As the United States becomes more diverse, there is a growing body of literature that delineates the impact of sociocultural factors such as race and ethnicity on health and clinical care.¹ Sociocultural differences between patients and physicians influence communication and clinical decision making, and there is evidence that patient-physician communication is directly linked to patient satisfaction, adherence, and overall quality of care.^2,3 Unexplored or misunderstood sociocultural differences between patients and physicians can lead to patient dissatisfaction, poor adherence to treatment, and poor health outcomes.⁴ In an effort to provide health care professionals with the knowledge and skills to effectively care for diverse populations, an educational movement in “cross-cultural care” has emerged.⁵ This field is not new, but has received a new emphasis during the past 10 years as a result of statements made by the American Medical Association (AMA) and the Accreditation Council for Graduate Medical Education, among others, that cross-cultural training is necessary for the effective practice of medicine in the United States.^6,7

To the Editor: In 2000, the US Department of Health and Human Services Office for Civil Rights provided guidance regarding the Civil Rights Act of 1964, stating

An Institute of Medicine report issued in 2002 cited cross-cultural training as a mechanism to address racial and ethnic disparities in health care, but little is known about residents’ training and capabilities to provide quality care to diverse populations. This article explores a select group of residents’ perceptions of their preparedness to deliver quality care to diverse populations. Seven focus groups and ten individual interviews were conducted with 68 residents in locations nationwide. Qualitative analysis of focus-group and individual interview transcripts was performed to assess residents’ perceptions of (1) preparedness to deliver care to diverse patients; (2) educational climate; and (3) training experiences. Most residents in this study noted the importance of cross-cultural care yet reported little formal training in this area. Residents wanted more formal training yet expressed concern that culture-specific training could lead to stereotyping. Most residents had developed ad hoc, informal skills to care for diverse patients. Although residents perceived institutional endorsement, they sensed it was a low priority due to lack of time and resources. Residents in this study reported receiving mixed messages about cross-cultural care. They were told it is important, yet they received little formal training and did not have time to treat diverse patients in a culturally sensitive manner. As a result, many developed coping behaviors rather than skills based on formally taught best practices. Training environments need to increase training to enhance residents’ preparedness to deliver high-quality cross-cultural care if the medical profession is to achieve the goals set by the Institute of Medicine.

Leadership sets the tone in organizations. Even with a positive view on race by leaders, powerful hidden biases and blind spots continue to persist among professionals and their organizations. Few models for organizational change are geared towards addressing institutional racism. Interpersonal and institutional cultural responsiveness can improve community engagement, work place culture, and strengthen organizations. Using the social work profession as an exemplar, this paper describes barriers to organizational and institutional change. The roles of organizational leadership and culture are discussed. Recommendations for addressing and establishing organizational change consistent with the values of inclusion and cultural diversity are provided.

Fishing industry workers are at high risk for work-related musculoskeletal disorders (MSDs) and injuries. Prescription opioids used to treat pain injuries may put these workers at increased risk for developing substance disorders. Using a Community-Based Participatory Research approach, formative research was conducted to inform the eventual development of relevant interventions to prevent and reduce opioid use disorders among fishing industry workers. Qualitative interviews (n = 21) were conducted to assess: knowledge and attitudes about opioid use disorders; features of fishing work that might affect use and/or access to treatment; and community and organizational capacity for prevention and treatment. Participants reported numerous pathways connecting commercial fishing with opioid use. The combination of high stress and physically tasking job duties requires comprehensive workplace interventions to prevent chronic pain and MSDs, in addition to tailored and culturally responsive treatment options to address opioid use disorders in this population. Public health programs must integrate workplace health and safety protection along with evidence-based primary, secondary, and tertiary interventions in order to address opioid use disorders, particularly among workers in strenuous jobs.

Social work is uniquely poised to lead in the development and implementation of multilevel strategies to both address substance use disorders (SUDs) and tackle existing inequities in SUD treatment. It is critical that there be an explicit focus on context, racial justice, and community empowerment in educational efforts designed to train graduate social work students when preparing them for professional work in the behavioral health field. This article provides a review of the literature on disparities in SUD and SUD treatment. The notion of cultural competence in SUD treatment is critically examined. Finally, the role of social work education and training in tackling inequity and the realization of justice is discussed.