The Importance of Culturally Competent Care

Racism is entrenched in the American healthcare system and is a public health issue. In the state of North Carolina, medical racism coupled with an ongoing emergence of health disparities remains prevalent. While there are several historical turning points throughout the medical history of North Carolina and its connection to disproportionately impacting underserved communities, one movement remains profound. The eugenics movement was catastrophic, and the impact on forced sterilization victims is unfathomable. The Eugenics Board was formed in 1933 and forcefully sterilized an estimated 7,600 individuals from the board’s formation until its closure in 1977. While forced sterilization impacted an array of individuals, mainly individuals with mental illness or traits deemed undesirable were increasingly victimized by this inhumane atrocity.

Stark moments such as the eugenics movement throughout history have led to medical apprehension for underrepresented communities. Addressing medical apprehension will require effective policy changes, biopsychosocial research, systemic change, and more. One additional solution is to amplify the importance of culturally competent care. Healthcare workers must be representative of their patients in hopes of changing perspectives on patient-provider experiences.

Medical racism is evident in Black communities, with racial health disparities in the U.S. being a continuous concern. To address this, the Millennium Development aimed for a 75% reduction in maternal mortality worldwide. The outcome was an international effort in developing and developed countries to reduce maternal mortality rates. Contrary to other developed nations, the U.S. has constantly shown disturbing downward trends, with a staggering incidence of 26.4 per 100,000 compared to Italy’s 4.2, Denmark’s 3.2, and Finland’s 3.2 per 100,000 maternal mortality rates. When assessing the national Black maternal mortality rate, it is quadruple that of non-Hispanic White women.

Black men had a 6% higher incidence rate and 19% higher mortality for cancer compared to White men in 2022. They also have a 2-fold higher risk of death from myeloma, stomach cancer, and prostate cancer. Black women had an 8% lower incidence of cancer but a 12% higher mortality than White women. Mortality rates for endometrial and breast cancers were up to 40% higher in Black women. These disparities are most evident in later-stage diagnoses in Black women and a lower 5-year survival rate.

Racism and Black Women’s Maternal Health

A study on clinicians’ perspectives on racism and Black women’s maternal health showed that Black women experience maltreatment and preventable adverse outcomes in perinatal healthcare settings at higher rates than White women; medical racism accounted for provisions in inequitable care, surveillance of Black women and families, and structural care issues that showed implicit racial biases in health care institutions.

In both urban and rural communities across North Carolina, Black women experience a limited number of maternal and reproductive healthcare resources available to them. For Black women who have lived in North Carolina all of their lives and those who are new to the area, it is unclear where to go for maternal healthcare services. The resources available in the community are not visible. Black mothers in Craven, Pitt, and Wilson counties reported that when they sought out breastfeeding support, they could not find any peer support groups led by and for women of color. When they turned to their local WIC offices for resources, it was unclear when they offered classes. The health department provided little information when they visited the WIC offices in person.

Black mothers in Craven and Wilson counties encountered providers lacking patience and empathy after experiencing one of the greatest joys of life, welcoming a newborn into the world. After delivery, they felt like a number on the assembly line, and providers couldn’t be bothered to dedicate extra time to their care if they had questions or needed more time to get ready to nurse their baby. Breast milk offers many health benefits for mothers and their babies. Still, unfortunately, Black mothers are not provided the same support and resources to initiate and sustain breastfeeding. When they visit their OB/GYN, they find that providers have their agenda and push other resources on Black mothers but make no mention of asking Black mothers if they plan to breastfeed and the benefits of breastfeeding. Providers make themselves available to assess mothers’ needs while at the hospital but do not provide any information or reach out after leaving the office.

Experiences of Medical Racism among Black Men

Similar to Black women, Black men also have a problematic relationship with our healthcare system. The absence of culturally competent care and familial negative experience with the healthcare system creates mistrust. In Wilson County, a young Black male expressed dealing with migraines, and his doctor prescribed medication to help with the migraines. After being on this medication, he was later rushed to the hospital because he was experiencing chest pain and high blood pressure–two health issues he had not experienced before taking this medication. At the hospital, he was diagnosed with a Level 1 Heart Block, which means his heart is not firing all the way. He and his family learned that chest pain and high blood pressure are side effects of the migraine medication. Before taking the medicine, his doctor did not inform him of these side effects.

Overcoming Health Disparities and Improving Outcomes

Black people are more likely to experience conditions related to heart disease, such as high blood pressure, diabetes, and high cholesterol. However, this is not always a genetic predisposition but rather the result of living in food deserts that do not offer access to healthy food options. With the presence of culturally competent care, the provider could have made a better medication recommendation that did not have side effects that impacted his heart health while ensuring better food recommendations did not exacerbate the heart challenges.

Cultural competency improves healthcare quality by enabling services to be customized to each patient’s needs. It contributes to more precise diagnoses and suitable therapies by assisting healthcare professionals in understanding the social determinants of health and their impact on one’s overall health. Numerous health differences exist due to racial, ethnic, and cultural groupings. Culturally competent care seeks to overcome these disparities by fostering equal access to healthcare services and enhancing health outcomes for marginalized communities. Patients are more inclined to actively participate in their care when they feel their healthcare providers understand and value them. Building trust between patients and caregivers through culturally competent care promotes greater treatment plan adherence and improved health outcomes. It is pivotal to address the significance of culturally competent care to advance health equity, enhance patient outcomes, and guarantee that healthcare services are available and inclusive to all individuals, irrespective of their cultural background.