13.1 Collecting Data and Monitoring Outcomes

Collecting data and monitoring outcomes are best practices that can improve health equity by identifying disparities in care. Data can be used to develop outreach and education programs aimed at reducing disparities in chronic disease management among marginalized communities. Additional best practices include developing community partnerships, increasing access to care for people living in underserved communities, and developing culturally relevant programs.

13.2 Developing Partnerships

Developing partnerships with public health agencies and community-based organizations provides valuable insights into the needs of the people they serve and helps healthcare providers develop targeted interventions that are effective and sustainable.

Existing expertise within a healthcare organization’s workforce can have a significant and positive impact of health equity. Black and Latino individuals—especially women—comprise an essential part of the healthcare workforce, often serving in support roles such as nursing assistants and dietary service staff. In many cases, these healthcare workers have closer relationships with their communities than other healthcare professionals, representing an untapped opportunity to improve workforce cultural competence (Rivera-Núñez et al., 2022).

These workers often live in the same communities that they serve and have strong ties with community members. Many times, they share ethnicity, language, socioeconomic status, and life experiences with the community. Compared to physicians and nurses, they are underpaid and undervalued (Rivera-Núñez et al., 2022).

13.3 Increasing Access to Care

Increasing access to care and services in underserved communities can reduce cultural disparities in healthcare. This is achieved by reducing transportation barriers, increasing affordability, and providing more convenient hours to accommodate different work and family schedules.

13.4 Developing Culturally Relevant Programs

Developing culturally relevant programs reduces healthcare disparities by helping patients learn about preventive care and other healthcare services. These programs should be tailored to the needs and cultures of the community and should be designed to address health issues in a culturally appropriate way.

Health literacy is closely related to culturally relevant care. Providing health information in a way that is easy for patients to understand, using clear language, avoiding medical jargon, and developing well-designed visuals and written materials helps patients understand their health status and treatment options.

Existing law https://dpbh.nv.gov/uploadedFiles/dpbh.nv.gov/content/Reg/HealthFacilities/dta/Training/R016-20AP.pdf.

13.5 Diversity Training

Diversity training encourages providers consider the unique, individual context of each patient and to remember that a situation may be experienced differently by different patients. It helps providers employ an attitude of curiosity about how each patient’s experiences and culture shape their views and behaviors (Togioka et al., 2022).

There are five key principles associated with diversity training (Ogrin et al., 2020):

1. Awareness: understanding unconscious bias and prejudice, self-identifying biases.
2. Promotion: focusing on similarities between people rather than differences.
3. Embedding: ensuring access and equity in policy and practice.
4. Identifying: uncovering individual characteristics that promote participation, sharing decision-making, trust-building, and rapport.
5. Understanding: acknowledging the intersectionality of people’s various characteristics.

13.6 Following National CLAS Standards

Culturally and Linguistically Appropriate Services (CLAS) standards are a set of 15 action steps intended to advance health equity, improve quality, and help eliminate healthcare disparities by providing a blueprint for individuals and healthcare organizations to implement culturally and linguistically appropriate services (OMH, 2022).

CLAS standards can improve the quality of services provided to all individuals, which can reduce health disparities and improve health equity. CLAS standards encourage respect and responsiveness: respect the whole individual and respond to the individual’s health needs and preferences.

To reduce barriers to accessing quality and appropriate care for priority populations and advance health equity, the Nevada Department of Health and Human Services expects all healthcare organizations to provide services consistent with National CLAS Standards. This means all health services, including telemedicine services:

• Are culturally responsive.
• Provide meaningful access to language services.
• Are provided in an equitable and inclusive manner.

13.7 Following Nevada Regulations Against Discrimination

The Nevada State Board of Health has established regulations against discrimination that inform best practices in any of its programs in relation to protected classes as defined by State of Nevada law and Federal law. Protected classes include but are not limited to:

• race
• color
• religion
• national origin
• ancestry
• age
• gender
• physical or mental disability
• sexual orientation
• gender identity or expression
• human immunodeficiency virus status of the patient or resident or any person with whom the patient or resident associates (DBPH, 2020)

Nevada Resource Code 449.103 states that a facility that provides care to a patient of resident, shall conduct training relating specifically to cultural competency for any agent or employee of the facility who provides care to a patient or resident of the facility. The purpose is to better understand patients or residents who have different cultural backgrounds.

The full text of Nevada’s non-discrimination policy is available here.

13.8 Becoming Familiar with The Equality Act and Predecessors

Introduced by Congresswoman Nancy Pelosi, The Equality Act would amend existing civil rights law—including the Civil Rights Act of 1964, the Fair Housing Act, the Equal Credit Opportunity Act, the Jury Selection and Services Act, and several laws regarding employment with the federal government—to explicitly include sexual orientation and gender identity as protected characteristics. The legislation also amends the Civil Rights Act of 1964 to prohibit discrimination in public spaces and services and federally funded programs based on sex (HRC, 2023).

13.9 Overcoming Perceptions

Overcoming myths, stereotypes, and perceptions that adversely impact marginalized groups is not easy. In healthcare organizations, as in other business settings, the failure to address myths and stereotypes not only affects health outcomes for the people the organization is serving, but this failure can also lead to lawsuits.

In a report compiled by the Corporate Research Project for Good Jobs First found that most large corporations throughout the U.S.—including 99% of the Fortune 500 companies—have made payments to plaintiffs in at least one employment discrimination or harassment lawsuit since the beginning of 2000 (Mattera, 2019).

Addressing and overcoming harmful and negative perceptions about marginalized groups take a strong commitment by organizations and by individuals. The process begins by identifying bias, stereotypes, and myths that affect marginalized groups. In Power and Influence for Positive Impact, the author recommends the following (Gibson, 2022):

1. Embrace diversity: Don’t put yourself in a bubble. Learn about individuals you admire from other genders or races. Read books authored by people who don’t share the same beliefs. Listen to music from various cultures. This can gradually recondition your perceptions.
2. Interact with individuals from other groups: Hiring a diverse workforce doesn’t guarantee that employees will converse. Take the time to talk to people from different backgrounds.
3. Confront stereotyping: If you see something, say something. Sometimes, the most impactful thing you can do is call out prejudice or stereotyping when it’s happening.