Criss Smith met a nurse who was also a Black queer man during his experience transitioning. Talking to him felt like talking to an older brother, Smith said. “I could speak freely. There is a certain freedom there that you don’t get every day,” he said. “I cannot imagine even starting that conversation with someone outside of that shared experience.” Smith’s experience at Callen-Lorde, a community health organization for New Yorkers who identify as lesbian, gay, bisexual, transgender, queer or nonbinary based in Chelsea, is an instance of culturally competent health care, a concept that centers on the idea that providers who look like patients, hail from their communities, speak their language, or even are aware of their speci c cultural values, beliefs and behaviors, can facilitate better health outcomes. It can be as simple as a doctor speaking the same Spanish dialect as their patient, or a community member who has a chronic health condition teaching their neighbor how to manage their own condition.

To avoid necessary care altogether. Providers have had to get creative to ensure they can meet rising demand from an increasingly diverse patient population. When Smith rst walked into Callen-Lorde, he was greeted by stickers inviting him to write out his pronouns, a signal to him that the staff cared about addressing him correctly. Smith had also experienced “white coat syndrome,” in the past, a term used to describe the fear some patients feel around doctors who might not understand them. The doctors at Callen-Lorde, who are well aware of the source of anxiety, wear plain clothes to put their patients at ease. The sense of comfort gave Smith the condence to ask questions about the surgeries he was eligible for that he says he wouldn’t have had with other providers. He learned that he was eligible for top surgery, a procedure he wondered if he was too old for. Physicians at Callen-Lorde guided Smith through the mental health aspects of his transition and made appointments for his surgeries. Since transitioning, the Jamaicabased New Yorker said the successful physical changes have helped him move through the world authentically.

“I’ve heard some stories about people having issues with being trans but thank goodness for me personally, I have not experienced that,” he said. “I have a wonderful life.” Increasing access Smith’s experience is one many of the city’s health care institutions are trying to replicate through a mix of hiring the right providers, training them in how to be sensitive and raising patients’ awareness of their services. There are plenty of stories like Smith’s where patients feel seen because they reach a physician or nurse who shares their background patient counts and potential city agency budget cuts are putting pressure on organizations providing the care that is vital to underserved New Yorkers. Certain patient groups lack ready access to care: According to a McKinsey analysis, half of non-white survey respondents in the city reported challenges reaching counseling for mental health issues or substance use disorders. Many New Yorkers–about 400,000, according to elected o cials–have also recently lost access to public health insurance programs since the state began reassessing residents’ eligibility for Medicaid last spring, putting their ability to access care in jeopardy. According to Elisabeth Benjamin, the vice president of health initiatives at the Community Service Society, swaths of people are now searching for programs, such as one her organization runs, where providers speak their languages and connect them with insurance. There’s an awareness component, too: Patients’ understanding of his organization is not where it could be, said Dr. David Collymore, the chief medical o cer and senior vice president of clinical affairs at the Acacia Network, a group of nonpro ts. The key to bridging that awareness and access gap is more caregivers who look like and have similar experiences to their patients. More than 70% of Acacia’s clients receiving behavioral health, substance use and primary care are Black and Hispanic. The network prefers to hire providers of color who speak different dialects of Spanish to communicate with large Colombian and Puerto Rican patient populations. Acacia is also seeing its West African patient population grow in the Bronx, Collymore said, and must hire accordingly. This ensures that no nuanced medical information slips through the cracks of translation once patients are connected with care. Acacia also goes to “trusted community-based entities” like churches, large housing complexes and senior centers to connect with patients. “It’s important to make sure that we get out of our four walls and go to where people are congregating and gathering in a comfortable setting. And then bring the message to them,” Collymore said. “They may be more and more apt to take that step to trust you or to at least initiate the rst appointment.”

The 25,000, largely Hispanic immigrant patients who go to Somos providers daily are only able to read at elementary school levels, she said. Therefore, when they enter a Somos o ce, staff take them aside to explain their medical rights, such as informed consent, verbally. In exam rooms, providers speak to each patient’s culture, recommending a Dominican patient avoid plantains to lower their carbohydrate intake, she said, while a physician working with a Mexican patient could advise against too many tortillas. Since mental illness is still stigmatized in many Hispanic households, Peña, who is Dominican American herself, asks patients how they’re feeling at every initial appointment and lets them know her o ce is a safe space to express any challenges. The network has doubled down on proactively reaching out to patients within their communities through means such as health care fairs, where people are screened for signs of depression. About 2,000 New Yorkers have been able to get care through the fairs at times of crisis, Peña said. Going forward, her goal is to create and grow preventive programs around nutrition and exercise. Additional trained staff members are also necessary to meet the rise in demand. For Patrick McGovern, chief executive at Callen-Lorde, hiring solutions sometimes come from within the population the clinics serve. About 40% of the nonpro t’s patient population identi es as Black and Hispanic. Callen-Lorde has found success hiring patients who have rst-hand experience with the organization to serve as frontline workers at its locations, he said. But sta ng shortages require a multi-pronged approach. “[It’s] de nitely part of the solution. I would say it’s necessary, but not su cient,” he said. “We still have to reach out to the medical schools and residency programs that we know are trying to build LGBTQ competence.” To that end, the nonpro t has started a residency program in partnership with NYU Langone Health, and a Keith Haring Nurse Practitioner Postgraduate Fellowship, to increase the number of physicians in the workforce who understand how to sensitively treat LGBTQ+ individuals. The residency program is one of the rst of its kind, McGovern.

Proposed budget cuts spark uncertainty Providers are worried that proposed city agency budget cuts and potential City Council funding declines could threaten their culturally competent care programs; both the city Department of Health and Mental Hygiene and New York City Health + Hospitals had to trim their budgets by 5% in November and could be subject to additional slashes. According to the city O ce of Management and Budget’s latest numbers, proposed cuts would shave $5 million off the DOHMH’s roughly $2 billion budget in contract reductions for scal 2025. Patrick Gallahue, a representative for the department, declined to comment on whether community organizations should expect contract cuts, but said the health department is committed to upholding culturally competent care such as community clinics for New Yorkers in the languages they need. H+H’s budget for scal 2025 is roughly $3 billion. Its budget for NYC Care, which provides primary, specialty and mental health care to 121,000 New Yorkers who can’t afford or who are not eligible for insurance, is estimated to be $100 million. More than one million total patients get care through H+H each year; more than 70% identify as Black, Hispanic or Asian American and more than 70% rely on Medicaid or have no insurance. Ivelesse Mendez-Justiniano, New York City Health + Hospitals’ vice president of diversity, equity and inclusion who oversees workforce development, said the public health system has worked around budget cuts in the past and will do the same if proposed cuts come to fruition. H+H has moved some of its cultural competence education to virtual settings to save resources in the past, she said. The system has also employed a network of community health workers to address patients’ pressing social needs, a program that reached more than 5,000 vulnerable New Yorkers in its rst year through about 250 employees. “We’ve already built all these programs into our fabric and we prioritize them,” she said. “[Uncertainty] doesn’t really impact the level of cultural sensitivity that we provide.”