1

Introduction¹

“One of the six aims for improving health care in the Institute of Medicine (IOM) report Crossing the Quality Chasm (IOM, 2000) is to provide care that is equitable—that is, care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, or socioeconomic status,” said Bernard Rosof, Chief Executive Officer of the Quality in Healthcare Advisory Group, as an introduction to the topic of this workshop. “Increasing health equity and reducing health disparities requires aligning health care system demands and complexities with individual skills and abilities, and such alignment requires attention to the integration of health literacy, culture competency and language access.”

The aging and evolving racial and ethnic composition of the U.S. population has the United States in the midst of a profound demographic shift, Rosof said, and health care organizations face many issues as they move to address and adapt to this change. In their drive to adequately serve increasingly diverse communities, health care organizations are searching for approaches that will enable them to provide information and service to all persons, regardless of age, race, cultural background, or language skills, in a manner that facilitates understanding and use of that information to make appropriate health decisions.

___________________

¹ This section is based on the presentation by Bernard Rosof, Chief Executive Officer of the Quality in Healthcare Advisory Group, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.

To better understand how the dynamic forces operating in health care today impact the delivery of services in a way that is health literate, culturally competent, and in an appropriate language for patients and their families, the Roundtable on Health Literacy established an ad hoc committee² to plan and conduct a public workshop on the integration of health literacy, cultural competence, and language access services (see Box 1-1).

Rosof noted that the complexity of health care delivery in today’s ever-changing demographic environment requires more than an evidence-based approach, more than measures that matter, more than a robust information technology infrastructure, more than choosing wisely, and more than a learning health system. “To that very important list we must add person- and family-centered care and shared decision making, and to accomplish this we must understand certain basics, specifically, integrating health literacy, cultural competency, and language access services.”

ORGANIZATION OF THE SUMMARY

The workshop was organized by an independent planning committee in accordance with the procedures of the National Academies of Sciences, Engineering, and Medicine. (See Appendix A for the agenda.) The planning

___________________

² The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

committee’s members were Marin Allen, Wilma Alvarado-Little, Dennis Andrulis, Ignatius Bau, Gem Daus, Alicia Fernandez, Suzanne LeLaurin, Janet Ohene-Frempong, and Winston Wong. This publication summarizes the workshop’s presentations and discussions, and it highlights important lessons, practical strategies, and opportunities for improving the integration of health literacy, cultural competence, and language access services in the delivery of health care in the United States. Chapter 2 discusses some of the opportunities the Patient Protection and Affordable Care Act (ACA) and other incentives are creating to support the integration of health literacy, cultural competence, and language access services. Chapter 3 raises critical issues and challenges to integrating health literacy, cultural competence, and language access, and Chapter 4 explores some of the real-world approaches the health care enterprise is taking to address those issues and challenges. Chapter 5 reports on the discussions that took place in breakout groups focused on research, policy, and services and care, and Chapter 6 recounts the roundtable member’s reflections on the key lessons learned at this workshop.

In accordance with the policies of the National Academies of Sciences, Engineering, and Medicine, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the organizing committee’s role was limited to planning the workshop. The workshop summary has been prepared by workshop rapporteur Joe Alper as a factual summary of what occurred at the workshop.

This page intentionally left blank.