The conversations on health equity have put a magnifying glass on the “one size fits most” healthcare model and exposing its flaws. Disparities are being brought to the surface and health system stakeholders are scrambling to find solutions.
While gathering data and analyzing systemic issues is key to unraveling ongoing healthcare disparities, embracing the humanity of our members and meeting them where they are is crucial in ensuring equitable access and outcome improvement.
Conversations centering Social Determinants of Health as a key barrier to receiving adequate healthcare is crucial, but it's only part of the picture. There are other elements, cultural and historical, that fully encompass one's humanity and create better understanding for addressing health inequities.
May is Asian American and Pacific Islander Heritage Month so we will be focusing in particular on the lens of the Asian American perspective on healthcare barriers. The demographics ‘Pacific Islander’ or ‘Asian American’ encompasses more than 50 sub demographics each with distinct cultures, over 100 spoken languages, religious practices, and immigration history.
Breakdown in communication due to language barriers has made receiving adequate healthcare exponentially more difficult for Asian American communities. These barriers lead to miscommunication of symptoms, misunderstanding of treatments, and misdiagnosis.
If a patient is struggling with a language barrier, describing symptoms, treatments, and instructions are easily lost in translation.
In a survey conducted to dive into the barriers of healthcare for Asian Americans, with 19 focus groups representing 13 different Asian American communities, 57% of the Cambodian women surveyed had trouble getting adequate medical care because they couldn’t find an interpreter. Some would end up bringing their children to interpret creating additional problems of embarrassment and miscommunication because of the lack of knowledge on medical terminology.
It was also voiced that there is a pressing need for providing test results, educational materials, and prescription information in the patient’s preferred language.
The nuances of different cultural norms are not widely understood or respected in the medical space. A majority of Asian communities continue to practice elements of traditional healing and alternative medicine practices in tandem with Western medical practices.
When these cultural practices are not respected, it discourages patients from volunteering information about using what is called complementary and alternative medicine (CAM). When physicians don’t have this information they are unable to see the whole picture of how these practices could either work with or create negative side effects for treatment plans and prescriptions, possibly leading a patient to stop treatment too early.
Unfortunately, when preventative treatments and check ups are not regularly performed and adhered to, serious conditions can go undiagnosed for years resulting in poorer health outcomes and lower quality of life.
Foregoing care appointments and treatment regimens is exacerbated by overwhelming healthcare costs. When you look at Asian Americans as a blanket group, their uninsured rates are comparable but still slightly higher, than those of white americans. However, rates of uninsured Asian Americans varies greatly among the different sub demographics:
In the study, participants noted that many elders face insurance gaps in coverage between loss of employment and turning 65 (qualifying for Medicare); purchasing insurance during this time can pose a financial hardship. The high-cost of healthcare pushes some people to seek care in other countries for larger procedures or medication because it’s cheaper. Going to these means results in putting off necessary services and misinformed utilization data for Asian American healthcare.
Western medical practices are widely based on research conducted with a majority caucasian test subjects. These studies therefore do not account for differences in diet, lifestyle, medical practices, traditional herbal remedies, and cultural sensitivity for people in different cultural and ethnic demographics when testing medical theories and pharmaceuticals.
An example of this is the response patients of Asian American descent have shown to certain psychotropic medications. Asian Americans often require a lower dosage than is traditionally recommended due to diet, allergies, genetics, or lifestyle. Data has also suggested that homeopathic treatments can react negatively to certain psychotropic medications.
This information is crucial when treating all patients, especially with the increased public interest in alternative medicine practices. Having a working knowledge of alternative practices and the nuance of dosage and treatment plans for each individual. Failure to do so creates non-adherence due to adverse effects and ultimately mistrust.
Low utilization rates, as previously stated, can lead to misinformation about health outcomes for Asian American communities. This is particularly highlighted in mental healthcare utilization in these populations as well as cultural stigma.
For a long time researchers concluded that low utilization of mental health services meant lower rates of psychopathology among Asian American and Pacific Islander (AAPI) communities. One article noted that despite facing discrimination, trauma, and hardships people in the AAPI community were “more resilient” to mental health conditions.
In fact, these conditions were actually presenting more severely in Asian Americans than other demographics and required more intensive care. So how are these cases going unrecognized for so long?
Previously, we discussed the language barrier as well as cultural norms and traditions creating misunderstandings in health care visits. There is a similar pattern in seeking mental health care.
Terminology may not translate as well to other languages and become misused or mis-interpreted. For example, in Japan and China the use of the word neurastenia would be used in place of a schizophrenia diagnosis through misinterpretation and to minimize the severity of the condition because of societal expectations and stigma.
Apart from language, the philosophy around talking about the mind and body differs greatly between Western and Eastern cultures. In Western philosophy (the basis for the US medical understanding) views the mind and body as separate entities, while Eastern philosophy states the mind and body as one. These points of view influence the way a patient talks about their symptoms and can be a barrier when a caregiver does not have a well-rounded understanding of differing medical philosophies.
Because of cultural stigma of mental disorders and an Eastern philosophy of health that views the mind and body as one, Asian Americans will often present their symptoms as physical complaints rather than talking about any emotional stressors or symptoms.
Suppressing these symptoms leads to foregoing interventions for a longer period of time than in other ethnic groups. In one example, patients with developing Schizophrenia would be kept within the family unit or community and not seek mental health care until 3 years after the symptoms had presented themselves.
However, by providing culturally sensitive care these utilization gaps close. Cities with a higher concentration of Asian American populations such as Los Angeles, New York, Boston, Seattle were able to establish networks of bilingual and bicultural care professionals and have proven to shorten the delay between the onset of symptoms and seeking care.
With the complexities and nuances of addressing care across diverse cultural backgrounds, how are healthcare professionals meant to keep up?
Digital health platforms, such as Wellth, are improving healthcare accessibility across the board and can help bridge these cultural barriers as well. Digital solutions offer capabilities such as a wide variety of supported languages and personalization to meet members where they are.
Wellth also offers a team of member support specialists to give knowledgeable and empathetic support in a culturally relevant way. Once trust is established, digital platforms can be utilized to improve access to care and communication of additional member needs.
Platforms that are easy to use and widely accessible can be used to screen for social determinants of health, enabling providers and care teams to better assess and assist the needs of their members.
Wellth’s straight forward design makes it manageable for all to use, keeping the experience personal, while still offering support for the most common social determinants of health through rewards. With intuitive design and data utilization, Wellth has been able to create programs that are the perfect fit to help empower each of their members to take ownership and get involved in their care plans.
As the diversity of the member base widens, the data collected helps improve the specificity of the member’s journey. Honing in on specific verbiage usage helps limit misinterpretation and frustration, equipping members with the tools and language to communicate effectively with their care teams.
Collecting data through digital health platforms can also help create a more culturally aware experience across the board from customized scheduling, anticipating challenges, respecting cultural practices, tailored rewards, and an overall inviting experience that’s one size fits one.