Greetings from the Center for Linguistic and Cultural Competence in Health Care (CLCCHC) at the HHS Office of Minority Health!

We are excited to introduce to you Mayra Alvarez, MHA as the Project Director of the Center for Linguistic and Cultural Competence in Health Care! In September, Ms. Alvarez was appointed the Associate Director of the Office of Minority Health. At OMH, Ms. Alvarez’s portfolio will comprise priority OMH initiatives including the Affordable Care Act, community health workers and promotores de salud, and language access. Welcome, Ms. Alvarez!

This edition of Think Cultural Health News will explore the concepts of "health" and "culture" as seen in efforts to understand and address health disparities. In April 2013, the HHS Office of Minority Health published the enhanced National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (the National CLAS Standards). The enhanced National CLAS Standards have expanded definitions of "health" and "culture," two of the Standards' foundational concepts. Read below for information about these elements.

For more information on the National CLAS Standards, we encourage you to visit Think Cultural Health and download The Blueprint, the Standards’ guidance document that offers explanations, implementation strategies, and additional resources for each Standard.

Thank you for your dedication to advancing health equity!

Research shows that disparities persist in mental health care.¹ The HHS Agency for Healthcare Research and Quality’s National Healthcare Disparities Report found that the mental health care system does not effectively address the needs of culturally diverse individuals due to barriers including social stigma, mistrust of providers, and lack of culturally competent providers.

For example, as CNN recently highlighted, many Latinos in the U.S. struggle to seek and find mental health services when they’re needed. The news feature discusses the role of stigma and lack of workforce diversity as barriers to accessing mental health services. However, the CNN story notes that culturally appropriate interventions can build awareness of mental health problems in the Latino community and help families to reduce the fear of stigma. Culturally tailored mental health services can be an important strategy to reduce mental health care disparities.^2,3,4

Health, as defined by the National CLAS Standards, encompasses physical, mental, social, and spiritual well-being. This broad definition encourages health professionals and systems to take into account multiple dimensions of well-being when providing services. Implementing culturally and linguistically appropriate services across a broad spectrum of health services will advance health equity for our nation’s diverse communities.

¹ Ault-Brutus, A.A. (2012). Changes in racial-ethnic disparities in use and adequacy of mental health care in the United States, 1990-2003. Psychiatric Services, 62, 531-540.

² Briggs, H.E., Briggs, A.C., Miller, K.M., & Paulson, R.I. (2011). Combating persistent cultural incompetence in mental health care systems serving African Americans. Best Practices in Mental Health, 7, 1-25

³ Pumariega, A.J., Rothe, E.M., Song, S., & Lu, F.G. (2010). Culturally informed child psychiatric practice. Child and Adolescent Psychiatric Clinics of North American, 19, 739-757.

⁴ Sue, S., Zane, N., Nagayama Hall, G.C., & Berger, L.K. (2009). The case for cultural competency in psychotherapeutic interventions. Annual Review of Psychology, 60, 525-548.

The National CLAS Standards define culture to include racial, ethnic and linguistic groups, as well as geographical, religious and spiritual, biological, and sociological characteristics. This conceptualization aims to reflect the complex and dynamic nature of culture. The inclusion of geography in this definition acknowledges the fact that where one lives and works influences one’s cultural identity. Geography is also closely associated with many factors that influence health, such as social policies; housing; transportation; distribution of money, power, and resources; and access to and the quality of health systems.

The Robert Wood Johnson Foundation’s Commission to Build a Healthier America created maps of several U.S. cities that portray the varying average life expectancies for different areas of the cities. These city maps highlight significant disparities in life expectancy between nearby neighborhoods of the same city. In Washington, D.C., for example, individuals who live just a few metro stops away from each other have up to a seven year difference in life expectancy. The map for New Orleans shows a 25-year gap in life expectancy across neighborhoods just a few miles apart from each other.

Geography influences health by influencing one's opportunities to access healthy food, good education, high quality health care, affordable and safe housing, employment opportunities, and other factors that affect well-being. By adopting a definition of culture that encompasses geography, the National CLAS Standards aim to help health organizations understand and use the myriad and complex factors that inform one's cultural identity to advance health equity.

On December 9, 2013, Think Cultural Health will present on the National CLAS Standards at the Northern Virginia Language Access Leadership Conference in Fairfax, Virginia. Please join us!

Do you have an event you'd like to share with the TCH team and other members of the CLCCHC community? Submit the event to our Community Calendar.