Diversity and Cultural Competency in Health Care

Jean Gordon, RN, DBA

LEARNING OUTCOMES

After completing this chapter, the student should be able to: ? Define diversity. ? Define cultural competency. ? Define diversity management. ? Understand why changes in U.S. demographics affect the health care industry.

OVERVIEW

Demographics of the U.S. population have changed dramatically in the past three decades. These changes directly impact the health care indus- try in regard to the patients we serve and our workforce. By 2050, the term “minority” will take on a new meaning. According to the U.S. Census Bureau, by midcentury the white, non-Hispanic population will comprise less than 50 percent of the nation’s population. As such, the health care industry needs to change and adopt new ways to meet the diverse needs of our current and future patients and employees.

The American Heritage Dictionary of the English Language (4th ed.) defines diversity as: “(1) the fact or quality of being diverse; difference, and (2) a point in which things differ.” Dreachslin (1998) provided us with a more specific def- inition of diversity. She defined diversity as “the full range of human similari- ties and differences in group affiliation including gender, race/ethnicity, social class, role within an organization, age, religion, sexual orientation, physi- cal ability, and other group identities” (p. 813). For our discussions, we will focus on the following diversity characteristics: (1) race/ethnicity, (2) age, and (3) gender.

This chapter is presented in three parts. First, we discuss the chang- ing demographics of the nation’s population. Second, we examine how these changes are affecting the delivery of health services from both the patient’s and employee’s perspectives. Because diversity challenges faced by the health care industry are not limited to quality-of-care and access-to-care issues, in part three of our discussions we explore how these changes will affect the health services workforce, and more specifically the current and future leader- ship within the industry.

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CHAPTER 2

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CHANGING UNITED STATES POPULATION

There is no doubt that the demographic profile of the U.S. population has undergone significant changes within the past 10 years regarding age, gender, and ethnicity (see Table 2–1 ).

Data from the 2010 Census provide insights to our racially and ethnically diverse nation (Humes, Jones, & Ramirez, 2011). According to the 2010 Cen- sus, 308.7 million people resided in the United States on April 1, 2010—an increase of 27.3 million people, or 9.7 percent, between 2000 and 2010. The vast majority of the growth in the total population came from increases in those who reported their race(s) as something other than White alone and those who reported their ethnicity as Hispanic or Latino. For the first time in the 2000 Census, individuals were presented with the option to self-identify with more than one race, and this continued with the 2010 Census. Using the five race categories (White, Black/African American, American Indian/Alaska Native, Asian, and Native Hawaiian/Other Pacific Islander) required by fed- eral agencies, there are 57 possible multiple race combinations that could have been selected by individuals in addition to “some other race.” In fact, over 7 million or 2 percent of the U.S. population did so in the 2010 Census by identifying with and choosing “some other race” or “two or more races.” It is predicted that the number of Americans reporting themselves or their chil- dren as multiracial will increase in the future. In addition to the changing eth- nic and racial composition of America, another issue is the aging population.

Table 2–1 Population of the United States by Age, Gender, and Race/Ethnicity a

2000 2010

Number Percent Number Percent

Total population 281,421,906 100.0 308,745,538 100.0

Under age 19 80,473,255 25.7 83,267,556 26.9 Ages 19 to 64 165,956,888 61.9 185,209,998 60.0 Ages 65 and over 34,991,753 12.4 40,267,984 13.0

Males 138,053,563 49.1 151,781,326 49.2 Females 142,368,343 50.9 156,964,212 50.8

White 211,460,626 75.1 196,817,552 63.7 Black 34,658,190 12.3 37,685,848 12.2 Hispanic 35,305,818 12.5 50,477,594 16.3 Asian 10,242,998 3.6 14,465,124 4.7 American Indian 2,475,956 0.9 2,247,098 0.7 Some other race 15,359,073 0.5 1,085,841 0.1 Two or more races 6,826,228 0.2 5,966,481 0.2

a Percentages do not add up to 100 percent due to rounding and because Hispanics may be of any race and are therefore counted under more than one category. Data from U.S. Census Bureau, 2010 Census. DP-1 – United States: Profile of General Population and Housing Characteristics: 2010 Demographic Profile Data: U.S. Census Bureau 2000 Census Data as shown in the 2009 Population Estimates table; U.S. Census Bureau: National Population Estimates; Decennial Census.

16 DIVERSITY AND CULTURAL COMPETENCY IN HEALTH CARE

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According to the 2010 Census, 40 million people (13 percent of the U.S. popu- lation) are 65 years of age or older. This is 12.3 million more people than in 2000 (see Figure 2–1 ).

During the past decade, the population aged 65 and over grew at a faster rate (15.1 percent) than the population under age 45. This trend was expected as the Baby Boomers (those born between 1946 and 1964) began reaching age 65 in 2011 (see Figure 2–2 ).

In addition to the increasingly older population, there is a declining number of young people in America. From 1940 to 2010, the percentage of the Ameri- can population under the age of 18 fell from 31 percent to 24 percent (U.S. Census Bureau, 2012). This decline in America’s younger population will have a direct effect on the industry’s ability to recruit health care professionals to provide sufficient services in the future. Young people of all ethnicities must be attracted to the health care industry as a career choice in order to meet the health care needs of the country’s growing population.

Males and females are almost evenly divided for the total population, rep- resenting 49.2 percent and 50.8 percent, r