Cultural Competency Considered Vital to San Francisco Universal Health Care Plan

Experts and observers 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 at the 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 pressure levels and cholesterol counts, medical professionals also are taking into account patients' race, gender, age, sexual orientation, native language and other demographics in marketing the plan and providing the best medical care once they enroll" (Knight, San Francisco Chronicle, 11/18).

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

Beneficiaries are assigned to a primary care facility that focuses on preventive care, and they also have access to emergency care, mental health care, substance abuse services, radiology, pharmaceuticals and other medical services. Enrollment in the program has been higher than anticipated; city officials had estimated that between 600 and 1,000 residents would enroll by the end of August (Kaiser Daily Health Disparities Report, 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 Health Department, 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 Chronicle reports. 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 of uninsured city residents have annual incomes below 300% of the federal poverty level. The city also has thousands of immigrants, who speak more than 100 languages, according to the Chronicle. Thirty-nine percent of the uninsured in the city are thought to be U.S. citizens, and another 39% are undocumented immigrants, while 22% are documented immigrants.

Clinics in the area offer a variety of culturally competent services, including a no-cost smoking cessation class that incorporates acupuncture, a class that gives make-up tips to women undergoing chemotherapy in their native languages and 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 are available at no cost.

Lei-Chun Fung, a health educator at one of the clinics participating in the plan, said that cultural competency is important in cancer education for Chinese immigrants because many believe that cancer is contagious and think they 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," Albert Yu, director of the Chinatown Public Health Center, said, adding, "It's not easy to hire staff that are bilingual or trilingual. And then to allocate them throughout the system -- that's always been a limiting factor" (San Francisco Chronicle, 11/18).