Although there have been significant improvements in the health of Americans in the last quarter century, startling disparities continue to exist in the health outcomes of African Americans, Hispanics, Native Americans, Alaska Natives, as well as Asian and Pacific Islander Americans. The statistics showcased in the U.S. Department of Health and Human Services’ Healthy People 2010 initiative highlight some of these striking gaps in health outcomes.

A few of their findings:

• African Americans are about 34 percent more likely to die of cancer than are whites and more than two times more likely to die of cancer than are Asian Pacific Islander Americans, Native Americans, and Hispanics.
  
• Among women with AIDS, African Americans and Hispanics have been especially affected, accounting for nearly 77 percent of cumulative cases reported among women by 1998.
  
• The relative number of persons with diabetes in African American, Hispanic, and Native American communities is one to five times greater than in white communities.

What can be done to help correct these disparities? Clearly, efforts must be made to incorporate racial and ethnic minorities more fully into research, prevention, and treatment efforts. In addition, it is imperative that all people are afforded equal access to services. But what does “access” entail? The issue of “access” highlights a number of different concerns, which include ensuring that all people have the right and ability to enter a health facility for care (which encompasses the issues of transportation and proximity to a facility) and guaranteeing that efforts are made to have cultural and linguistic competency in services. All together, by providing access to health care, the goal is for health facilities to make their space accessible to clients and to make individuals feel welcome.

In an effort to work toward decreasing racial and ethnic disparities in health care, the 214th (2002) General Assembly of the Presbyterian Church (USA) urged the U.S. Department of Health and Human Services to promote the adoption of “Culturally and Linguistically Appropriate Services in Healthcare Standards” (CLAS), by all providers of health-care services that receive federal funds, either directly or through reimbursement. (The standards are to be promulgated by the Office of Minority Health/Public Health Service of the U.S. Department of Health and Human Services.)

The Department of Health and Human Services Office of Minority Health issued the standards in their final form on December 22, 2000. The Office of Minority Health noted that the reason for the CLAS standards was to “respond to the need to ensure that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner.” They also noted that: “These standards for culturally and linguistically appropriate services (CLAS) are proposed as a means to correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all patients/consumers… Ultimately, the aim of the standards is to contribute to the elimination of racial and ethnic health disparities and to improve the health of all Americans.”

A summary of the standards is listed and organized by themes:

• Culturally Competent Care (1-3),
  
• Language Access Services (Standards 4-7), and
  
• Organizational Supports for Cultural Competence (8-14).

The standards are also categorized in varying levels of stringency. Standards 4,5,6, and 7 are current Federal requirements for all recipients of Federal Funds. Standards 1,2,3,8,9,10,11,12, and 13 are recommended by the Office of Minority Health for adoption as mandates by Federal, State, and national accrediting agencies. Standard 14 is suggested by the Office of Minority Health for voluntary adoption by health care organizations.

For further information about the standards, log on to www.OMHRC.gov/CLAS, or contact Carolynn Race at the Washington Office, (202) 543-1126.

National Standards for Culturally and Linguistically Appropriate Services in Healthcare

The following national standards issued by the U.S. Department of Health and Human Services’ (HHS) Office of Minority Health (OMH) respond to the need that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner. These standards for culturally and linguistically appropriate services (CLAS) are proposed as a means to correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all patients/consumers. The standards are intended to be inclusive of all cultures and not limited to any particular population group or sets of groups; however, they are especially designed to address the needs of racial, ethnic, and linguistic population groups that experience unequal access to health services. Ultimately, the aim of the standards is to contribute to the elimination of racial and ethnic health disparities and to improve the health of all Americans.

1. Health care organizations should ensure that patients/consumers receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.
   
2. Health care organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.
   
3. Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.
   
4. Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.
   
5. Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.
   
6. Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).
   
7. Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.
   
8. Health care organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to provide culturally and linguistically appropriate services.
   
9. Health care organizations should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluations.
   
10. Health care organizations should ensure that data on the individual patient’s/consumer’s race, ethnicity, and spoken and written language are collected in health records, integrated into the organization’s management information systems, and periodically updated.
    
11. Health care organizations should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.
    
12. Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS-related activities.
    
13. Health care organizations should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers.
    
14. Health care organizations are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information.
    For more information about CLAS Standards, go to www.OMHRC.gov/CLAS.

General Assembly Policy:

In 2002, the U.S. Department of Health and Human Services’ Office of Minority Health completed a comprehensive study that looked at barriers to health care. Recommendations from that study form the basis for Cultural and Linguistically Appropriate Services Healthcare Standards (CLAS) – recommended for implementation by all health care providers. In support of efforts to ensure that all people, regardless of culture, language or ethnic background, have equal access to health care, the General Assembly:

1. Calls upon the U.S. Department of Health and Human Services to promote the adoption of all CLAS Standards, promulgated by the Office of Minority Health/Public Health Service of the U.S. Department of Health and Human Services, by all providers of health-care services that receive, either directly or through reimbursement, federal funds.
   
2. Urges the General Assembly Council (National Ministries Division, Office of Health Ministries, and the Presbyterian Washington Office) to work proactively to educate the leaders and membership of the Presbyterian Church (U.S.A.) of the need for such (CLAS) standards, and to advocate for the adoption of the standards by all individual health-service providers and facilities, as well as those entities that accredit and provide quality assurance for those providers and facilities, and, submit public comment and appropriate testimony supporting the need for these standards.
   
3. Urge that the Cultural and Linguistically Appropriate Services in Healthcare Standards (CLAS) be taken into consideration in the written contractual agreements between the Presbyterian Church (U.S.A.) and all health-service providers that receive, directly or indirectly, PC(USA) funds.
   
4. Urge that local churches and presbyteries work with health care providers in their areas to help implement these standards.

By Carolynn Race, 4th quarter 2002