Health Policies and Vulnerable Populations Presentation

Relevance of the New System

Achievements of medicine

• HIV prevention,
• cancer therapy,
• heart disease reduction.

However, there are problems

• discriminating treatment,
• unequal opportunities,
• stigmatization.

Over the past decades, health care providers and researchers around the world have made tremendous progress in preventing, predicting and treating the most devastating diseases, such as HIV, cancer and cardiovascular diseases. This was made possible by global commitment, clear goals, resources, innovative approaches, and, last but not least, the efforts of local communities.

However, these achievements are unevenly distributed across regions and social groups. Globally, stigma, discrimination, exclusion, and inequality, including inequality of opportunity and gender relations, continue to threaten women and immigrants, youth, persons with disabilities, key populations, and other affected groups. This makes them vulnerable to disease and hinders their access to prevention, treatment, and care services.

Main Causes of Discrimination

• Illegal residence;
  • people without citizenship cannot get health services in full;
• Linguistic barrier;
  • differences in languages prevent medical personnel from doing their work to the fullest;
• Handicapped person;
  • as a rule, people with disabilities are treated incorrectly.

People around the world face barriers to accessing quality health care. The reasons for this may vary from country to country and from culture to culture, but some restrictions are commonplace (Hacker, Annies, Folb, & Zallman, 2015). For example, residents living in a country without formal citizenship do not have access to adequate health services. Studies show that public funding for adult immigrants residing in the U.S. is, on average, 55% lower than for adult citizens of the country (Gusmano, 2012). In other words, the state does not provide the minimum number of medical services to illegal residents.

Such discrimination and other human rights violations are widespread in health facilities and hurt the health of these marginalized groups. Also, due to their specific provisions, illegal immigrants usually lack health insurance. In terms of cultural and linguistic diversity, it is not difficult to see that people with limited English language skills tend to have less adequate access to care and a lower quality of care (Gusmano, 2012). For this reason, immigrants in the United States cannot afford already quite expensive health care services, and either refuse to see a doctor or pay from their wallets.

CLAS

Of all the forms of inequality, injustice in health care is the most shocking and inhumane.

1. CLAS standards have been developed as a guide for medical organizations;
2. The mission is clear: to prevent injustice in health care;
3. They are designed to be culturally and linguistically appropriate for patients.

Many international companies and organizations have been created to address discrimination against patients based on specific grounds. Each company develops its behavioral health strategy, creates recommendations and instructions for medical personnel, and offers medical services. One such program is the National Culturally and Linguistically Appropriate Services policy, better known as CLAS (Think Cultural Health, 2017).

What Are the Principles of CLAS?

Respect and efficiency

• Allow patients to receive respectful and effective treatment without discrimination.

CLAS standards bring together culturally and linguistically services across the entire medical organization according to the populations and communities that the organization serves. It is a human-centered policy designed to address inequalities by providing specific guidance to health care providers.

CLAS policy is based on fundamental principles of health, ethics, and social equity. These principles are complex ideas and include subparagraphs (Think Cultural Health, 2017). The first and fundamental principle is to strive to provide equitable and quality health services to all, without exception, but in a culturally and linguistically sensitive manner.

Training and development

1. Promote CLAS ideas;
2. Ensure the cultural and linguistic diversity of employees;
3. Conduct regular training and preparation.

The second standard is based on the promotion of the idea of barrier-free health care, the maintenance of adequate norms, and the training of staff. CLAS principles need to be taught not only to nurses but also to managers.

Communication and support

1. Give patients language support;
2. Report that the organization has language assistants;
3. Facilitate access to promo materials in common regional languages.

The third CLAS standard characterizes communication assistance to potential patients. It offers a medical facility to provide its clients with free support of interpreters in case of discrepancies between the linguistic cultures of doctors and the patient. Any information distributed in institutions should be duplicated in languages that are common in the area.

Engagement, improvement, and accountability

1. Follow these instructions;
2. Conduct regular assessment of achievements;
3. Collect demographic data to improve efficiency;
4. Cooperate with other organizations;
5. Collect complaints and analyze them.

The most ambitious is the latest standard, which aims to improve the system continuously. To understand what needs to be enhanced CLAS management offers through regular surveys and questionnaires of different groups: staff, patients, and third parties. Any conflicts and complaints that may arise in the work process should be recorded for further analysis. It is important to draw on the experience of other organizations that have already implemented the system to understand which factors have a positive impact and which ones are best to get rid of now.

Four Main Ideas

• Respect and efficiency;
• Communication and support;
• Training and development;
• Engagement, improvement, and accountability.

The modern health care system shows its imperfection in the issue of non-discriminatory provision of health services. It is wrong to think that, in most cases, when a vulnerable social group has not been able to receive medical facilities in the required amount, it is the doctor’s fault. It is unlikely that a doctor would not accept a patient only because he or she does not have citizenship.

Why Is This Important to the Hospital?

1. hospitals have bureaucratic problems that prevent some sectors of society from receiving medical services;
2. it helps to eliminate bias against patients;
3. rehabilitation after surgery is less painful;
4. CLAS helps to enrich the cultural outlook of medical staff and to introduce them to other nations.

Many patients do not reach the stage of consultation with a doctor due to bureaucratic problems, in particular with the medical insurance policy (Hacker et al., 2015). As part of their human rights obligations, states should ensure accountability and redress, including monitoring compliance with the principles of non-discrimination in health care. The introduction of the CLAS in all departments of a health facility, from the door to the doctor’s office, contributes to a more effective treatment process for the population.

CLAS enables staff to learn about the cultural and linguistic background and beliefs of the patient, and then use it in their work. In this way, the patient will be able to trust the health care provider, and the treatment process will be optimized. Any hospital department, such as the administration desk where medical referrals are issued or the surgical operating room, must have CLAS competence to eliminate even the fleeting possibility of bias against employees.

Moreover, if the patient has already undergone surgery and is now in the rehabilitation phase, the standards will help to establish effective communication between the patient and the nursing staff (Think Cultural Health, 2017). This will allow for better identification of the patient’s preferences and timely response to the patient’s needs. It is also interesting to note that training in the basic principles of the National Culturally and Linguistically Appropriate Services policy helps to enrich the cultural world of the clinic staff and make them more educated and erudite.

How Can the Clinic Start Using This?

• explore the linguistic diversity of the region. It is important to identify all the most used languages that clients may speak;
• do not put a lot of responsibility on doctors. Give them assistants;
• conduct training and teach staff to be polite.

With an understanding of the basic principles of CLAS, the organization’s therapeutic activities can undergo minor changes. The starting point is to assess which social groups do not receive appropriate care in the context of a particular health care organization. If the clinic is located in a small town in the U.S., for example, it is necessary to study which linguistic groups live in the area, except, of course, American English. Doctors should not be expected to follow all prescribed instructions. Generally, doctors have enough of their work to do, so you should add an assistant who oversees the implementation of CLAS standards. These staff members can act as interpreters and nurses at the same time. A vital step described in the second paragraph of the CLAS is the training of staff. For this purpose, training sessions are welcome to introduce each employee to the principles of social equality. The program opens the way to solving a pressing problem. It calls on stakeholders to ensure the protection of human rights and health.

References

AETC National Multicultural Center at Howard University. Web.

Gusmano, M. (2012). Undocumented immigrants in the United States: Use of health care. Web.

Hacker, K., Anies, M., Folb, B. L., & Zallman, L. (2015). Barriers to health care for undocumented immigrants: A literature review. Risk Management and Healthcare Policy, 8(1), 175-183.

National Center for Cultural Competence. Web.

National Minority Quality Forum. Web.

National Standards for Culturally and Linguistically Appropriate Services (CLAS) in health and health care. Web.

Think Cultural Health (OMH). Web.