The future deserves better - seeking health equity through interprofessional education, cultural humility and understanding structural context

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Introduction

Future health practitioners must learn skills in interprofessional collaborative practice during their educational preparation in order to perform effectively and efficiently in their professional roles. Students gain these skills through exposure to interprofessional collaboration, structured opportunities to practice interprofessional skills, and the demonstration of competency during applied experiences (Interprofessional Education Collaborative, 2016). There is clear evidence that effective interprofessional collaborative practice does improve health outcomes for individuals (Lee et al., 2021; Reeves et al., 2013; World Health Organization [WHO], 2010); however, inequities in morbidity and mortality persist between populations (National Academies of Science, Engineering, and Medicine, 2021). While interprofessional collaborative practice is necessary, it is not sufficient to create health equity. The differences observed in morbidity and mortality between populations of color and the dominant population are partially attributable to structural inequities in society that adversely affect populations of color and emerge from discrimination and marginalization either intentional or unintentional (Braveman et al., 2011; Milburn et al., 2019).

Background

In a time of radical social change and unprecedented divisions regarding beliefs and practices between people and communities, it is urgent for institutions to build future health professionals’ capacity for collaboration, understanding, and compassion. Health professionals must develop a greater self-awareness and humility when working with and for underserved populations, and clearly recognize that each of us is embedded within social, political, economic and other systems and structures that determine where we live, how we are educated, what we will achieve, and how we are treated. Interprofessional education methodologies and goals are an optimal fit for addressing the intersectionality of these learning outcomes. The capacity to understand self, possess high levels of cultural fluency, and address contextual and ecological factors is required for optimal interprofessional collaborative practice. This necessitates that team members possess these skills and an interprofessional collaborative approach to address the health care disparities associated with racism and social determinants of inequity. It is only with the combined efforts of individuals approaching the problem from different lenses that an untenable problem such as this can be addressed. In addition, research focused on these areas is critical for enhancing our understanding of optimal educational approaches and advancing equitable health outcomes.

While there is still much to learn, a growing body of evidence suggests that high impact practices, such as undergraduate research, global learning, community-based learning, and internships have important impacts on deep learning and students’ gains in practical competence and personal and social development (Finley & McNair, 2013; Kuh, 2008). In particular, these engaged learning practices incorporate potent characteristics such as a significant investment of time and effort, substantive interactions with faculty and peers, experiences with diversity, real-world applications and opportunities to reflect and integrate learning (Kuh & O’Donnell, 2013). In addition, among several areas demanding attention, it is evident that in order to promote optimal health outcomes for all people efforts must be directed toward addressing the needs of older adults (Institute of Medicine, Board on Health Care Services and Committee on the Future Health Care Workforce for Older Americans [IOM], 2008), primary care services (Bolt et al., 2019; Kuo et al., 2013) and global health (Satcher, 2000).

The special issue

The purpose of this special issue of the Journal of Interprofessional Care is to highlight a holistic and coordinated effort in a School of Health at a Midwest University to promote research and prepare health professions students for interprofessional collaborative practice, cultural humility and an understanding that individuals are embedded in families, communities, and systems that influence their experiences. Herewith, the article by Broughten et al. (2021), defines the framework for approaching this work which seeks to promote health equity by directing efforts toward faculty development, curriculum and co-curriculum, and research and scholarship. Five further articles are included demonstrating the breadth of how this integrated educational approach provides opportunities for faculty, staff and students. These opportunities include novel curricular pathways (Ririe et al., 2021); campus-based opportunities to be exposed to interprofessional education (Winkler et al., 2021); clinic-based interventions (Coss et al., 2021; De Sam Lazaro & Riley, 2021); research (Okstad et al., 2021); and an international course (Barrett et al., 2021). High-impact practices and characteristics are incorporated into each of these activities. For example, global and domestic community-based learning are embedded into the clinic interventions described by Coss et al. (2021) and the course in Zambia depicted by Barrett et al. (2021). Similarly, several of the research activities supported by this initiative are grounded in collaborations with community-based organizations (Okstad & Dahlk, 2021). This orientation allows students to apply their learning in real-world settings and gain the foundational experience necessary to enact system and structural level change as new professionals.

Furthermore, these activities are focused on three identified areas of need: senior living, global health, and primary care; and reflect broad interprofessional collaborations with individuals both within and outside of typical health disciplines. Examples of pediatric and community-based primary care incorporating occupational and physical therapy are provided by De Sam Lazaro and Riley (2021), Coss et al. (2021), Ririe et al. (2021), and Winkler et al. (2021) and focus on the critical need to prepare future practitioners to work with a rapidly growing population of older adults. Student learning relative to collaborative practice, cultural fluency and ecological approaches as they relate to global health is described by Barrett et al. (2021); and Winkler et al. (2021). Finally, the article by Okstad and Dahlk (2021) offers an example of how research and scholarship were expanded in support of improving societal health and wellbeing and included a broad range of community, student and faculty collaborations.

Conclusion

We are in the midst of a centuries old pandemic of racism. Phenotypical traits, ethnicity, country of origin, language, religion, and sexual orientation, gender identity and ability, should not predestine health and well-being. The time is long past due for educational transformation. If we want different results, we need to try a different approach. It is vital for the healthcare workforce to be holistically prepared while developing their team-based skills if we are to achieve a more equitable world.

The Guest Editors and Authors of this special issue would like to specifically thank the GHR Foundation for their support of our initiative.

Acknowledgments

The Guest Editors and Authors of this special issue would like to specifically thank the GHR Foundation for their support of our initiative.