Answer:

The institute fo medicine (IOM) in its landmark report unequal treatment: Confronting racial and ethnic disparities in health care identified two causes of health care disparities: Health care systmes and discrimination at the patient/provider level defined as biases, prejudiices, streotyping and uncertanity in clinical communication and decision making.

Cameron Jones theoretical framework is used to  define racism and disparities in health care. According to Jones, there are 3 levels of racism

• Institutionalized racism
• Personally-mediated racisim
• Internalized racism

Institutionalised racism: defined as dofferential access to goods, services and opportunities by race, includes differential access to health insurance, which is described as a major contributing factors to communication disparities between African-American and their physicians

Personalized racism: is defined as prejudice(differential assumptions about the abilities, motives,and intentions of others according to thier race) and discrimination (differential actions towards others according to their race). Prejudice and discrimination may manifest as disrespect,poor service and failure to communicate effectively

Internalized racism: as the acceptance by members of stigmatized races of negative messages about their abilities and intrinsic worth. Internalized racism can have many  manifestations, including helplessness, self-devaluation and limiting one's right to self-determination and self-expression

2.Health promotion and Disease prevention and culture

Culturally congruent care is sometimes different from values and meanings of professional health care system. Discovering patient's values, meanings, beliefs,of individuals and communities. Effective health care needs to integrate the cultural values and beliefs of individuals, and communities

Cultural competence is the process of acquiring specific knowledge , skills and attitudes to ensure delivery of culturally congruent care.This process have 5 inter-locking components

1.cultural awareness; An in-depth self examination of one's own background, recognising biases, prejudices, and assumptions about other people

2.Cultural knowledge: Obtaining sufficient comparitive knowledge of diverse groups including their indigenous values, their health beliefs , care practices , world view and biocultural ecology

3.Cuktural skills: being able to assess social,cultural,and biophysical factors influencing treatment and care of patinets

4.Cultural encounter: engaging in cross-cultural interactions that provide knowledge about other culture and opportunities for effective intercultural communication development

5.Cultural desire: the motivation and commitment to caring that moves an individual to learn from others , accept the role as leaner, be open and accepting of cultural differences and build on cultural similarities

Specific knowledge skills and attitudes are required in the delivery of culturally congruent care to individuals and communities.Health care workers who provide culturally competant care bridge cultural gaps to provide meaningful and supporive care for patients.