Cultural Competency Considered Vital To San Francisco Universal Health Care Plan

Experts andobservers have said that the success of San Francisco's new universal health care plan"hinges on a notion rarely discussed in the health care debates raging atthe state and national levels: cultural competency," the San Francisco Chronicle reports. According to the Chronicle,instead of "treating patients using just raw data such as blood pressurelevels and cholesterol counts, medical professionals also are taking intoaccount patients' race, gender, age, sexual orientation, native language andother demographics in marketing the plan and providing the best medical careonce they enroll" (Knight, San Francisco Chronicle, 11/18).

The Healthy San Francisco health initiative seeks to coverall 82,000 uninsured city residents within 18 months to two years. Under the$200 million annual plan, proposed by Mayor Gavin Newsom and Supervisor TomAmmiano, uninsured residents are eligible to receive services within the San Francisco city limits.Proof of citizenship, employment and pre-existing conditions are not consideredfor eligibility (Kaiser Daily Health DisparitiesReport,8/16). Participants pay a quarterly premium on a sliding scale and copayments (SanFrancisco Chronicle, 11/18).

Beneficiaries are assigned to a primary care facility that focuses on preventivecare, and they also have access to emergency care, mental health care,substance abuse services, radiology, pharmaceuticals and other medicalservices. Enrollment in the program has been higher than anticipated; cityofficials had estimated that between 600 and 1,000 residents would enroll bythe end of August (Kaiser Daily Health DisparitiesReport,8/16). To date, nearly 5,000 residents have enrolled in the program.

Cultural competency "has long been a part of the city's Public HealthDepartment, its neighborhood clinics and San Francisco General Hospital,"but the idea "becomes all the more crucial, especially because so many of[the uninsured] are poor and hail from other countries," the Chroniclereports. Of the uninsured in San Francisco, 32% is either white or Asian-American, 26%is Hispanic, 3% is black and 2% is American Indian. Sixty-three percent ofuninsured city residents have annual incomes below 300% of the federal povertylevel. The city also has thousands of immigrants, who speak more than 100languages, according to the Chronicle. Thirty-nine percent of theuninsured in the city are thought to be U.S. citizens, and another 39% areundocumented immigrants, while 22% are documented immigrants.

Clinics in the area offer a variety of culturally competent services, includinga no-cost smoking cessation class that incorporates acupuncture, a class thatgives make-up tips to women undergoing chemotherapy in their native languagesand a program that developed a healthy cookbook inspired by Chinese recipes,which organizers are seeking to make available in local Chinese restaurants.The programs are not necessarily covered under the health plan, though many areavailable at no cost.

Lei-Chun Fung, a health educator at one of the clinics participating in theplan, said that cultural competency is important in cancer education forChinese immigrants because many believe that cancer is contagious and thinkthey will automatically die once diagnosed.

"The entire health system, from the front desk to the treating physicians,have to have linguistic fluency, as well as cultural competency," AlbertYu, director of the ChinatownPublicHealthCenter, said, adding,"It's not easy to hire staff that are bilingual or trilingual. And then toallocate them throughout the system -- that's always been a limitingfactor" (San Francisco Chronicle, 11/18).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Weekly Health Disparities Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Weekly HealthDisparities Report is published for kaisernetwork.org, a free service of The HenryJ. Kaiser Family Foundation.