Cultural Humility Call to Action

Editor’s Note: The John A. Hartford Foundation is collaborating with ASA to advance equity in aging by supporting ASA RISE, a 20-week social justice and leadership program for rising leaders of color in aging, and via the development and dissemination of equity-related, partnership-based thought leadership through ASA’s Generations platform. This blog post from an ASA Rise Fellow is the eighth in that series.

By the time my fellow Co-Conspirators on the health and wellness team and I finished delivering our ASA RISE capstone presentation on cultural humility—to an audience of fellow fellows, our erudite mentors, our generous sponsors and, yes, my loving parents—dozens of Zoom boxes had erupted into cheers, smiles and heart reactions.

We had been fervently preaching to the choir: entreating all who listened to employ strategies for centering BIPOC beneficiaries and providers to create health equity. Our demand: that they align with us as more than allies, that they act as Accomplices and Upstanders. We urged that they turn their rousing applause into the tangible tenets of cultural humility: lifelong learning and self-reflection, mitigating power imbalances and institutional accountability. Given the enthusiastic thumbs up with which our witnesses (as in, “can I get a…”) regaled us, we graduated from ASA RISE savoring avid forward momentum. The choir trilled in harmony with us.

For our project, my colleagues and I began by applying the cultural humility lens to the stakeholders who have the authority, wherewithal, funds and influence to address challenges and craft solutions for establishing and broadening cultural humility. These are healthcare systems, providers and funders with the greatest responsibility for engaging in thoughtful, comprehensive, lasting programs for uncovering bias, implementing health equity strategies, and reshaping the healthcare system. Some solutions we recommend:

  • Implementing diversity, equity, inclusion and justice training in medical, social work, law and other professional schools, with acutely concentrated attention on BIPOC learners and leaders.
  • Unrestricted funding for healthcare education and services to develop health equity.
  • Replacing color-blind philanthropy and outreach with methods that highlight and foster BIPOC leadership and respect the intersectionality of age, race, gender and more.

Beyond those remedies, we unequivocally believe that stakeholders must center the beneficiaries of their programming. Ours is not a top-down, trickle-down approach, but rather one that uplifts the people we profess to serve. To reach our ongoing, ever-evolving goal of cultural humility, we are called to create, evaluate and distribute materials with accurate, accessible language that beneficiaries recognize, respond to and respect.

‘Ours is not a top-down, trickle-down approach, but rather one that uplifts the people we profess to serve.’

We are obliged to involve target audiences in the design, development and distribution of these materials in ways that honor them and hold their culture dear. We must continuously evaluate viability, strengths and sustainability of the services we provide to improve social determinants of health, and we do this by listening, really listening, to our BIPOC clients about what works well and what needs improvement. We do this with language, images, accessibility and behavior that respects and reflects what is meaningful to them.

But Wait, What? Words Matter

One month after our ASA RISE graduation, the proposed 2022 Inflation Reduction Act generated buzz among climate change advocates, Medicare beneficiaries and providers, as well as the general public. Its proffered bids aim to reduce energy bills and carbon emissions, create jobs, invest in disadvantaged communities and protect families and small businesses.

Of particular interest to older adults, the Act would allow Medicare to negotiate medication costs, lower prescription drug prices and cap individuals’ annual out-of-pocket drug spending at $2,000.00 (by 2025). As a Medicare counselor with 11 years of diligent work to save the most vulnerable beneficiaries more than $1 million (plus easing their worry and stress about meeting their healthcare needs), I assess this legislation as the answer to many prayers.

Eager to learn more about the impact of the Inflation Reduction Act, I scoured trusted resources to ascertain the estimated timeline, scope and outcomes of the legislation. Most articles I read had an air of cautious optimism—with a side of skepticism—about the Act’s facets, with predictable support and opposition drawn along political party lines.

One assessment I reviewed, however, brought me to my knees. In a discussion of anticipated outcomes of the Inflation Reduction Act for Medicare beneficiaries, this article acknowledged that Black and Hispanic Medicare beneficiaries are more likely than white beneficiaries to have incomes between 135% and 150% of the federal poverty level.

Good, I mused—recognition of racial, health and socioeconomic disparities for BIPOC populations is an important component of cultural humility. However, an accompanying comment dispelled me of the hope that this awareness would be an entrée into dismantling that inequality. Alongside identifying the likelihood that Black and Hispanic beneficiaries were more likely to have the lowest incomes, the article posited that the Inflation Reduction Act would mean that Blacks and Hispanics would disproportionately benefit from the cost savings and other gains that the legislation would impart. The article did not supply any additional context or framework for that estimation. Encouraging update: the article has since been amended to read “this provision would benefit low-income Black and Hispanic Medicare beneficiaries in particular.”

We should not use language that pathologizes realities for disproportionately served populations.

The “disproportionately” descriptor originally cited in the article is concerning to me, and it struck me as not at all culturally humble. If we’re going to reveal healthcare and socioeconomic disparities, then we should develop, embrace and promote strategies that will minimize and eliminate them, not use language that pathologizes realities for disproportionately served populations. It seems to me a net positive that populations that have generally received fewer benefits, resources and support because of systemic racism and bias in healthcare services would benefit from interventions that would overall improve outcomes for them and for all beneficiaries.

Characterizing as disproportionate the programs and funding that lead to those enhanced results for BIPOC people devalues both the people and the help. It unnecessarily and unreasonably shifts the focus from where it genuinely belongs: on those tenets of cultural humility—lifelong learning and self-reflection, mitigating power imbalances and institutional accountability. Language matters—the words we use to describe, define and denote people carry power. Furthermore, it is incumbent upon those with the most power to transparently transfer that power to those who are most vulnerable.

Now that Congress has passed the Inflation Reduction Act and on Tuesday President Biden signed it, this call to action for cultural humility is even more timely and imperative. The messaging we fellows investigated, analyzed and conveyed as part of ASA RISE, whose mission includes improving well-being across an increasingly diverse aging population, fuels us—and our Co-Conspirators, Accomplices and Upstanders, and everyone who reads these words—to pave the road to health equity.

We summon you to consider how you are individually applying cultural humility in your daily professional and personal activities. We implore you to explore in what ways your company and community are including BIPOC populations in creating solutions to address health equity. We beseech you to raise your voice and join the chorus!

Kelly G. Loeb, MSW, is an older adult care manager and Medicare counselor at Jewish Family Services of Greater Kansas City, and an alumna of the inaugural class of ASA RISE fellows.