The United States has a long and well documented history of systemic disparities. Healthy People 2020 defines a health disparity because”a particular type of health difference that’s closely linked with social, economic, and/or ecological disadvantage. Health disparities negatively influence groups of people who have systematically undergone greater obstacles to health according to their racial Caucasian counterparts or ethnic group; faith; socioeconomic status; sex; age; psychological wellbeing; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographical place; or other characteristics historically associated with ignorance or discrimination.”Women and ethnic and racial minorities are shown to receive less accurate diagnoses, curtailed treatment options, less pain management, and found to have worse clinical outcomes. Pregnancy-related mortality rates have been 3-4 x greater for non-Hispanic Black girls compared to their non-Hispanic Caucasian counterparts. In 2014, researchers found that Native influence groups Americans and Alaskan Natives have an infant mortality rate 60 percent higher than the rate because of their white counterparts. Both Hispanic and Black women are shown to have higher unintended pregnancy rates than their Caucasian peers, which has also been shown to be linked to multiple adverse perinatal outcomes. Even outside of the civilian health care system, disparities have been among army veterans as it pertains to healthcare access, use of health care, and higher prevalence rates of specific chronic diseases. Much like healthcare in general, access to mental health care and absence of health insurance are all associated with important mental health disparities among ethnic minorities.Given the aforementioned, healthcare providers must ensure they are doing their part to not just bring awareness to societal inequities, but also recognize the impact they can have on treatment delivery, individual self-management and collaborative treatment planning between provider and patient. The strategies listed below are not a comprehensive solution to a systemic issue, but only some suggested first measures opening up dialog, encouraging systemic assessments and emphasizing the importance of continuous observation and process improvement.Self-assessment:Be vigilant in continuously monitoring our own projected biases regarding groups distinct from our own. Champion cultural proficiency as a norm through ongoing staff development training, subject matter expert consultation, anti-racist education, case consultations, and peer reviews. Ask Questions:Don’t be afraid to politely ask your patients and peers rather than assuming particular practices, beliefs and behaviours hold true for all members of a particular racial or ethnic category. Be mindful that treatment planning is a collaborative process between the patient and therapy providers. Allow the patient to provide input and listen to their worries. Assess medication adherence in your patients on a regular basis. Discuss non-compliance and variables possibly impacting adherence, such as cultural or historical mistrust and/or obstacles to treatment. Relationship/Family Dynamics:Facilitate patients being able to go over their concerns privately without their spouse or relative in attendance. Discuss outlined treatment strategy with partners only with patient consent. For teenage minors, encourage parents to permit a split appointment where their teenager can be observed alone before having the parent/guardian rejoin the appointment to the end. Language Barriers:Allow for professional translators to be used, and arrange them beforehand. Do not assume that patients need their buddy or relative to be privy to their health advice because they attracted them to their appointment. Normalize translator use and ensure it is clear this is not an inconvenience so as to minimize self-consciousness about limited English proficiency. Financial Barriers:When summarizing therapy recommendations, be mindful of any related costs that may impede follow up or medication adherence. When possible, facilitate the individual having the ability to access drug reduction programs. Do not assume that all patients have been covered by health insurance. Transportation Barriers:Discuss with patients their capacity to get to follow up appointments or other medical consult referrals. When possible, discuss strategies to schedule several appointments on the same day to minimize greater gas, toll expenses, or the individual’s reliance on others for transportation. Patient Surveys:Use a patient survey to obtain their feedback regarding the care they receive. Pay particular attention to patterns and consistently deficient areas. Produce a corrective action plan to handle complaints/areas of concerns. Staff Training:Organizations are encouraged to ensure that employees are regularly trained on cultural competency including how numerous demographic variables affect provision of care for patients. Make sure that staff incorporates cultural proficiency expectations as part of regular procedures and procedures. Authors:Dr. Sheffield is a Licensed Clinical Psychologist with extensive clinical, treatment and program management experience with socioeconomically and ethnically diverse adults and youth. Dr. Sheffield has written more than three dozen parenting and self explanatory posts for the general public. Her volunteer jobs include being a part of this Science Cheerleaders, a national nonprofit 501(c)3 organization comprised of current and former NFL/NBA professional cheerleaders with STEM degrees who participate, encourage, and empower kids and young girls to pursue science, technology, engineering and mathematics careers.Dr. Ray is a certified physician, adjunct professor, and trainer. She specializes in family medicine and has extensive experience working with patients of all ages and ethnic backgrounds. As an educator, she enjoys executing interactive trainings focused on evidenced based practices and diminishing healthcare disparities. Dr. Ray is presently pursuing a Master’s degree in public health whilst living overseas and practicing in a primary care clinic.

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