1. Build Trust
Trust is foundational to all other steps. It includes an openness to inquiry, listening to understand the values, experiences and beliefs among persons of color. Central to this is taking what is said by patients of color at face value, recognizing how one’s own bias may enter into the therapeutic relationship, and choosing to prioritize care over judging the individual or the situation. Genuine communication is predicated on empathy and compassion, cornerstones of all healing practice.
2. Community Driven CIH Programs
CIH providers and organizations should partner with communities of color to advance the health and wellbeing of diverse groups, increase training opportunities, and improve access to CIH services. Whether designing research projects or creating business plans for a community-based clinic, planning
should consider a shift of focus away from the majority, and toward a “centering at the margins” of healthcare. (29) This intentionality to think of the ‘other’ refocuses the point of view to consider, involve, and promote those who are marginalized.
3. Serve Communities of Color
CIH providers must recognize that health goes beyond individual responsibility, to include the complex contributions of social structure and societal (dis)advantages. Every community has a unique set of social determinants that influence the health of its citizens. Authentically guiding an individual along a healthcare journey can only be achieved if the provider journeys alongside the community that individual identifies with. For patients who identify as Black or as a person of color, this may include seeking to understand community norms and infrastructure through relationships with cultural advocacy groups, elders or influencers. CIH providers may become strong allies of communities of color, to improve and enhance investment in social services, and direct patients toward a supportive network of resources if needed.
4. Improve Cultural Competence
CIH providers must demonstrate the knowledge, skills and attitudes necessary to effectively care for communities of color. The United States Department of Health and Human Services defines culturally competent programs as those that, “… maintain a set of perspectives, behaviors and policies … that promote positive and effective interactions with diverse cultures.” (25)
The first step toward improved cultural competence is learning about, understanding, and accepting that structural racism is inherent in the United States. Toward that end, CIH disciplines should explore how racism historically shaped our professions’ histories, and how it continues to explicitly and implicitly influence us today.
With that background in mind, CIH academic institutions and programs should develop and implement curriculum and clinical experiences addressing the domains of cultural competence*. Organizations that accredit CIH academic institutions and programs should define and implement cross-cultural educational standards that can serve to guide this work. We have examined the educational standards for CIH programs and find them lacking in requirements for curriculum content, including in areas such as empathy, respect and other core cross-cultural issues, and assessment measures aimed at evaluating cultural competence similar to those found in other healthcare professions. (26)
5. Elevate Professionals of Color
The composition of leadership within CIH professions, including academic institutions and affiliated organizations, professional associations, regulatory and licensing boards, should reflect a diverse citizenry, and consider efforts to ensure equity and diversity a central tenant of their responsibility. Organizations may wish to review their history to identify instances where they have been complicit in racial injustice, and commit to periodic audits of current policies and procedures to ensure racial equity and justice. They may also benefit from seeking out opportunities for learning, listening, and partnering with external stakeholders, with shared goals of social justice.
6. Increase CIH Workforce Diversity
An important strategy to advance healthcare among communities of color is to actively recruit members from these communities to enter CIH professions. First, CIH professionals of color* may relate to the sensitivities, perspectives and values of the community they culturally identify with in a way not achievable by others. This intimacy fosters trust and understanding in the patient-provider relationship. Second, professionals of color often chose to work in and focus on the health of their communities; persons of color may in turn encourage more individuals of color to join the CIH professions. Finally, recruiting students of color recognizes that ability is present across all segments of a population; soliciting talent from diverse groups ensures that capable individuals are not overlooked due to race.
7. Inclusive Educational Environments
CIH educational institutions should be purposeful in creating welcoming, supportive environments to support Black and other students of color. This includes measures to ensure that neither explicit nor implicit racial bias is exhibited by faculty and administrators, and is not tolerated from anyone within the campus community. Curricula on disease and disease management should reflect their impact on Black persons, to include images in learning materials, case studies, and variations in presentation to accurately reflect the experiences among diverse races and genders. The creation of health and wellbeing should be taught to consider the unique bio-psychosocial influences experienced by an individual, including those from Black communities. Black students should feel represented among their school’s faculty, administration, board, clinical supervisors and mentors, and support services should be designed to accommodate their needs.
8. Dedicated Curriculum
Curriculum in our CIH educational institutions, as well as continuing education for professionals, should correctly identify race as a social construct, and seek to dispel beliefs about biological or intrinsic differences between races. (27) Students should be guided to identify their own biases, and the ways in which their own biases may influence healthcare interactions and decision making. CIH educational programs should model civil discourse around racial bias, exploring the moral imperative of all healthcare providers to address social determinants of health and promote equitable healthcare within their spheres of influence. (28) These discussions should be conducted in safe learning environments, with faculty who are equipped to constructively address elitist and pejorative attitudes pervasive in healthcare. Treating all individuals with empathy and compassion are critical competencies that must be intentionally and actively cultivated among students and within healthcare teams.