Promoting Equitable Healthcare Quality in Nutrition: Improving Outcomes Through Cultural Safety
Lauryn Chew, Northwood High School, Irvine, California, USA
Globalization has led to culturally diverse nations around the world, increasing the need for equitable healthcare quality. Nutrition is just one field where ethnic health disparities are becoming increasingly prevalent. Targeting these disparities requires providers to create a culturally safe healthcare environment by reflecting on their own privileges and acknowledging power imbalances caused by social, economic, political, and geographic factors. In low- and middle-income countries, it is especially important for foreign medical professionals to practice cultural safety since patients’ access to quality care is limited. Health outcomes can only improve if providers center health-related discussions around their patient’s needs or concerns because it strengthens trust and communication. Additionally, effectively improving food choices requires partnerships between communities and policymakers to emphasize food values and culture over nutritionism. Addressing the systemic roots of all health disparities by promoting cultural safety is necessary to improve global health equity.
Globalization has accelerated rapidly in recent years, enabling the spread of ideas, knowledge, and practices. But with the rise of cultural diversity across the globe, necessary institutions like healthcare must adapt. Part of adapting requires targeting ethnic health disparities particularly prevalent in nutrition.
Ethnic health disparities are rooted in power imbalances, unexamined privileges, and marginalization (Curtis et al., 2019). In nutrition, those disparities are evident in the prevalence, morbidity, and mortality of diet-related diseases and conditions. Factors contributing to such disparities include education, accessibility to healthy foods, food production systems, social institutions, historical mistreatment of certain ethnic groups, environmental conditions, and language barriers (National Institute of Allergy and Infectious Diseases, 2022). Rather than focusing solely on nutritionism, which is the value placed on certain foods based on its scientifically identified nutrients, providers must also consider the aforementioned factors in order to better understand their patient’s food practices and choices. In doing so, providers can build the trust necessary in patient-provider relationships to ensure personalized responses and better outcomes.
Health systems have historically relied on quantitative information alone, which provides less insight into individual experiences and may enforce racial or ethnic stereotypes among providers. For instance, the United States consistently prides itself as a culturally diverse nation, yet a recent study conducted by BioMed Central Medical Education found that the vast majority of medical students in the United States did not have access to any courses or assignments specifically addressing Asian American culture and health disparities (Le et al., 2022). The few participants that had discussions relating to Asian American patients in school noted that the group was treated as a monolith and was often misrepresented by the model minority myth, which is a stereotype that largely emerged in the 1960s and has since led to the aggregation of all Asians and Pacific Islanders as wealthy, hardworking, and healthy. Quantitative data on this group consistently supports the model minority myth even though there are severe discrepancies between different subgroups within the Asian and Pacific Islander communities. Given that personal experience was the most common source of knowledge about Asian American patients among the respondents, the lack of inclusive education and accurate data collection in the medical field clearly poses a significant barrier to reducing health inequities. Misrepresented populations are more likely to be discouraged from participating in well-being studies due to the underlying social stigma, which weakens patient engagement in decision-making (Napier et al., 2017). Therefore, collecting both qualitative and quantitative data is necessary to identify inequitable health outcomes. These power imbalances must be recognized and addressed to create a culturally safe environment free of racism that empowers individuals by reinforcing the validity of their values and beliefs (First Nations Health Authority, 2016).
Globalization has also made it increasingly common for medical professionals to work in other low- to middle-income countries with the intent of reducing health inequities. But such interventions have highlighted another issue: oversimplification and generalization of patients’ cultural values based on stereotypes, internal bias, or racial prejudice (Curtis et al., 2019). By disregarding sociocultural determinants of health and inevitable power imbalances between providers and patients when giving recommendations and engaging in health-related discussions, patients may receive healthcare that does not align with their beliefs. As a result, patients may feel isolated and are more likely to only seek costly treatment in emergency settings rather than affordable, primary-care prevention (Llácer, 2009). The diabetes epidemic is a clear example of the negative impact from this skepticism; in some countries, social and cultural factors such as unaffordable care, limited health literacy, lack of family support, and unsatisfactory health messages affecting non-diagnosis or non-adherence to treatment cause over 90% of diabetes mortality and morbidity (Napier et al., 2017).
To address this issue, current health systems must mandate cultural safety training and involve local communities in health-related policies to progress towards health equity. Healthcare organizations should train their staff to recognize power imbalances and self-reflect on their biases when interacting with patients from different cultural backgrounds. Additionally, tools such as research networks, support forums, and patient surveys to increase communication between researchers, communities, and individuals are crucial to interpreting quantitative health data and identifying the needs of diverse groups. Policymakers should also partner with communities to strategically promote healthier food choices by implementing nutrition standards for marketing and coordinating trade, food system, and agricultural policies to reduce costs of healthier food while validating cultural food practices beyond nutritionism.
Over the past few decades, there has been some progress towards equitable health; in 2014, the Ministry of Health in Brazil acknowledged cultural context with food-based over nutrient-based dietary guidelines (Napier, 2017). In the United States, the Biden-Harris administration hosted the White House Conference on Hunger, Nutrition, and Health in 2022. At the conference, FoodCorps, a national nonprofit organization, committed to increase the diversity of nutritionists and support culturally relevant meals in schools by training 1,000 leaders of color for nutrition service careers. Additionally, Canadian Institutes for Health Research launched its Strategy for Patient-Oriented Research in 2019 to increase patient engagement by establishing collaborative research networks. Despite some of this progress towards equitable healthcare, more efforts are needed to promote cultural safety. Stakeholders must look to these initiatives as an example to improve individual health outcomes worldwide.
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