What Are Racial Health Disparities
Having a meaningful conversation about the intersection of race, racism, and substance abuse first requires explaining what is meant by the term racial health disparities.
The Kaiser Family Foundation defines racial health disparities as the higher burden of illness, injury, disability, or mortality experienced by one population group relative to another.
Health disparities can also exist across other dimensions, such as:
- age
- socioeconomic status
- geographic location
Experiencing marginalization across several of these dimensions may even further increase or decrease a persons risk for experiencing these disparities.
For instance, being a Black American in a low-income bracket, or living with disability in a rural area with lesser access to medical resources, may have a greater impact on a persons risk for illness, disease, and access to quality care.
Acknowledging the unique struggles that marginalized populations can face in health spaces does not discount the very real and distressing experiences of people who arent similarly marginalized.
Struggling with life-threatening issues such as drug and alcohol addiction, or watching a loved one struggle, is painful regardless of racial and ethnic background.
Recognizing the ways non-white Americans are disproportionately affected by these health disparities, however, can build a pathway to greater understanding and developing solutions.
Principles In Delivering Culturally Competent Iot Services
The Commonwealth Fund Minority Health Survey found that 23 percent ofAfrican-Americans and 15 percent of Latinos felt that they would have received bettertreatment if they were of another race. Only 6 percent of Whites reported the samefeelings . Againstthis backdrop, it clearly is important for providers to have a genuine understandingof their clients from other cultures, as well as an awareness of how personal orprofessional biases may affect treatment.
Most IOT counselors are White and come from the dominant Western culture, but nearlyhalf of clients seeking treatment are not White . This stark fact supports the argument that cliniciansconsider treatment in the context of culture. Counselors often feel that their ownsocial values are the normthat their values are typical of all cultures. In fact,U.S. culture differs from most other cultures in a number of ways. IOT clinicians andprogram staff members can benefit from learning about the major areas of differenceand from understanding the common ways in which clients from other cultures maydiffer from the dominant U.S. culture.
Assessing Unique Treatment Needs
If addiction is a disease that transcends the boundaries among demographic groups, why is it so important to consider the needs of a specific client in treating this disorder? To some degree, addictive behaviors can be addressed as universal, but when it comes to resolving the problems that affect an individual, then the factors that contribute to addiction, which may be genetic, environmental, or experiential, must be addressed. Otherwise, the client may be more likely to feel alienated, isolated, or lonely in treatment and more likely to drop out early.
Years of research in the areas of mental health and substance abuse treatment have guided treatment providers toward personalized, culturally sensitive care that reflects the needs of the individual. Personalized assessment and evaluation at the beginning of the treatment process, and at various stages throughout rehab and recovery, are critical components when aiming for long-term sobriety. Listed below are some demographic considerations that are taken into consideration when a treatment provider evaluates a patient.
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Individualize Treatment Based On Specific Clinical Needs
Individualized treatment is the key. If you treat each of your clients as an individual with specific clinical needs, your treatment will be a success. You dont need to be pregnant to work with a pregnant woman, and you dont need to be black to work with a black client. However, you do need to avoid generalizing and stereotyping. You will see common issues that all addicts and alcoholics deal with, but they might be communicated or influenced differently based on cultural experience. If you create a truly individualized treatment plan, you will always be in a better position to provide professional, and competent care. At the end of the day, if the client leaves the session and feels you care about them and you know your job, you will be effective.
Where Do I Go From Here
Check out the resources below for more information on cross-cultural mental health and substance use:
BC Partners for Mental Health and Substance Use InformationVisit www.heretohelp.bc.ca for information on mental health and substance use in Arabic, Simplified Chinese, Traditional Chinese, Farsi/Dari , French, Korean, Punjabi, Russian, Spanish, Japanese and Vietnamese. You can sign up for Within Sight, a free e-newsletter that highlights mental health and substance use resources in many languages. And you can read the Older Adult Immigrants and Refugees issue of Visions: BC Mental Health and Substance Use Journal.
Our Aboriginal community members also face unique issues. See the info sheet, Lets discuss: Aboriginal Mental Health and Substance Use.
The Affiliation of Multicultural Service Providers Visit www.amssa.org for information, events and resources. You can find service providers across BC and search the Multicultural Health Resources database. Visit www.amssa.org/cultureswest to read Cultures West, a magazine that discusses migration, immigrant settlement and integration. A past issue also looks just a mental health and culture.
About the author
The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.
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Client A: Centered In Ones Own Culture
- Has made no attempt to fit into the majority culture.
- May be described by some as a separatist and maybe even a racist.
- Might wear culturally identifiable garb and associate primarily with others from their own race and culture.
- Has little interest or desire to be accepted and approved of by the dominant culture.
- May often see cultures different from their own as the enemy or someone who doesnt understand their issues.
- Feels much more comfortable with people of their own race and culture and avoids others.
- Distrusts and has difficulty relating with people outside of their race and culture.
This client type can be the most difficult for counselors to work with, and they might even be more difficult for a counselor from the same culture who is centered in the dominant culture . In dealing with this client, you might often see anger, resistance, and denial. They might excuse or explain their behavior by describing it as retaliation for racial oppression that their culture may have endured. They might demonstrate a sense of entitlement that causes power struggles, and be very distrustful of the counselor and their techniques. They might be resistant to taking responsibility for their addiction, instead blaming it on racism, prejudice and/or a lack of understanding. They can be controlling and antagonistic, and will most likely trigger any unresolved racial or cultural issues for the counselor.
Understanding The Difference: Race Versus Racism
In discussions about race and health, its important to create a distinction between race and racism. Public health professionals warn against conflating the two.
Health scholars, Jennifer Jee-Lyn GarcÃa, Ph.D., and Mienah Zulfacar Sharif, MPH, assert that race is a social construction with no biological basis, whereas racism refers to a social system that reinforces racial group inequity.
Misinterpreting the role that race has to play in the underlying causes of health disparities does a disservice to the process of meaningfully addressing health-related inequalities.
Additionally, pointing to race as a driver of health disparities could be interpreted as a form of victim-blaming.
According to a growing body of research, the fact that physical and mental health outcomes tend to be poorer in communities of color is largely driven by social and economic conditions. In the field of public health, these are known as social determinants of health.
Social determinants of health that contribute to health disparities include:
- income
- access to a variety of foods
- quality education
Health disparities can also be influenced by the very real physical, mental, and psychological tolls that racism can have on communities of color. Stress, for instance, can have major effects on all aspects of health.
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Naatp Dei Advisory Committee
In August of 2020, the first meeting of NAATPs Advisory Committee on Diversity, Equity and Inclusivity was held to discuss the impact of systemic racism and other forms of discrimination on addiction treatment and recovery. Thirteen behavioral health leaders, researchers, and clinicians from organizations across the country participated. The group was asked, If you could implement one change right away to improve our field with respect to increasing treatment access and improving outcomes, what would it be? The responses to that question identified three themes:
The group members identified potential efforts that are currently underway to address each of these areas, including:
- Videos, blogs, and podcasts featuring People of Color discussing their experience and commitment to working in the treatment field
- A training series on addiction healthcare inequity and promoting inclusivity in business and clinical practices
- Mentorship for People of Color who are interested in entering or advancing careers in behavioral health
The DEI Advisory Committee has expanded to over 20 members. The group meets regularly to establish measurable goals for each of the above areas.
Substance Abuse In Hispanic And Latinx Communities
According to 2018 national survey data in Hispanic and Latinx communities:
- Hispanics have similar rates of substance use disorders compared to the general population.
- Puerto Ricans have the highest heavy drinking rates among Hispanic Americans, and are three times more likely to develop alcohol use disorder compared to non-white, non-Hispanic Americans.
- About 7.1 percent of Hispanics have a substance use disorder compared to 7.4 percent of the general population.
Hispanics and Black Americans are more likely to have shorter inpatient stays for substance abuse, and tend to fare worse after treatment.
Hispanics are also incarcerated at disproportionately high rates and have less access to specialty treatment services, especially those that are culturally competent. According to SAMHSA, nearly 90 percent of Hispanic Americans with substance abuse issues are unable to receive the specialized treatment they need.
Among those in treatment for substance abuse, Hispanics are more likely to be houseless. Housing instability, unemployment, and low socioeconomic status can be major barriers to completing addiction treatment programs.
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Adolescents And Young Adults
During adolescence, a teenagers brain is still developing. The brains reward systems are the first to mature and yet the prefrontal cortex, or the area of the brain responsible for judgment and impulse control, is not yet developed fully.22 This makes teens more likely to take risks and makes them vulnerable to substance use disorders. 22 Those most at-risk of developing an addiction to drugs or alcohol are those who initiated substance use in their early teens. 22
Adolescents are not as likely as adults to see the need for treatment, and many need to be persuaded to enter treatment by a parent or required by the juvenile justice system. Adolescents are also less likely to have experienced a large range of adverse outcomes from their drug use and may be resistant to change. Programs aimed at treating adolescents with substance use disorders use specialized treatment approaches and well-trained staff. These programs typically emphasize behavioral treatment vs. pharmacological approaches. 22
Chapter 10 Addressing Diverse Populations In Intensive Outpatient Treatment
Intensive outpatient treatment programs increasingly are called on to serveindividuals with diverse backgrounds. Roughly one-third of the U.S. population belongsto an ethnic or racial minority group. More than 11 percent of Americans, the highestpercentage in history, are now foreign born .
Culture is important in substance abuse treatment because clients’ experiences ofculture precede and influence their clinical experience. Treatment setting, copingstyles, social supports, stigma attached to substance use disorders, even whether anindividual seeks helpall are influenced by a client’s culture. Culture needs to beunderstood as a broad concept that refers to a shared set of beliefs, norms, and valuesamong any group of people, whether based on ethnicity or on a shared affiliation andidentity.
In this broad sense, substance abuse treatment professionals can be said to have ashared culture, based on the Western worldview and on the scientific method, with commonbeliefs about the relationships among the body, mind, and environment . Treating a client fromoutside the prevailing United States culture involves understanding the client’s cultureand can entail mediating among U.S. culture, treatment culture, and the client’sculture.
This chapter contains
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Discriminatory Attitudes As Barriers To Treatment
Aside from the financial element of treatment, some doctors project mistrust onto African-American patients when treating them. Surveys revealed discrimination toward African-Americans based on race, financial status, and other factors. Racial stereotypes have been another factor in the decision to treat patients.
Some doctors believe black people have an ability to be strong and tough out painful conditions, and therefore do not give them the meds they need. Reports noted doctors not trusting black patients to take the meds properly. Other doctors have believed the patients will sell the drugs.
A 2017 report released by the Agency for Healthcare Research and Quality stated Overall access to efficient health care was worse for blacks than whites. Additionally, 20% of Asian Americans, 30% of Native Americans, and a third of Pacific Islanders and Hispanics have access to effective healthcare.
Causes Of Racial Health Disparities
The existence of racial health disparities in the U.S. cannot be linked to a single cause. The reality of how these disparities came to be and why they still exist in a country with the largest economy in the world is complex.
Health disparities may often be affected by factors such as geographic location, the safety and public health infrastructure of communities, and to a lesser extent, family medical history.
Many health conditions, including drug and alcohol abuse, run in families. However, the role that biology and genetics play in health differences among racial groups has been increasingly challenged in recent years.
With greater research into health disparities, many health researchers now argue that these disparities are driven primarily by inequalities in wealth and power across society.
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Ethnic Cultural And Religious Issues In Drug Use And Treatment
In national statistics for the United States, including many national surveys on drug use, Americans are divided into four racial groups: white, black, Asian or Pacific Islander, American Indian or Alaska native. The races are often subdivided into ethnic groups. For example, people with recent or distant family origins in such countries as Spain, Portugal, Mexico, and Cuba belong to an ethnic group called Iberian, Hispanic, or Latino. People also belong to cultural groups, which share similar customs, ideas, and behaviors. Racial, ethnic, cultural, and religious backgrounds often overlap.
The use of drugs and alcohol differs from one ethnic, cultural, or religious group to another. Drug abuse, as well as the way in which people respond to treatment, also varies within groups. It is helpful for public health officials to be familiar with these differences, so that they know which segments of the population have a greater need for alcohol and drug treatment and prevention services. However, the evidence of racial and ethnic differences in alcohol and drug use does not mean that these differences are due to heritable , genetic factors. Conditions such as poverty and neighborhoods with high rates of crime must be taken into account to explain different rates of drug abuse among ethnic groups.
This article discusses issues of drug and alcohol abuse among some major ethnic groups and treatments specifically geared toward these groups.
What Is Cultural Competency
As has been stated, clinicians are responsible for practicing cultural competency when working with clients who come from cultural backgrounds that differ from their own . In the event that we cannot identify a clients cultural background, we are responsible for uncovering this information and learning about it. Being culturally competent includes possessing knowledge of the culture, understanding of what makes up cultural systems, and acknowledging the roles of subcultures and other variations within larger cultures .
Based on this understanding, clinicians must possess the skills to establish a rapport with clients to gain more information about their culture and the skills to use this knowledge during the counseling process . During the course of treatment, the counselor must keep judgmental, ethnocentric beliefs and perceptions about the clients cultural group at bay if treatment is to be successful and effective .
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What Is Cultural Adaptation
Cultural adaptation has been defined as the systematic modification of an EBT or intervention protocol to consider language, culture, and context in such a way that it is compatible with the clients cultural patterns, meaning, and values . Castro et al. conceptualize cultural adaptation as a compromise on a continuum ranging from a universalist perspective, which favors the implementation of the generic intervention without modification at one end, to a culturally tailored intervention, developed for a specific group, that typically does not start with a generic intervention at the other end.
A culturally adapted intervention maintains the core components of an EBT but translates the EBT to be more relevant and consistent with the ideas, values, beliefs, norms, attitudes, and knowledge of the target group . The adapted version addresses the cultural, social, and contextual factors related to the problems the target group brings to treatment. The remainder of this section reviews several issues related to cultural adaptation including the emphasis on adding cultural, social, and contextual factors to the intervention and incorporating empowerment into the adapted version.
