While humans around the world are remarkably consistent in biological terms, different cultures often have very different ideas about health and different attitudes toward healthcare professionals. This makes intercultural competency in healthcare especially important, with one entrepreneur saying it’s even more important than linguistic competency.
Abner Mason got the idea to start ConsejoSano – whose name is Spanish for “healthy advice” – in about 2013, on the heels of a corporate wellness company he and others had founded called the Workplace Wellness Council of Mexico. Based in North Hollywood, California, near Los Angeles, ConsejoSano bills itself as comprising a multidisciplinary group of healthcare experts and combining data, behavioral science and cultural understanding to “making healthcare work for everyone.” Mason explained that it came from a confluence of factors, such as the rise in the consumerization of healthcare, the passage of the Affordable Care Act, and the fact that Hispanics are among the most under-insured populations in the US.
Mason will take part in a panel discussion next week at the MedCity INVEST Twin Cities conference in Minneapolis, “Medicaid Innovation: The Key to Bending the Cost Curve.” Joining him will be Adaption Health co-founder and panel moderator David Kulick, Unite Us founder Dan Brillman and Livio Health Group co-founder and FRITZFINN CEO Mike Nathan.
What makes culture more important than language, Mason said in a phone interview, is that even if people speak the same language, their cultural attitudes may differ markedly. For example whereas a Miami resident of Cuban origin may have no difficulty trusting healthcare institutions, a person of Mexican origin in Los Angeles may be fearful of seeking care due to the current political environment. That’s especially true because the safety net providers in the US are Federal Qualified Health Centers, or FQHCs. “You’ve got to have a trusted enough relationship that you’ve got to trust them and help them understand that this FQHC is a safe place,” he said.
A study published in 2013 speaks to the importance of cultural competence in medicine. Researchers at the University of Hawaii at Manoa reviewed the Accrediation Council for Graduate Medical Medication program requirements and documents from the organization’s website to evaluate cultural competency requirements across medical specialties. They found that a majority of medical specialty and subspecialty programs had little or no specificity with regard to cultural competency in their program requirements.
More recently, an article published last month by ProPublica and STAT found that African-American and Native American patients are often underrepresented in clinical trials in part due to mistrust of the medical system due to abusive practices in recent history. In particular, those are the Tuskegee study, in which African-American sharecroppers were infected with syphilis and had treatment withheld, while thousands of Native American women were sterilized in the 1970s without their consent by the Indian Health Service, part of the Department of Health and Human Services.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
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Of course, language remains an important factor as well. For example, Mason said, it’s imperative when working with the Chinese population to know to engage people in the correct language, such as Mandarin or Cantonese. There are also smaller communities, like Aramaic-speaking Iraqi Christians, who have an especially large population in San Diego County served by one of ConsejoSano’s FQHC clients. According to the 2010 Census, Iraqi Christians – including Chaldeans, Assyrians and Syriac people, comprise 110,807 people, with 61,272 speaking Syriac, a form of Aramaic.
But despite California’s diversity, Mason said the skills of its medical community haven’t necessarily kept up. For example, a 2016 study by the Latino Physicians of California found that the state has a shortage of Spanish-speaking doctors. Less than 5 percent of doctors are Latino, even though Latinos make up 40 percent of the population. Moreover, Mason pointed out that 56 percent of the Medicaid population is Hispanic. “Not every doctor takes Medicaid patients, so it’s really a struggle for these patients to engage because the healthcare system and the providers are just not equipped to understand who these people are culturally and linguistically,” he said.
Photo: mathisworks, Getty Images
