Not by knowing everything about the full cultural history of the patient, but by being comfortable in understanding that the healthcare system does not know, and that it is okay to not know. It involves self-reflection, and a willingness to be vulnerable, and to ask questions. Furthermore, cultural humility promotes the idea of raising minorities into positions of power withing organizations. This is important so that when people of color come into a medical establishment, they know that they have a greater likelihood of at least being understood by someone in the medical establishment that can look out for their best interests. Khan explains how this works within and between coworkers, also. Working around others who appear differently, were raised differently, or speak a different language increases the likelihood that

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Smith 7 their cultural is appreciated. This understanding can help to foster a place of humility, curiosity, appreciation and understanding. When a medical establishment has these values, the patients can truly be seen and treated with the appropriate healthcare measures for their entire person. It is not enough for just physicians to get involved in the act of cultural humility. Social workers who use cultural humility will benefit their clients by being able to offer diverse resources that would sync with the backgrounds of their clients. Mental health professionals who understand the need for cultural humility will be able to see the cultural taboos or norms of mental health within their patient’s backgrounds. Nurses who use cultural humility will not blow off their patients because they may understand that their patient or patient’s families need things explained in different ways. Kitchen staff of medical facilities who understand cultural humility will be able to provide healthful comfort food for all different types of people to aid in recovery. Religious leaders in the medical establishment using cultural humility will be able to provide religious counseling that is diverse, expansive, and multi-layered, just like their participants. Everyone within the healthcare space can use cultural humility. All are responsible for making a patient feel like they are removed from the eyes of the racist system to which they belong. No large change needed, just refocusing of DEI training and cultural appreciation. A shift from the binary thinking process of people being either Black or White, Hispanic or Non- Hispanic, or any other binary to a way of thinking that understands intersectionality. A shift in thinking will take people from being boxed in and misunderstood to being treated as a whole person. This solution is a workable one because there is no end. Cultural humility can free the entirety of the healthcare system from the institutional suffering from the racist scaffolding that has been holding it up since healthcare began.

Smith 8 Works Cited Bell, Blythe. “White Dominance in Nursing Education: A Target for Anti‐Racist Efforts.” Nursing Inquiry , vol. 28, no. 1, 3 Oct. 2020, https://doi.org/10.1111/nin.12379. “Cultural Humility: People, Principles and Practices.” Vivian Chávez , The Social Work Practitioner, 19 Aug. 2013, https://thesocialworkpractitioner.com/2013/08/19/cultural- humility-part-i-what-is-cultural-humility/. Accessed 19 Mar. 2023. Davies, Dave, and Linda Villarosa. “'1619 Project' Journalist Lays Bare Why Black Americans 'Live Sicker and Die Quicker'.” Fresh Air, WHYY, NPR, 14 June 2022. Geronimus, Arline. “Arline Geronimus - Faculty Profiles - U-M School of Public Health.” Faculty Profile , University of Michigan, https://sph.umich.edu/faculty-profiles/geronimus-arline.html. Gross, Cary P., et al. “Racial and Ethnic Disparities in Population Level Covid-19 Mortality.” 11 June 2020, https://doi.org/10.1101/2020.05.07.20094250 . “Health Equity Guiding Principles for Inclusive Communication.” Centers for Disease Control and Prevention , Centers for Disease Control and Prevention, 2 Aug. 2022, https://www.cdc.gov/healthcommunication/Health_Equity.html. Hoffman, Kelly M., et al. “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites.” Proceedings of the National Academy of Sciences , vol. 113, no. 16, 4 May 2016, pp. 4296–4301., https://doi.org/10.1073/pnas.1516047113 . Khan, Shamaila. “Cultural Humility vs. Competence - and Why Providers Need Both.” HealthC- ity , 9 Mar. 2021, https://healthcity.bmc.org/policy-and-industry/cultural-humility-vs-cul- tural-competence-providers-need-both.

Smith 9 Kwate, Naa Oyo. “‘Racism Still Exists’: A Public Health Intervention Using Racism ‘Counter- marketing’ Outdoor Advertising in a Black Neighborhood.” Journal of Urban Health , vol. 91, no. 5, 2014, pp. 851–872., https://doi.org/10.1007/s11524-014-9873-8. National Commission to Address Racism in Nursing. “Infographic: Racism’s Impact in Nurs- ing.” American Nursing Association , https://www.nursingworld.org/~48f9c5/globalas- sets/practiceandpolicy/workforce/commission-to-address-racism/infographic--national- nursing-survey_understanding-racism-in-nursing.pdf O'Reilly, Kevin B. “Ama: Racism Is a Threat to Public Health.” American Medical Association , 16 Nov. 2020, https://www.ama-assn.org/delivering-care/health-equity/ama-racism- threat-public-health. “Racism and Health.” Centers for Disease Control and Prevention , Office of Health Equity, 24 Nov. 2021, https://www.cdc.gov/minorityhealth/racism-disparities/index.html. Tervalon, Melanie, and Jann Murray-Garcia. “Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education.” Journal of Health Care for the Poor and Underserved , vol. 9, no. 2, 2 May 1998, pp. 117–125., https://doi.org/https://doi.org/10.1353/hpu.2010.0233.

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