Patient Advocate Certification Board Statement and Call to Action
June 4, 2020
Since early 2020, our nation has joined much of the rest of the world in the fight against significant health crisis. COVID-19 is a pandemic that has so far claimed the lives of more than 107,000 people in the U.S. alone. But our country is facing another major public health crisis that has been happening in our nation since its founding—the systemic racism that unfairly disenfranchises so many black and brown persons in our society. These two health crises are related. A recent study from Yale University reported that black Americans die from COVID-19 at 3.5 times the rate of whites, while Latinos die at twice the rate of white Americans. The reasons for these differences are many and complicated, and are rooted in the inequities that are part of the social determinants of health.
In the past several days, America has been overwhelmed with heart-wrenching images of the egregious killing of George Floyd and the killing of Breonna Taylor over mistaken identity in Louisville, Kentucky. We have seen images of Ahmaud Arbery being shot while out on a run in his neighborhood, and Christian Cooper being reported to 911 for watching birds in Central Park and asking a white woman to follow the rules and put her dog back on the leash. These are but a few of the many incidents of racial injustice that have occurred in just the past month. Yet these incidents are nothing new. Trayvon Martin, Rodney King, Eric Garner, Freddie Gray, Stephon Martin, the Tulsa race riots and all the way back to Emmett Till and before. Our black and brown brothers and sisters are hurting. They deserve better.
As patient advocates, we hold as part of our core ethical principles,
- The belief that equal access to appropriate healthcare and treatment is the right of each individual. Advocates strive for clients’ equal access to health services without regard to age, race, religious/spiritual practice, culture, ethnicity, sexual orientation or gender identity, and immigration status.
- Advocates are committed to assisting clients of all cultural and ethnic backgrounds. They shall be mindful of the cultural context of medicine and each client’s cultural contexts by respecting individual perspectives. When unfamiliar with a client’s ethnic or cultural background, advocates will work to understand preferences, and to include that regard into the provision of the client’s healthcare. (PACB Code of Ethics)
PACB stands in support of those who are marginalized, disenfranchised, or feel they are unheard, unseen, or dismissed. We believe that all people deserve to receive the best care, to be listened to, to be understood, and to be valued. May we all be willing to listen, open-minded enough to learn, compassionate enough to care unconditionally. Those who struggle most are often the ones who need advocates. Will you be there for them? I will. Because this demands all of us!
Christine L. North, PhD, MPH, BCPA
President, Patient Advocate Certification Board
This ‘Call to Action’ as a student starting to become a patient advocate means a lot because it shows that our job of being an advocate is never fully done. Our society will continue to need advocates as we work towards having an equal society. This call also shows that our job as a patient advocate is not limited to a healthcare setting but to every aspect of life instead. One actionable step that may be necessary to leverage the ‘Call to Action’ would be to have mandatory volunteerism work such as volunteering at a local soup kitchen, providing pro bono services and working at the local youth center. This would be a reminder that our job is to help those who need it, even of it outside of healthcare. The ‘Call to Action’ informs the role of the patient advocate that their job is to fight against systemic racism, to educate themselves on cultures and beliefs different to their own, and to provide the highest quality services to those of any gender, race, sexual orientation or ethnicity. I will apply this call to my work as a patient advocate through educating myself on different cultures, beliefs and ideas that are different to my own, by listening to everything my client has to say and by realizing and acknowledging my own ignorance and privilege.
As a student that has an interest in being a patient advocate, the ‘Call to Action’ stands as a reminder for me as to why being an advocate is intriguing. The ‘Call to Action’ embodies one of my core beliefs when it comes to healthcare, and that is the fact that everyone, regardless of what makes classifies them to be “different” from me or you, deserves to have equal access or opportunity to receive adequate care and treatment. One measure that can be taken to leverage the ‘Call to Action’ is to emphasize the value and importance of being a patient advocate. This emphasis on importance and value can be used to specifically help end the systemic racism in healthcare systems by stressing the importance of having a culturally and racially diverse network of advocates. By simply advocating for more opportunities for people of minority groups to become educated on becoming advocates or providers, our not-so-diverse healthcare system would become more diverse, and ideally, more equal. The ‘Call to Action’ shows that the role of a patient advocate is much more than simply ensuring that people get treated fairly and receive adequate treatment in hospitals, or from government agencies and non-profit organizations. This ‘Call to Action’ shows how advocacy is needed in all places where people can be mistreated, and one way that people are being mistreated is through the systemic racism that is plaguing our society today. It shows that, as an advocate, we can truly make a difference in the world we live in, so long as that we fulfill our promise to advocate for the equal and adequate care of everyone regardless of their race, religion, gender, or sexuality. I will use this ‘Call to Action’ in my work as a patient advocate to be more open and understanding of cultures outside of my own in an attempt to be as good an advocate as I can be for those in need.
Thank you Chris. Well said.
Christine, I echo the sentiment about the need for and inspirational tone of your message for our organization and our discipline. Thank you. While I know that it is not the PacBoard’s role to create or manage core continuing education offerings, I would also offer that perhaps this is a time for the PACBoard to search for and provide a list of continuing education options that would either be an option for applying for our CE credits or would simply expand an advocate’s knowledge and understanding of the health inequities that you address in your post. This seems an important part of our individually increasing our awareness of the privilege that Ruth speaks of in her post, and serve to truly advance our professionalism in a meaningful way.
Thank you for the suggestion. I did want to let everyone know there is a pre-approved program that may be of interest. It is entitled ‘Culturally Competent Nursing Care: A Cornerstone of Caring’ from the HHS Office of Minority Health. It is approved for 7 General CEs and 2 Ethics CEs for Board Certified Patient Advocates. Here is the link: https://ccnm.thinkculturalhealth.hhs.gov/
Core ethical principles sound great on paper, as does belief in equal access to appropriate healthcare and treatment; a commitment to assisting clients of all cultural and ethnic backgrounds; supporting those who are marginalized and/or disenfranchised; and a willingness to listen, learn, and care unconditionally. But at a time of crisis,such as we now face at ervery level of society, talk, beliefs, feelings, and principles are cheap. Actions are what count.
How many questions on the PACB certification exam address health disparities among individuals and within communities of color? Are health advocates–to be sure, a disproportionately white, female, heterosexual, and middle-aged group of practitioners–tested on their knowledge of black maternal health outcomes or transgenerational trauma? Do health advocates know how to utilize community and public health research and resources to best serve their low-income clients? (Do they even know that the acronym APHA was purloined from the esteemed American Public Health Association, founded in 1872?) Does the PACB hold a core ethical principle that emphasizes providing pro bono service to marginalized and/or disenfranchised people of color who would otherwise fall through the gaping holes in the healthcare safety net?
“It is not your responsibility to finish the work of perfecting the world, but you are not free to desist from it either.”
Rabbi Tarfon, Pirke Avot 2:21
Thank you,
Ruth
Thank you very much Dr. Linden for your thoughtful comment; we welcome your engagement and advocacy.
While many have been working tirelessly to create greater awareness of the existence of patient advocates, as well as greater access to such services, uniting the ranks is not so easy; those serving in such roles come from a broad variety of backgrounds and there are still active debates as to the appropriate designation: patient advocate, health navigator, healthcare advocate, etc. The primary mission of the PACB was to create a certifying exam that would set a minimum standard for what a professional patient advocate should know. The exam content follows the domains, standards and guidelines originally set forth and as such there are questions related to different religions, belief systems, gender, cultural competency, access to care, etc. Content is continually reviewed and revised as the need arises. Establishing patient advocacy as a recognized profession is still a work in progress, and one of the things the board is working on is conducting a comprehensive role and function study. We sincerely hope you will help in that effort and complete the survey as those results will help to inform the direction of the board and refine the content of the exam going forward.
PACB does not choose who becomes certified or who practices in the field of patient advocacy. People who become certified choose us. We welcome anyone interested and qualified in the field of patient advocacy, regardless of race, gender, age, creed, or any other difference or ability, to become a Board Certified Patient Advocate to advance our field.
Most would agree that anyone who chooses this profession does so out of a deep desire to help patients. Many of the independent advocates we are aware of provide pro bono or reduced fee services to disenfranchised clients, and while we wholeheartedly encourage and support such efforts, it is not something the PACB will mandate. We are well aware that we may all be in the same storm, but sit in dramatically different boats. The PACB will continue to advocate for a rising tide that will lift all vessels equally and we hope you will continue to stay engaged and contribute your expertise toward advancing our profession.
Well said….Now Christine…if only we could get you to run for President of the US
Thank you Christine for always being an inspiring voice for our organization!
This statement is consistent with my personal belief and encourages me to promote my association with the organization. Thank you, I wasnt expecting such inspiration.
Thank you for going on record as the voice of each person who has studied and worked to hold the honor of being a board certified patient advocate! I highly value my certification and this call to action has made advocacy all the sweeter!
Thank you for posting. Will repost to our website.
Elizabeth Pruett
Care Weavers
Charlotte, NC
I will continue to support all who need advocacy and value them as fellow brothers and sisters as described in our Code of Ethics. May we all find common ground and love for one another.
I support this PACB Statement and Call to Action. Five qualities in a lawyer are the same for Patient Advocates: Compassion, Listening, Assertiveness, Creativity and Perseverance. In Health Care there is a need for Patient Advocates to champion access and delivery. Patient Advocates work toward a favorable outcome for patients of all cultural and ethnic backgrounds. Covid-19 has served to highlight another vulnerable population that we all will become members of one day. Ageism is not new. Covid-19 related resources allocated by age became an ethical debate or was covertly implemented. Too many folks passed away alone. Families are helpless to check on those in Nursing Homes. The “Greatest Generation” is disappearing. Seniors, Elders, Baby Boomers are being subject to derision and more not less, Ageism in health care. Over and under treatments are risks with an older demographic. By 2030 one in five Americans will be over 65. Patient Advocates make a difference. We will need more to assure equality in health care.