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Abstract
In this article, I propose and define the new concept of cultural health capital, based on cultural capital theories, to help account for how patient-provider interactions unfold in ways that may generate disparities in health care. I define cultural health capital as the repertoire of cultural skills, verbal and nonverbal competencies, attitudes and behaviors, and interactional styles, cultivated by patients and clinicians alike, that, when deployed, may result in more optimal health care relationships. I consider cultural health capital alongside existing frameworks for understanding clinical interactions, and I argue that the concept of cultural health capital offers theoretical traction to help account for several dynamics of unequal treatment. These dynamics include the often nonpurposeful, habitual nature of culturally-mediated interactional styles; their growing importance amidst sociocultural changes in U.S. health care; their direct and indirect effects as instrumental as well as symbolic forms of capital; and their ability to account for the systematic yet variable relationship between social status and health care interactions.
Keywords
cultural health capital, patient-provider interaction, cultural capital, health care disparities
The U.S. system of health care continues to be plagued by social inequities in perceived quality, patient satisfaction, and service provision (Smedley, Stith, and Nelson 2003). This remains so despite the efforts of many well-intentioned health providers and administrators and despite significant investments of resources. The weight of this evidence has motivated a multitude of efforts to elucidate the social origins of unequal care. These efforts have largely focused on phenomena at either the micro-level of the patient-provider relationship, or at the macro-structural level. These distinctive foci recapitulate two long-standing sociological questions. First, how are macro-level phenomena manifested and actualized in lived experience and the day-to-day unfolding of social life? And second, how do micro-level interactions accrete and constitute larger-scale social processes and structures? in this article, i propose and describe a new concept-cultural health capital (CHC)-as a theoretically coherent framework for understanding how broad social inequalities operate in patient-provider interactions, and shape the content and tone of health care encounters.
The concept of CHC argues that certain socially-transmitted and differentially distributed skills and resources are critical to the ability to effectively engage and communicate with clinical providers. It is substantially rooted in Bourdieu's ([1980] 1990, [1983] 1986) notion of...