In some parts of America, such as Sacramento County, California, the white population has become smaller than the combined populations of black, Hispanic, and Asian residents. Other parts of the country are predicted to follow this trend in demographic change, which means the healthcare system will need to change as well, learning how to best fulfill the health needs of non-white patients.

A Changing Population

Over the past few decades America has become more and more diverse, both ethnically and racially. Much of the growth in population over the past fifty years has come from immigration, with the country importing approximately 59 million new citizens during that time, the bulk of which come from Latin American and Asian countries. As the national rate of birth in white Americans declines, the demographics of the entire country will change. In just three decades the white population in the United States is predicted to no longer be a national majority.

A more diverse population will inevitably lead to a more diverse set of health conditions in the public. For example, patients who originally migrated from Asia have a higher rate of Hepatitis B. Those from sub-Saharan Africa are also more likely to have sickle cell anemia, a genetic blood disorder.

Health Challenges

Serving a larger, more diverse population offers health care professionals a broader array of challenges.

An obvious challenge is the language barrier. Many immigrants from lower socioeconomic backgrounds have poor or nonexistent English skills, which can rob providers of their biggest resource, direct verbal complaints from their patients.

In a recent study done by San Diego State University, it was found that almost a third of hospitals in the country don’t offer translation services. The reason is two-fold: First, poorer hospitals can’t afford the service, and second, for-profit hospitals don’t need the service because they cater to wealthier patients who speak English. Funding is a major issue for any hospital, as the many costs of operating a hospital, such as liability insurance, administrative costs, enterprise imaging, and equipment management and maintenance leaves little left for what is perhaps the most important aspect of healthcare, patient services.

Only fifteen states actually dispense funding for the services of interpreters through Medicaid. Surprisingly California, which has the largest Spanish-speaking population in the country, is not one of them. The state does however require that private health insurers to provide translations services, although it doesn’t require those insurers to pay for them.

Even when translations services are available, there is still a decreased level of communication between patient and health care provider, leading to a decrease or delay in care.

Differences in Care

Caring for a more diverse patient population also means understanding the differences in care quality that different patient groups receive.

Socioeconomic status is a factor, but statistics show that regardless of income level, Hispanics and African-Americans trend towards a lower level of care. White patients are more likely to be prescribed medication than their black counterparts. For example, black HIV positive patients are less likely to receive anti-retroviral drugs than white patients with the same condition.

At the moment there is no simple explanation for this gap in care quality. It’s thought that unconscious bias by healthcare professionals may play a role. This can be over any number of factors, from a language barrier, cultural differences, or perhaps even geography.

David Acosta, Associate Vice Chancellor for Diversity and Inclusion at the University of California Health System, has said “Race and ethnicity matter, whether you like it or not.”

To combat these gaps in care, one strategy is to include more minorities in the health care industry. Another is to train providers, regardless of race, to be more sensitive to differences in culture and to examine their own internal biases when dealing with a patient of a different race, culture, ethnicity, or language.

The makeup of America’s demographics are changing, and the healthcare system will need to change with it. Health care professionals will need to change procedures as well as their own attitudes in order to maintain excellent patient care. It will be a slow change, but by being self-aware of the very real problems minorities face when trying to receive care, health providers will be able to provide the same quality of treatment to everyone, no matter their racial or ethnic background.


by: Lee Flynn