Healthcare Inequalities in Contemporary Clinical Encounters: The Lens of Cultural Health Capital

On average, the United States spends almost three times more on healthcare per capita than most developed countries, yet our health outcomes are generally no better. Systems of care continue to be plagued by social inequities in quality, patient satisfaction and service provision. In 2010, the landmark Patient Protection and Affordable Care Act (ACA) provided momentum in addressing these health disparities. It ushered in a number of fundamental changes to the US healthcare system including expanded access to insurance, mandating substance use and mental health treatment on par with other conditions, institutionalizing what has become known as patient-centered care, and focusing on socially and medically complex patients. However, with these recent organizational transformations in healthcare delivery, the demands being placed on patients and providers alike have intensified and heightened the degree to which cultural resources and skills matter in clinical interactions.The framework of “cultural health capital” (CHC) uses Bourdieusian concepts to help account for how patient-provider interactions unfold in ways that may generate and exacerbate inequalities in health care. CHC has been defined as a repertoire of cultural skills, verbal and non-verbal competencies, attitudes, behaviors, and interactional styles that are exchanged in clinical interactions by patients and providers alike. Using data from ongoing qualitative studies, we will explore several healthcare priorities that are emblematic of how structural inequalities are operationalized at the clinical-interactional level: 1) the recent focus on patient-centered care, 2) treatment of substance use, and 3) services for high-utilizing, complex patients. Through the lens of CHC, we will examine the ways in which both patients and providers leverage cultural resources to shape clinical interactions and how the social position and expectations of patients and providers facilitate or mitigate the care that is offered and received.