By: Anita Mwalui, PhD, MPH, CWP

According to the Kaiser Family Foundation 2019 survey, disparities in race and ethnicity in healthcare and wellness remains a persistent challenge in the United States. Discrepancies in health status and access due to race and ethnicity not only results in inequalities, but also contributes to unnecessary health care costs due to over utilization of hospital emergency rooms as a primary source of care.

Primary care is a critical entrance to mental health treatment for ethnic and diverse communities. Minorities populations are more likely to seek help in primary care, as opposed to specialty care, from which inequalities and poor care may surface.

Circumstantial challenges, such as socioeconomic, environmental factors, food insecurities, access to healthcare, transportation, education, supportive services, and family structure are among the social determinants affecting community health.

Figure 1

Social Determinants of Health

(NHS Health Scotland, 2020)

The challenges, indifferences, and inequalities are seen across disease diagnoses, as well. Take mental health, as an example: racial and ethnic minorities have less access to mental health services than do White people. They are less likely to receive needed care. When they receive care, it is more likely to be poor in quality, according to Department of Health and Human Services. As an educator and advocate for cultural considerations for mental health education, it is important to understand how to effectively engage race and ethnicity in mental health dialogues.

Although the public health approach addresses the biological, psychological, and social factors as they relate to mental health interventions, it is important to incorporate aspects of multicultural competency to include individual, family, community, culture, and the larger society. The National Wellness Institute’s Multicultural Wellness Wheel is important to the changing demographic of United States, because by the year 2045, the United States will be a nation with a non-white majority population. As changes occur, public health, health and wellness programs, educators, clinicians, and other front-line workers will have to strategize an all-inclusive approach of awareness to embrace differences in race and ethnicity.

Figure 2

Multicultural Wellness Wheel

(National Wellness Institute)

Figure 3

Multicultural Variables

(National Wellness Institute)


Although various studies have demonstrated that interventions can successfully reduce the severity of certain mental illnesses and disorders and improve mental health outcomes, there are still grey areas in interventions, due to lack of understanding and acceptance that mental health can affect anyone at any time, and that no one is exempted. The inequalities and poor outcomes for minorities and ethnic and culturally diverse populations remain a challenge to be advocated for and addressed.

The lack of cultural awareness and sensitivity on how populations or communities perceive mental health poses additional challenges on appropriate educational materials. On a larger scale, the undeniable stigmatization on mental health, illnesses, and disorders is a limitation that includes a shortage of providers that are adequately equipped to attend to a culturally diverse population.


In addressing how health and wellness varies according to race and ethnicity, significant recommendations would be to address the subject matter from a unique perspective with circumstantial acknowledgement. In order to have effective outcomes, educators need to understand relatable circumstantial variables to multicultural competence that include the risk factors common to mental health, like family, individual, community, and social resilience. Because race, ethnicity, and culture shape people’s beliefs and behaviors, educators need to use instructional strategies that bring out more awareness to differences in race and ethnicity and prompt feedback. The overall utilization of multicultural competence and its impact on beliefs and attitudes is key to determine what kind of interventions are best fit for specific audiences.


Children’s Mental Health Matters. (2009). Cultural Competence. Mental Health Association of Maryland.

Healthy Fife. (2020). Health Inequalities.

NHS Health Scotland. (2020). Social Determinants of Health. The Right to Health.

U.S. Department of Health and Human Services. (2001). Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health: A Report of the Surgeon General. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.

Anita MwaluiAnita Mwalui PhD, MPH, CWP, is the Founder and CEO of Community Engagement & Consultation Group, as well as a member and Co-Chair of NWI’s Multicultural Competency Committee,
Public Education and Program Committee Member for the Mental Health Association of Maryland and Advisory Board Member-Division of Health Services for The Chicago School of Professional Psychology & Public Health.