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Increasing the cultural competence of health care providers serving Minnesota's diverse populations
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Common health equity issues for People Living in Poverty
Cultural competence is the ability to recognize and understand the role culture plays in health care and to adapt care strategies to meet patient needs.
Get to know patients on an individual level. Each person’s preferences, practices, and health outcomes are shaped by many factors. Generalizations in this material may not apply to your patients.
Poverty in Minnesota
Poverty is a key social determinant of health—economic and social conditions that influence the health of people and communities. Living in poverty can cause emotional and social challenges, acute and chronic stress, cognitive lags, and health and safety issues. How someone experiences poverty impacts their ability to manage its effects:
The U.S. Department of Health and Human Services set 2017 poverty guidelines as household income below $24,600/year for a family of four and below $12,060 for an individual. Minnesota’s overall poverty rate was 10.8 percent in 2016, 10.2 percent in 2015, and 11.5 percent in 2014. In 2016, poverty rates were highest for Minnesotans who are Black (34%), American Indian (31.4%), and Hispanic (22.2%), which are three to four times higher than the rates for Non-Hispanic White Minnesotans (8.2%). Minnesota’s poverty rate for persons of color is statistically significantly higher than the national average.
In Minnesota, poverty rates are twice as high for people with disabilities as they are for those without (21% and 10%, respectively). About one in three Minnesotan’s age 65+ have a disability; that rate jumps to one in two for older adults in poverty.
Minnesota's overall poverty rate was 10.8% in 2016.
In Minnesota, as in the rest of the US and the world, people living in poverty suffer from worse health and receive inferior health care when compared to people with higher incomes. Poverty contributes to poor health and poor health often results in poverty. The Minnesota Department of Health provides the following insights into how income affects health in Minnesota:
Obstacles such as financial barriers, less access to employer-sponsored coverage, time required to gather necessary documentation, and navigating complex enrollment processes all contribute to a higher uninsured rate for Minnesotans with low incomes than people at any other income level.
Social determinant disparities
Poverty is intertwined with other social determinants of health. A lack of financial resources can reduce access to healthy food, safe housing, educational attainment, and medical care.
Financial constraints often mean people living in poverty consume a diet based on inexpensive fast food restaurant offerings and processed foods, both of which are high in carbohydrates, sweeteners, and salt. Often called the “American diet,” this way of eating contributes to obesity, heart disease, and other health conditions. Although second lowest among all states, 10.3 percent of Minnesota households reported having a food hardship—not having enough money to buy food in the last year. Greater challenges were reported for households with children.
About 16 percent of Minnesota’s census areas are federally designated food deserts—areas with a high proportion of residents who live far from a full-service grocery store and a high proportion of residents who have a low- to moderate-income. Price is the most significant barrier to healthy food consumption for households with low- to moderate-income. Lack of transportation compounds the problem.
Hunger and food insecurity (i.e., reduced food intake and disrupted eating patterns due to a lack of household income and other resources for food) might increase the risk for lower diet quality and undernutrition. In turn, undernutrition can negatively affect overall health, cognitive development, and school performance.
Additional challenges can include lack of time and culinary literacy—knowledge about healthy food choices and cooking skills—and lack of access to storage and preparation supplies, especially for people who are experiencing homelessness.
Research indicates that poverty-related concerns, like unstable housing conditions and food insecurity, create mental and emotional strain that can leave people living in poverty with limited capacity to do many of the things that might lift them out of poverty. In the absence of protective factors, the stress of poverty on children can result in emotional disorders and cognitive deficits.
End of life
Lower socio-economic status has been associated with less utilization of preventative and early detection services, which may prevent or mitigate the effects of potentially terminal illnesses. People with lower socio-economic status are at increased risk of being diagnosed with late-stage cancers compared to people with higher socio-economic status.
People with higher incomes live longer. For example, Minnesotans who live in Twin Cities’ zip codes with the highest median household income live an average of eight years longer than those who live in zip codes with the lowest median household income. The mortality rate for people living in chronic homelessness is four-to-nine times higher than for the general population.
Lower socio-economic status appears to be associated with less utilization of quality-of-life sustaining programs like palliative care and hospice.
How can health care providers improve the health of people living in poverty?
The American Academy of Family Physicians offers these recommendations for health care providers who see patients living in poverty:
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