North Country HealthCare promotes diversity and equity as a way to improve health outcomes in new cultural competency report


Soraya Marashi


North Country HealthCare (NCHC), the primary federally-qualified community health center (FQHC) in northern Arizona, released its 2021 Cultural Competency Report earlier this month, in which it reviewed its efforts to improve cultural competency, diversity, equity and inclusion in 2020, as well as its plans for future endeavors.


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With over 50,000 patients across 12 rural and sparsely populated communities, NCHC asserts that community outreach to provide affordable, accessible, and high-quality primary care is a top priority for the FQHC. 

Published once per year, this report aims to provide employees, patients, and community members with a snapshot of the progress made toward improving accessibility to care, especially for those in rural areas of the state. This year’s report also notes major accomplishments in improving access to care for particularly underserved communities in the state, such as the LGBTQIA and American Indian community.

The report highlights the FQHC’s outreach and community health programs to address social determinants of health and reduce barriers to access to primary care, including enabling services related to care management, health education, transportation, and assistance with obtaining food, shelter, and benefits. In particular, the report notes how the programs have improved in terms of the number of patients who accessed the services compared to the previous year. 

Roxana Contreras Cardiel, equity and inclusion specialist at NCHC, emphasized that these services are also offered to patients experiencing homelessness. 

“We ensure that no patient is ever turned away from their inability to pay, and this is something that’s really important to us.”

Among others, the report highlights services that link patients to needed health services, like marketplace plans and AHCCCS KidsCare, as well as transportation assistance, housing resources, SNAP application assistance, maternal and child health programs, integrated behavioral health, HIV and cancer screenings, and intimate partner violence and sexual assault programs.

Contreras Cardiel discussed NCHC’s language assistance services, which include emergency language interpretation for all enabling services offered by NCHC. She stated how valuable Community Health Workers (CHWs) and promotores were to the services provided by NCHC, allowing for better understanding between community members and the health and social service system, enhanced communication between community members and health providers, and an improved adherence to health recommendations in the areas NCHC serves.

“They definitely are an integral part of North Country and work with patients in a way that providers may not be able to … [they] develop the kinds of relationships that can ensure that we’re addressing [patients’] needs in a culturally competent way.” 

The report also highlights NCHC’s employee engagement efforts surrounding cultural competency. Contreras Cardiel spoke to the value of diversity and inclusion in workforce training.

“[Diversity and inclusion training efforts] contribute to a sense of community and inclusivity … and when that happens, [employees] are more likely to help patients in the same way … and, of course, that helps with employee retention, which then leads to a more stable health care team and contributes to continuity of care. So the more we can focus on valuing diversity in our employees, the more we are able to ensure that employees reflect the communities they serve and the patients that they see. This will help patients identify where they connect with their health care team, and when that connection is made, a relationship can be established, and health outcomes will improve.”

Contreras Cardiel went on to say that actively promoting a diverse workforce was especially important for engaging with rural communities, who often experience the most challenging barriers to care.

“It is going to be that much harder to connect with our community, and so we want to make sure that they see themselves reflected in the employees that are serving them and we can bring those perspectives so we can understand the needs and we can address those needs.”

She said that she ultimately wants the report to serve as a conversation-starter for future policies and initiatives at NCHC.

“We really have a great opportunity at this point to approach health care from a more humbling place, to understand that there’s a lot of work to do in health care, to truly connect with and engage in meaningful ways with our employees and our patients and all our community stakeholders so that it can be much more effective. It often means being able to get into conversations around all these things — cultural competency, diversity, equity and inclusion — and when you’re able to [come] from a space of wanting to learn more and understand more about the people we are interacting with, especially in health care, then it leads to improved health outcomes.

[With] everything that is happening around us, certainly the pandemic and the kind of social issues that we’re … facing as a country, and certainly as a state …. we have a great opportunity to come to the table, and encourage others to come to the table and look at these [issues] in a very meaningful way.”