Let’s Build Something Together

In early June, The Archives of Internal Medicine published an article concluding that our health care system fails minority patients because of what the study’s author, Dr. Thomas D. Sequist, an assistant professor of health care policy at Harvard Medical School, called “a systemic failure to tailor treatments to patients’ cultural norms.” According to Dr. Sequist, “it isn’t that providers are doing different things for different patients. It’s that we’re doing the same thing for every patient and not accounting for individual needs. Our one-size-fits-all approach may leave minority patients with needs that aren’t being met.” To address these gaps, Sequist suggested that health care providers learn more about minority communities so they might better understand cultural barriers to treatment compliance.

As many of you know, Transdiaspora Network recently conducted a health survey in the Crown Heights community. After analyzing the survey results with  Gretchen Maneval, Lorna Mason*, and Naomi Braine at the Center for the Study of Brooklyn at Brooklyn College, we found that knowledge and impact of HIV/AIDS varied widely among survey participants, a diverse group ranging in ethnicity, age, and gender.

More than 60% of those surveyed reported that they had not participated in HIV prevention education, and 67% reported that they discussed ways to protect themselves only once per year or even less frequently.

Not surprisingly, an overwhelming majority of those surveyed (79%) reported that their HIV prevention education had not incorporated cultural elements at all.

But most interestingly, we found that 50% of those whose education had incorporated cultural heritage described their knowledge of HIV prevention as “excellent” compared to 27.7% of those whose education did not incorporate cultural heritage at all.

So what does this all mean? Sequist is right, but he is also quite wrong. While his study sheds light on the shocking lack of cultural sensitivity among most health care providers, an even more ambitious approach is needed. We must go beyond simple cultural sensitivity or even competency and demand cultural proficiency. Cultural differences need not be a limiting factor merely to be accommodated or referenced, as Sequist’s study suggests. Let’s not just consider culture. Let’s use it. Our rich cultural heritage can provide many of the tools we need to address our most intractable health challenges such as effective HIV prevention. Setting the bar higher – aiming for cultural proficiency – will allow organizations to develop more sustainable prevention programs within a community that improve the capability of its own residents. Let’s take a closer look at everything that our own community has to offer. Harnessing the full potential of our own very powerful cultural resources may well provide the more lasting, more comprehensive, and ultimately more sustainable approach to HIV prevention that we urgently need.

*TDN would like to give a special thank you to Lorna Mason for creating the beautiful graphs you see here.

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