Other factors than culture and ethnicity also impact clients. Socioeconomic status has an important influence on our lives and ability to effect change. Generally, those with lower socioeconomic status are less likely to participate in the political process and advocate for equality in educational, employment, and community environments. This self-defeating process results in poorer physical and mental health and fewer chances to advance in society. Clients have to gain strength from our interventions to strive for what they are entitled to receive and have a voice that is heard. Clients who enter a helping relationship feeling traumatized and vulnerable need to connect to their treatment provider and develop trust and attachment to feel empowered to make changes in their situation. Some of the basic elements for developing trust are for the clinician to provide emotional availability, to be attuned and responsive to the client's emotional state, and to provide the client with predictability and consistency. Interventions, suggestions, and options provided need to be reliable and shared in an accepting environment for the client to benefit.

Novello (2004) reported on health disparities and inequality in health care for minorities, citing, among numerous other statistics, the following: (1) the cancer mortality rate was 35% higher for African Americans than whites; (2) African American men had a 60% higher incidence of prostate cancer than white men; and (3) Hispanic women had a 2% times higher rate of cervical cancer than white women. She reported on a strong correlation between poverty and health status because of the lack of education on healthy foods, lifestyle choices, and access to health care. Iribarren and colleagues (2005) reported on great differences in death rates by sex and race because of AIDS, homicide, intentional injury, suicide, cancer, and coronary disease. These reports lend themselves to consideration of changes in social policy and preventive medicine, as well as health care access. Healthy lifestyles and education can be promoted to reduce health inequities, but when there is miscommunication between medical personnel, it may result in delays in treatment or insufficient information on how to take medication, leading to poor health outcomes (Snell, Allen, & Marsh, 2006). Health care is another area that requires understanding of cross-cultural alliances and cultural sensitivity for improved outcomes. The creation of a genuine bond between the helper and the client can be established through improving linguistic understanding, forming mutual expectations, and challenging assumptions while engaging in a helping relationship.

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