Page 7 - ASCO Cultural Competency Toolkit

BACKGROUND:
HEALTHCARE DISPARITIES; RACE, GENETICS, AND SOCIAL DETERMINANTS OF HEALTH
Health care disparities across minoritized populations are well documented and are attributed to a complex history of racism, discrimination, and inequality across the various sectors that encompass the social determinants of health. (Churchwell K, et al, 2020)(Taylor, 2019) Cultural differences between patients and healthcare physicians can affect patient-clinician interactions and decision- making regarding the appropriateness of care, which can lead to disparate processes and outcomes (Betancourt et al., 2003; Betancourt et al., 2002). In the USA, healthcare outcomes differ for people of different racial groupings due to systemic differences, institutional racism, and social determinants of health. People from marginalized racial, ethnic, and cultural backgrounds are disproportionately burdened with systemic and ocular morbidity.
Experiences of racism cause individual harm on a psycho- social and biological level as well as systemic racism in policies and structures that create barriers and
exclusionary practices that ultimately prevent access to quality health care, result in worse health outcomes, and deepen health inequities.
The CA
Endowment, 2003).
Race is a social construct and explains very little of the genetic diversity among us. In 1972, Harvard evolutionary biologist Richard Lewontin assembled genetic data from around the world to test how much human genetic variation could be attributed to “racial” groupings. He found that only 6.3% of genetic variation in humans could be statistically attributed to race categorization (Lewontin, 1972). Studies on the genetic difference among populations show that race is not a biological category and that genetic difference is greater within racial groups than between them (Duello, et. al, 2021, Goodman, 2020). Additionally, ancestral alleles that do affect disease rates do not align well with
These disparities, which include differences in
treatment, unnecessary testing, increased rates of disease, and worse overall healthcare outcomes,
are often the result of cultural or linguistic barriers and unexplored socioeconomic differences of
power and access to the healthcare system.
As the U.S. population diversifies, there is a critical need for
diverse and culturally humble healthcare physicians, healthcare systems, and healthcare policies to
respond to these changes to meet the needs of the communities in which they serve. (
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