Nair Lakshmi, Adetayo Oluwaseun A
Albany Medical College, Albany, N.Y.
Division of Plastic Surgery, Albany Medical Center, Albany, N.Y.
Plast Reconstr Surg Glob Open. 2019 May 16;7(5):e2219. doi: 10.1097/GOX.0000000000002219. eCollection 2019 May.
Today's model of healthcare has persistent challenges with cultural competency, and racial, gender, and ethnic disparities. Health is determined by many factors outside the traditional healthcare setting. These social determinants of health (SDH) include, but are not limited to, education, housing quality, and access to healthy foods. It has been proposed that racial and ethnic minorities have unfavorable SDH that contributes to their lack of access to healthcare. Additionally, African American, Hispanic, and Asian women have been shown to be less likely to proceed with breast reconstructive surgery post-mastectomy compared to Caucasian women. At the healthcare level, there is underrepresentation of cultural, gender, and ethnic diversity during training and in leadership. To serve the needs of a diverse population, it is imperative that the healthcare system take measures to improve cultural competence, as well as racial and ethnic diversity. Cultural competence is the ability to collaborate effectively with individuals from different cultures; and such competence improves health care experiences and outcomes. Measures to improve cultural competence and ethnic diversity will help alleviate healthcare disparities and improve health care outcomes in these patient populations. Efforts must begin early in the pipeline to attract qualified minorities and women to the field. The authors are not advocating for diversity for its own sake at the cost of merit or qualification, but rather, these efforts must evolve not only to attract, but also to retain and promote highly motivated and skilled women and minorities. At the trainee level, measures to educate residents and students through national conferences and their own institutions will help promote culturally appropriate health education to improve cultural competency. Various opportunities exist to improve cultural competency and healthcare diversity at the medical student, resident, attending, management, and leadership levels. In this article, the authors explore and discuss various measures to improve cultural competency as well as ethnic, racial, and gender diversity in healthcare.
当今的医疗保健模式在文化能力以及种族、性别和族裔差异方面面临持续挑战。健康由传统医疗保健环境之外的许多因素决定。这些健康的社会决定因素（SDH）包括但不限于教育、住房质量和获得健康食品的机会。有人提出，少数族裔的健康社会决定因素不利，这导致他们难以获得医疗保健。此外，与白人女性相比，非裔美国女性、西班牙裔女性和亚裔女性在乳房切除术后进行乳房重建手术的可能性较小。在医疗保健层面，培训和领导层中文化、性别和族裔多样性的代表性不足。为满足多样化人群的需求，医疗保健系统必须采取措施提高文化能力以及种族和族裔多样性。文化能力是与来自不同文化的个人有效合作的能力；这种能力可以改善医疗保健体验和结果。提高文化能力和族裔多样性的措施将有助于减轻医疗保健差异，并改善这些患者群体的医疗保健结果。必须尽早开始努力，吸引合格的少数族裔和女性进入该领域。作者并非主张为了多样性而牺牲功绩或资格，相反，这些努力不仅要发展到吸引，还要留住和晋升积极性高、技能娴熟的女性和少数族裔。在实习生层面，通过全国性会议和他们自己的机构对住院医生和学生进行教育的措施，将有助于促进具有文化适宜性的健康教育，以提高文化能力。在医学生、住院医生、主治医生、管理人员和领导层等层面，存在各种提高文化能力和医疗保健多样性的机会。在本文中，作者探讨并讨论了在医疗保健中提高文化能力以及族裔、种族和性别多样性的各种措施。
