Fostering Inclusivity in Patient Care

Healthcare providers have an ethical and moral obligation to deliver the highest quality care to every patient who comes through their doors, regardless of background, identity, or circumstances. However, despite progress in recent decades, significant barriers and disparities still prevent many marginalized groups from receiving the inclusive, culturally competent care they deserve.

In this article, we’ll examine some of the health and cultural obstacles some patients face and discuss concrete steps healthcare providers and organizations can take to foster inclusivity and improve care for diverse patient populations.

The Unequal Landscape of Health

When assessing a range of health indicators, a clear pattern emerges; certain groups, especially racial and ethnic minorities, women, and people with disabilities, routinely experience poorer health outcomes than their peers. These health disparities are the result of a complex interplay of factors, including economic disadvantages, poor living conditions, racial discrimination, systemic obstacles, and both subtle and overt biases in healthcare.

Let’s examine the specific challenges faced by each demographic below to better understand the extent and impact of these inequities.

Racial and Ethnic Minorities

Racial and ethnic minority groups often shoulder a disproportionate burden when it comes to health challenges. Each of the communities below face unique obstacles that contribute to poorer health outcomes and lower life expectancies.

Black Americans

Black Americans have a shorter life expectancy compared to White Americans, as well as higher rates of chronic illnesses like heart disease, stroke, diabetes, and certain types of cancer. According to a 2011 report by the Centers for Disease Control and Prevention (CDC), Black Americans are 30% more likely than Whites to die prematurely from heart disease, and Black men are twice as likely to die prematurely from stroke. A separate study reported that nearly 44% of Black men and 48% of Black women have some form of cardiovascular disease. These statistics demand solutions, given that heart disease and stroke are among the leading causes of death in the United States.

Native Americans

Similarly, Native American and Alaskan Native communities struggle with significantly higher rates of suicide, accidental injuries, liver disease, and diabetes. The national suicide rate among Native American communities is a particularly pressing concern, with some studies suggesting that it is up to 50% higher than among Whites. This devastating statistic is largely rooted in historical trauma, socioeconomic disadvantages, and cultural disruption that has plagued these communities for generations, leading to an increased prevalence of depression, drug and alcohol abuse, and PTSD.

In addition to the mental health crisis, Native American and Alaskan Native populations also suffer from disproportionately high rates of physical health problems. According to the U.S. Department of Health and Human Services (HHS), Native Americans are twice as likely as Whites to be diagnosed with end-stage renal disease.

Perhaps more shockingly, Native Americans and Alaskan Natives have the highest diabetes prevalence rates of all racial and ethnic groups in the United States; these groups are almost three times as likely as White Americans to be diagnosed with diabetes and 2.3 times more likely to die from the diagnosis. The Pima Indians, native to Central Arizona, have the highest rates of Type II diabetes in the world, with about 50% of Pima adults suffering from the condition. This is due mainly to a combination of genetic predisposition, poverty, and limited access to healthy food options in many Native American communities.

Hispanic Americans

Hispanic Americans also face health disparities, though there are differences based on country of origin. For example, among Hispanic subgroups, Puerto Rican mothers have the highest rates of premature births, while Cuban mothers have the lowest. According to a 2018 CDC report, Hispanic adults as a whole are 1.2 times more likely to be obese than non-Hispanic White adults, and they have a 50% higher death rate from diabetes.

In addition to these physical health challenges, Hispanic Americans may also face barriers to accessing quality healthcare services. According to a survey by the Pew Research Center, Hispanic Americans cite hazardous occupations, poor access to quality medical care, language difficulties, cultural differences, and limited health insurance coverage as contributing to lower utilization of preventive care and poorer health outcomes.

Women

Women’s health concerns have long been under-researched and undertreated. The historical focus on male physiology in medical research has led to a lack of understanding of women’s unique health needs, and the exclusion of “women of childbearing potential” from clinical trials until 1993 has had lasting consequences. Many medications and treatments have been developed based on data from male participants, resulting in women experiencing more adverse drug reactions and less effective treatments compared to men.

Reproductive health is another key area where women face disparities. Conditions like endometriosis, which affect an estimated 10% of women, are frequently misdiagnosed or dismissed. Women with endometriosis suffer for an average of 4-10 years before receiving a proper diagnosis, leading to unnecessary pain, infertility, and emotional distress. Furthermore, postpartum depression, which affects roughly 1 in 7 women, goes undiagnosed and untreated nearly 50% of the time.

Gender disparities are closely linked with social determinants of health. One of the most striking examples of this is the gender pay gap. Income is one of the most powerful social determinants of health, shaping access to resources, opportunities, and care. Women consistently earn less than men, with this disparity being even more pronounced for women of color, according to a report by the Pew Research Center. A study by the National Academies of Sciences, Engineering, and Medicine (NASEM) found that across different income groups, men in the top 60% of the income distribution were making steady gains in life expectancy at age 50, and women in the bottom 40% experienced losses.

Finally, violence against women – primarily in the form of intimate partner violence – is a strong predictor of health issues, given that women are more likely than men to sustain injuries from an assault. Women who experience violence are at increased risk for chronic conditions like arthritis, asthma, heart disease and gynecological problems.

People with Disabilities

Adults with disabilities, representing up to 27% of the U.S. population, face significant health disparities compared to those without disabilities. People with disabilities are four times more likely to report fair or poor health and experience higher rates of obesity, physical inactivity, and cardiovascular disease, according to NASEM.

Furthermore, race, ethnicity, age, language, gender, poverty, and low education may compound the effects of having a disability. People with disabilities are more likely to have lower educational attainment, less employment, limited access to the Internet, annual incomes below $15,000, and inadequate transportation. The CDC reveals that cost is a major factor barring people with disabilities from accessing healthcare. They also report significant difficulties in navigating the healthcare system, alongside stigma and provider misconceptions. As a result, people with disabilities are significantly less likely to receive preventive care despite higher rates of chronic disease.

Common Healthcare Barriers and Their Consequences

Individuals from marginalized groups – including racial and ethnic minorities, women, and people with disabilities – often face significant barriers that compromise their health outcomes and experiences with healthcare. These barriers can be cultural, socioeconomic, or related to accessibility and discrimination. Healthcare providers must grapple with these uncomfortable truths and the roles they play, even if unintentional.

Some common barriers in healthcare include:

1. Stereotyping and Unconscious Bias

Stereotyping, prejudice, and unconscious bias from providers can take various forms, ranging from microaggressions to overt discrimination. Microaggressions are subtle, often unintentional insults or snubs that convey negative messages to individuals belonging to marginalized groups. These can be verbal or non-verbal and are often rooted in stereotypes and unconscious bias. Examples might include assuming an obese Black patient is just lazy or dismissing a woman’s severe abdominal pain as menstrual cramps. While microaggressions may seem minor, they can significantly damage patient trust and well-being. Patients who experience microaggressions often feel invalidated, misunderstood, or stigmatized, leading to a reluctance to seek care or disclose important health information.

Provider discrimination and implicit bias can severely impact treatment for marginalized communities. Unconscious biases can also influence provider decision-making and treatment recommendations. For example, studies have shown that healthcare providers may underestimate pain severity in Black patients compared to white patients, leading to inadequate pain management. Providers may also make assumptions about a patient’s lifestyle, health literacy, or treatment adherence based on their race, ethnicity, or socioeconomic status, resulting in inappropriate or ineffective care plans. These biases both damage patient trust and place their health at risk.

2. Lack of Cultural Competency and Understanding

Cultural competency, or the ability to collaborate effectively with individuals from different cultures, is a critical skill for healthcare providers. Many aspects of a patient’s culture can impact their understanding of their condition and treatment, including traditional health practices, religious or spiritual beliefs, modesty norms, gender roles, dietary restrictions, attitudes towards Western medicine and healthcare systems, and communication styles. For example, some cultures may perceive mental health issues as problems to be overcome with willpower, leading to internal stigmas and reluctance to seek professional help.

When healthcare providers lack awareness of cultural or religious norms, they may make dangerous assumptions that compromise patient care. This can manifest in various ways, such as misinterpreting or dismissing cultural expressions of pain or distress, failing to provide language assistance, recommending treatments that conflict with a patient’s religious or cultural beliefs, or minimizing the impact of cultural trauma, discrimination, or immigration-related stressors on health. Ultimately, failure to respect and understand the diverse backgrounds of patients can result in inadequate treatment, mistrust, and reluctance to seek medical assistance.

3. Language and Health Literacy Barriers

Language barriers, combined with cultural stigma, may prevent patients from scheduling appointments or effectively communicating their concerns to healthcare providers. One study showed that patients with limited English proficiency were more likely to be harmed than their English-proficient counterparts after experiencing an adverse event.

Effective communication between patients and providers is crucial for accurate diagnoses, treatment plans, and medication management. Therefore, relying on a patient’s family members for interpretation can seriously compromise quality of care. Lastly, low health literacy can also hinder patients’ abilities to communicate symptoms, understand diagnoses and instructions, and make informed health decisions.

Steps Toward Solutions

To address these complex issues, healthcare organizations can take a multifaceted approach that addresses gaps in the workforce, inclusive practices, and community engagement.

Below are some recommendations:

1. Enhance Workforce Diversity and Cultural Competency

One foundational step in fostering inclusivity is to improve staff diversity at all levels of the organization. Despite a national increase in racial and ethnic diversity, Black, Hispanic, and Native American healthcare professionals are severely underrepresented across various specialties.

To address this issue and reap the countless benefits a diverse workforce provides, healthcare organizations should prioritize recruiting and retaining diverse talent. This may involve adapting recruitment strategies to reach underrepresented candidates, offering additional mentorship and professional development opportunities, and creating inclusive workplace policies and cultures that celebrate diversity.

“When we have a diverse group, including our physicians, nurses, and corporate teammates, those experiences can help shape the way we care for patients,” states SCA Health’s Diversity, Inclusion, and Belonging (DIBs) manager Ricky Phillips.

“Patients are more likely to feel understood and respected when they see healthcare providers who share their backgrounds or understand their cultural nuances – this can lead to better health outcomes and patient satisfaction,” he adds.

Alongside diversification efforts, providing ongoing training on unconscious bias, cultural sensitivity, health disparities, and cross-cultural communication skills should be a core part of professional development for all staff. This training should be interactive, scenario-based, and regularly reinforced to drive permanent organizational change.

2. Create Inclusive Care Settings

Every aspect of the care environment should signal to patients that their identities and experiences are valued. Details like signage, intake forms, and appointment reminder messages should use plain, inclusive language that avoids race or gender-based assumptions. Visual representations, like artwork, photographs, and informational materials, should positively reflect racial, ethnic, and cultural diversity. It may be helpful to work with minority community members and leaders to ensure visual representations are culturally appropriate and inclusive.

The physical layout and features of the care space are also important to consider. Entrances, hallways, exam rooms and restrooms should be accessible for patients with visual impairments, mobility aids, or other visible or invisible disabilities. This likely may involve installing ramps, handrails, braille signage, and other accommodations. Finally, creating an inclusive care setting involves cultivating a culture of respect and empathy among staff. All employees, from front desk staff to providers, should be trained to interact with patients in a welcoming, non-judgmental manner.

3. Strengthen Language and Communication Services

Effective communication is essential for quality care. If possible, healthcare organizations should provide easy access to professional medical interpreter services in the most common non-English languages of their patient population, whether via in-person, video, or over the phone. Leaders should thoroughly train staff in how to identify situations requiring an interpreter and how to work with interpreters effectively.

It’s also important that all patient-facing materials, such as procedure instructions, medication information, and discharge paperwork, are available in the primary languages of an organization’s patient population. Large print, Braille, audio, and picture-based formats are vital for communicating with patients who have visual, hearing, or cognitive disabilities, according to the CDC.

4. Make Inclusive Policies a Priority

Policies are powerful tools for making inclusivity an explicit priority. Healthcare organizations should establish clear, strict anti-discrimination policies that apply to both patient care and employment practices, with well-defined consequences for violations. These policies should cover not only legally protected categories such as race, religion, and gender, but also prohibit harassment or bias based on factors like weight, language, or socioeconomic status.

“Inclusive policies should cover both patient care and employment practices.” Phillips said. “It is a must to provide comprehensive training to employees on anti-discrimination policies, including how to recognize, prevent, and report discriminatory behavior. This training should be ongoing and tailored to different staff groups’ specific roles and responsibilities.”

An easily accessible, confidential reporting system for both patients and staff to raise concerns about discrimination, bias, or culturally insensitive care is essential for individual and organizational accountability. Ideally, healthcare organizations should also have standardized protocols in place for handling patient requests related to cultural or religious accommodations to ensure a consistent and respectful approach. Finally, healthcare leaders should develop specific diversity, equity, and inclusion (DEI) goals.

5. Partner with Diverse Patient Communities

Building genuine, sustained relationships with diverse patient communities is vital for extending quality care beyond clinic walls. Healthcare organizations may find it beneficial to partner with local minority-led organizations, faith-based groups, and respected community leaders to plan and host cultural health education events, screenings, vaccination clinics, and other community engagement initiatives.

These partnerships can also help identify and collaborate on solutions to barriers that impede healthcare access, such as lack of transportation or childcare, difficulty affording medications, or distrust of the healthcare system. Involving community partners in creating outreach materials and campaigns may help ensure messaging is both culturally appropriate and delivered through trusted channels.

According to Ricky Phillips, “The best way to start building these relationships is through patient experience surveys. Gaining feedback from our patients and then following up with those who may have had negative experiences is a great way to show those communities that they are more than a line item to us. This could aid in building a positive perception of the organization within the community.”

Establishing an ongoing presence at cultural festivals, school events, and other community gatherings is also an excellent way to demonstrate an authentic commitment to meeting patients where they are.

Conclusion

Fostering true inclusivity in patient care requires sustained, proactive commitment and a willingness to confront uncomfortable realities about bias and discrimination in healthcare. With humility, empathy, and respect for the diversity of human experience, we can take meaningful steps toward ensuring every patient feels seen, heard, and valued.

“The best advice I can give to a healthcare leader who wants to create more inclusive environments is to listen,” Phillips said. “We tend to be wrapped up in our own vantage point and fail to learn about others who may have a different experience. We can’t empathize without listening, and empathy often drives change.”

This is the essence of health equity — not just equal treatment, but an intentional focus on meeting each patient’s unique needs.