Cultural Diversity: A Double-edged Sword?

Being from Coxsackie, NY- yes, this is a real place and yes, the hand, foot and mouth disease is our unique claim to fame in the medical world- I could not wait to set sail to the big city of Philadelphia. I was looking forward to the diversity, the culture, the arts, and, of course, the brotherly love! Well, while I found much of what I was looking for. I also found some things I wasn't looking for: poverty, neighborhood blight, food deserts, a fast food chain on every other corner, and many communities suffering unfairly from chronic diseases, such as diabetes and cancer. How could a beautiful city that boasts so many health care resources (hospitals, academic institutions, community-based organizations, etc.) experience so many challenges with health equity? One thought came to mind: diversity - the blessing and curse of Philadelphia.

Health Promotion Council of Southeastern PA (HPC) is the name of my organization and our mission is to promote health, and prevent and manage chronic diseases, especially among vulnerable populations, through community-based outreach, education and advocacy. One of our core principles is to celebrate diversity. We truly strive to mirror the communities we serve and to recognize the strength of culture and its role in health. It is through this lens that I have had the opportunity to witness how cultural diversity can be a double-edged sword. Please let me elaborate. Cultural identities can be extremely unifying elements in our society and can contribute to increased social capital, which research has shown improves rates of survival from heart attacks, reduces risk for cancer reoccurrence, and reduces depression and anxiety. Conversely, culture can create barriers in achieving and/or treating health, such as poor patient-provider communication due to linguistic and/or health literacy barriers. Essentially, the richer we as a nation become in terms of cultural diversity, the more complex it becomes to address health promotion and disease prevention.

The Latino community is of particular relevance to this conversation. While the U.S. population grew by 36 percent between 1980 and 2009, the Latino population in the U.S. more than tripled, increasing from 14.6 million to nearly 48.4 million - and it will continue to grow in coming decades. In Philadelphia, the estimated 2008 population of Hispanics/Latinos was about 155,100, comprising 10.8 percent of all Philadelphia residents - 73,100 of which are female.

Now remember, HPC looks at health disparities through the lens of diversity/culture. One area in which the impact of culture is highly visible is breast cancer. Although the incidence rate of breast cancer is lower among Latina women than it is among non-Hispanic White women, Latina women are more likely to die of breast cancer than White women.

Why? Well, there are many factors to be considered, but a common ingredient - no matter how you slice the pie - is culture. Many Latinas rarely use mainstream health care facilities due to language barriers and unfamiliarity with the U.S. health care system, which leads to decreased likelihood of breast health screenings, and delayed follow-up and treatment after a positive screening. Add to that mixing bowl:
•1 cup -fear and anxiety about interfacing with the healthcare system and having to deal with the outcome with a lack of insurance and/or unstable immigration status,
•1/2 cup -inadequate availability of trained medical interpreters, and
•1Tbsp -lack of culturally and linguistically-appropriate resources.
Voila, a recipe for decreased breast cancer screening rates among Latina women (and just to note, this recipe for health disparities is wide-spread across many other communities and health conditions).

To address these issues, HPC created the Naveguemos con Salud Breast Health Partnership Program (NCS). NCS is a culturally-specific approach to community-based patient navigation that places a Latina navigator in Latina communities to capture the women who are not already in the health care system to link them to breast health screenings and resources. HPC's navigator provides education about breast health - to reduce fear and taboo surrounding the topic, mitigate misinformation, and normalize conversation about breast health and breast cancer. She also makes appointments for screening, treatment, and ancillary services - and provides support to help reduce anxiety and increase action to seek care.

In recognizing the role that culture can play in promoting health, NCS builds on the power of linking Latinas with one another to not only help Latina women navigate an unfamiliar system that may not always feel welcoming, but also to begin to shift cultural norms within their communities and help women take a more active role in accessing health care.

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