To address calls for improving health equity, organizations could consider using CLAS Standards to advance diversity, equity, and inclusion (DEI).
In recent years, health organization leaders have prioritized the need to address systemic inequities. A 2021 survey of health care organizations identified health equity as a top priority [pdf]. This focus has grown since the prior survey was conducted in 2019. Similar findings from a separate 2022 survey showed that 95% of healthcare leaders believe health equity is a key issue. At the same time, many leaders reportedly had no plans in place to address inequity within their organizations. A lack of direction and actionable guidelines represent barriers to improving DEI.
Two additional barriers to improving health equity also may prevent organizational growth: introspection and publicity.
- Introspection requires organizations to acknowledge past and present inequities. Becoming an equitable organization means making peace with a history of being inequitable. Are health care companies ready to discuss the ways they have failed some populations?
- Organizations often seek positive publicity. Organizational leaders want to position their companies to be more competitive. Health equity gains may be a way to outpace other health organizations and generate beneficial publicity. However, public announcement of improved equity is also a de facto admission of prior inequity. Are health care companies ready to own past mistakes publicly?
In short, health equity improvements can be both an asset and a liability to health organizations.
Policy Context
The Executive Order On Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, signed January 2021, calls for equitable delivery of government benefits to historically marginalized communities. Priority groups include Black, Indigenous, and other people of color, people with disabilities, and people experiencing poverty. Government benefits with increased equity goals include many health and health-related programs such as Medicare, Medicaid, Public Housing, and Head Start.
A second order, Executive Order on Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals, signed in June 2022, promotes health equity for LGBTQIA+ people. Priorities include increasing access to mental health care, reproductive health services, and gender affirming care. The executive order also emphasizes safe housing, educational support, and inclusive care for older adults.
What are the CLAS Standards?
The Culturally and Linguistically Appropriate Services (CLAS) Standards were designed specifically to ensure equitable access to health-related services. The Office of Minority Health within the U.S. Department of Health and Human Services developed the CLAS Standards in 2000 and updated them in 2013. The CLAS Standards provide a framework for ensuring that all health services are accessible.
Clinical settings often come to mind first when thinking about health services. However, health services can be defined broadly as any program or support that contributes to the physical, mental, emotional, social, or spiritual health of individuals and communities. That could include social services like housing, education, nutrition support, and supplemental income.
The CLAS Standards include a principal standard and 15 specific guidelines that fall under 3 categories: Governance, Leadership, and Workforce, Communication and Language Assistance, and Engagement, Continuous Improvement, and Accountability.
Using the CLAS Standards to Advance DEI
The CLAS Standards provide guidance about both internal organizational practices and service-oriented approaches. Therefore, using CLAS Standards could help organizations reflect on a range of existing strengths and areas of opportunity. The CLAS Standards are specific enough to inspire concrete goals and broad enough to be applicable to different types of organizations. For example, one Governance, Leadership, and Workforce standard encourages organizations to “recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.” A prior post here at The Medical Care Blog describes one example of how cultural competence has been used to increase the quality and accessibility of services.
When making DEI goals, it is important to measure progress and adjust as necessary with the input of directly affected people. The Engagement, Continuous Improvement, and Accountability standards make up six of the 15 CLAS Standards and offer advice for moving into longer-term stages of DEI work.
Future Opportunities
Although the CLAS Standards have been around for a long time, they have not been applied broadly. Studies have linked CLAS Standards to minimizing disparities. Research also highlights the importance of supporting race, ethnicity, birthplace, cultural beliefs, and language assistance to achieve client satisfaction in care settings. Additionally, studies have found that culturally and linguistically appropriate services increase patient safety.
The CLAS Standards are a valuable tool that more health organizations could be using to assess the state of DEI internally and in their service delivery. Health organizations can apply the CLAS Standards to develop measurable goals that make progress toward improving health equity for diverse communities.
Sunnie Hodge
Latest posts by Sunnie Hodge (see all)
Lawren Bercaw