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Cultural Awareness and Diversity

As patient populations become more culturally diverse, being able to effectively communicate with your patients and provide culturally appropriate chiropractic care will become an even greater challenge. To help you with evaluating and improving your office’s cultural awareness, we have put together a brief article on the importance of diversity training, along with links to self-assessment tools.

Cultural competence is having the capacity to function effectively within the context of the cultural beliefs, behaviors and needs of diverse consumers and their communities.

The Minnesota population, most likely your patient base, is becoming more culturally diverse. Minnesota has large populations of Somalis and Hmong, as well as immigrants from other African countries, Asia, Hispanic/Latino countries and the Middle East. One in ten Minnesotans do not speak English. The ever-changing demographics in Minnesota and across the country require health care providers to take a proactive approach to providing effective care.

Fulcrum strongly encourages all providers to assess their ability to meet the specific health care needs of the communities they serve. Everyone in your office interacting with patients and their families can impact a patient’s experience and their perception of quality care.

Language and Effective Clinical Care

Effective communication is key in establishing relationships and providing effective clinical care to patients from diverse populations. Providing linguistically appropriate care is not only a good idea, it is mandated by the federal government. All health care providers receiving federal funds are required by Title VI of the Civil Rights Act to provide Language Access Services to limited English-proficient speakers (LEP). This includes providers receiving payments for patients in government-based programs (i.e., Medicare and Medicaid).

Know the 14 Standards

The Office of Minority Health (a division of the U.S. Department of Health and Human Services) has developed a set of 14 standards for health care providers related to culturally competent care, language access and organizational support. These are referred to as the Culturally and Linguistically Appropriate Services (CLAS) Standards and include four mandated standards related to Language Access Services. For example, CLAS Standard 4 states:

“Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.”

Language Access Services

Language Access Services (LAS) is the collective name for any service, including interpreting (oral communication) and translation (written communication), that helps diverse and non-English speaking patients obtain the same access to and understanding of health care services an English speaker would have.

Where can you go for information on interpretation services? The Minnesota Department of Health maintains a roster of interpreters. This list will contain contact and network participation status, along with specialty experience.

Health Issues and Treatment Customs VARY By ethnicity

Information on the Stratis Health website will illustrate the health differences between the 17 major ethnic groups. For example:

  • African Americans are affected disproportionately by the leading causes of death in the US, including cancer, obesity, diabetes, heart disease, hypertension, and HIV/AIDS.
  • Depression is common among Somali refugees, who may have lost family members or endured horrible events during the war. An estimated 30 percent of refugees have been tortured and may be suffering from post-traumatic stress disorder.
  • Adoptions of a Western diet and sedentary lifestyle have led to a dramatic increase in obesity, diabetes, hypertension, heart disease, and stroke in the American Hmong population. In addition, many Hmong who consume large quantities of fish taken from Minnesota lakes and rivers are at risk of exposure to mercury and PCBs.
  • Middle Easterners tend to prefer a gradual, prolonged disclosure of information, rather than a brief explanation of diagnosis and prognosis. Health care providers are advised to compare the treatment they recommend with the way they would treat a member of their own family.

Web Sites

There are many web sites available for resources regarding culture and health.

Here are a few key sites for your reference:  

Culture Care Connection

Cultural Competence Resources for Health Care Providers

A Physician’s Practical Guide to Culturally Competent Care
(NOTE:  Earn up to nine CMEs with this online course)   

BeliefNet (information on religions)

Center for Healthy Families and Cultural Diversity, Department of Family Medicine, UMDNJ – Robert Wood Johnson Medical School:  Aetna Foundation-Funded Cultural Competency/Quality Improvement Study

 U.S. Department of Health Human Services, Office of Minority Health:  Cultural Competency

Center for Victims of Torture

The Cross-Cultural Health Care Program

Cultural Diversity in Health Care

Cultural Orientation Resource Center, Center for Applied Linguistics  

Diversity in Medicine, American Medical Student Association:  Enriching Medicine Through Diversity


Immigration in Minnesota, Minneapolis Foundation

Minnesota Immigrant Health Recommendations

National Alliance for Hispanic Health

National Council on Interpreting in Health Care

National Library of Medicine (search by race group for health information: e.g. “American Indian Health”)

Culture Clues – Patient and Family Education Center, University of Washington Medical Center

Providers Guide to Quality and Culture

Resources for Cross Cultural Health Care

Transcultural C.A.R.E. Associates (President:  Josepha Campinha-Bacote)

The 24 Languages Project–Spencer S. Eccles Health Sciences Library and the Utah Dept of Health

Local Resources  

Refugee Health Program, Minnesota Department of Health:  Ensures that new refugee arrivals to the state receive a basic health assessment and follow-up. A provider’s guide to refugee health assessment is available. For more information, call 651-201-5414 or 1-877-676-5414.

United Way 2-1-1:  2-1-1 is the number to call that provides community information and referral to people in need of food and shelter, healthcare, job resources, childcare and other vital community services. The service is multilingual. If calling from a cell phone, call 651-291-0211 or 1-800-543-7709 (toll free).  You can also download the 211 database and search resources by topics online at  Support for downloading or using the database is available by calling 651-291-8401 or e-mail Cort at:   

Health Care Options for Uninsured or Underinsured Patients

Guide to Minnesota’s Public Health Care Programs:

Medical Assistance:  For eligibility requirements or additional information, call 651-431-2670 or toll free at 1-800-657-3739.

A list of County Human Services Departments, with contact information, is available at

MinnesotaCare: A subsidized health program for people who are:

  • Permanent Minnesota residents;
  • Not eligible for medical assistance;
  • Not covered by any other health insurance for the past four months;
  • Unable to get employer-paid health insurance for the previous 18 months; and
  • With income and asset limits.

Annual premium based on income, plus some co-payments. To apply or for more information call 651-297-3862 or toll free at 1-800-657-3672.

Neighborhood Health Care Network:  Provides information on community clinics with sliding fee scales and flexible payment schedules for people without health insurance. Call 651-489-2273 or toll free at 1-866-489-4899 for more information.

Assured Access:  Hennepin County Office of Multi-Cultural Services program provides Hennepin County residents with a list of clinics that charge for outpatient services on a sliding fee scale, depending on household income. Discounts range from 25 to 100 percent. Clinics determine the discount. 

Assured Access is not medical insurance. Discounts apply for one year unless you move outside of Hennepin County prior to the expiration date. Prescriptions may also be discounted at clinics with on-site pharmacies. For more information go to the Office of Multicultural Services website: Or call 612-348-6141 (English) or 612-596-6639 (Spanish)

Portico Healthnet: Subsidized health care for uninsured people, not eligible for medical assistance, and within income guideline. Call 651-603-5100 or 1-866-430-5111 toll free for more information.

Portico Healthnet serves the community by assisting children, parents, and individuals who are uninsured with applications to health care programs and by offering a primary and preventive health care access program for people with public programs.

St Mary’s Health Clinics: These clinics offer basic primary and preventative health care services for the uninsured residents of the seven-county metro area (St. Paul, Minneapolis, and its surrounding suburbs) within designated income guidelines. There are various locations throughout the Metro area. For appointments, call 651-287-7777.

Local Public Health Agencies: Current contact information is available on the Minnesota Department of Health web site at: