The importance of incorporating cultural humility into sustainable public health practices

During my first few days as a NHC Chicago Health Educator at my service site, Heartland Health Centers, I quickly learned how prominent our Spanish speaking population was. The location I serve at is  the intersection between Albany Park and Ravenswood, communities where generations of immigrants from Latin countries reside. Specifically, people of Hispanic descent make up 53% of the population within these two neighborhoods, 25% more than the average in the rest of the city of Chicago. Therefore, I soon realized that if I did not sufficiently improve my own Spanish skills, most of my appointments with patients would have to be through the screen of a translator.

Determined to offer similar services to all my patients, I began to practice on my Spanish daily. Luckily, within a few weeks I reached the point where the translator was no longer required. However, this step was far from enough in my effort to offer equitable resources to all my patients.

I walked out of many of my appointments with my Spanish speaking patients confident that I had not built that same connection I had with those that spoke English. Just merely being able to comprehend what each other were saying was not good enough when the purpose of our visits was for me to use motivational interviewing to truly understand a patient's life and help them work towards personal and sustainable changes for them. Additionally, I also began to realize that several of the great resources I received during my training on nutrition were researched around and tailored towards a white, Euro-centric population.

Many of the newer models in the nutrition world that are created to encourage healthier eating primarily focus on body-shaming and individualized guilt associated with eating. However, this method of thinking remains very narrow. Many cultures, especially Latin cultures have other unique and complex ideas associated with food and nutrition. For example, a BMI that might be considered typically overweight at a doctor's office may be considered healthy in several communities; anything under that weight may receive a ‘you're too thin, you need to be eating more' from family members. Also, food is often the center of large gatherings, where relatives encourage one another to eat ‘just a little bit more' as a sign of great hospitality and genuine care.

Luckily, I learned these facts as my time with Heartland progressed. The organization follows a form of culture humility that goes beyond just language translation in understanding its patients. Many of the staff members at Heartland are members of the community in which the clinics are located. From them I learned how many of our patients differed from what is often seen as the ‘ideal patient' that much of our medical research and practices are centered around. Additionally, I had the chance to learn from my patients themselves. I assist with a cooking class conducted in Spanish. Here, many of our patients have the chance to better understand nutrition from medical staff at the clinic, but also from each other. In these classes I have been able to see the strong role culture plays in all facets of our lives, but especially nutrition.

For these reasons, I have been incredibly grateful for my service term at Heartland. I have been able to see how to put knowledge around cultural humility into practice and hopefully these are techniques I will be able to continue in the rest of my career.

This blog post was written by NHC Chicago 2019-20 member Thwisha Sabloak.

Thwisha is a Health Educator at Heartland Health Center- Hibbard/Lincoln Square.