By David Midyette, Outreach and Communications Coordinator, NN/LM, SE/A Region
The old analogy of the United States as a melting pot is being transitioned into a more modern understanding of the U.S. as more of a salad. The various ethnic and cultural backgrounds of people in the country, legal, illegal, or otherwise, present the health care community with a plethora of beliefs about health and healing. Frequently these beliefs come into direct contact/conflict with the Western style of medicine that is the predominant practice in the U.S. healthcare system. State medical and allied health licensing boards are increasingly faced with the challenges of ensuring that new practitioners are culturally competent as they begin to practice their craft, and that experienced practitioners develop skills to deal with sometimes drastically different belief systems held by their patients.
The Office of Minority Health defines cultural competency as:
“Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations ‘Culture’ refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. ‘Competence’ implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.” (Office of Minority Health, 2005)
People from all over the world and from widely varying cultures enter the U.S. medical system and can be faced with a bewildering barrage of unfamiliar terms, concepts, and practices. Providing consumer health information in their native language certainly helps, but it is crucial for positive outcomes for practitioners to understand and work with patients by working to bridge understandings and perceptions.
Susan Landers (2009) wrote an article for American Medical News (AMA) on the status of cultural competency requirements among various states. She indicated that there was a great deal of resistance in many states, and that there was an uneven treatment. In July of 2012, a joint panel of Association of American Medical Colleges (AAMC) and Association of Schools of Public Health (ASPH) experts convened to tackle the issue of cultural competency among physicians and public health workers. (Association of American Medical Colleges, 2012) The report from their meeting outlines the basic areas of cultural competency education that medical schools and schools of public health should cover in developing and integrating this topic into their curricula. The report can be accessed here, and includes multiple case studies that clearly delineate the need for increased cultural awareness in the medical and public health communities. There are also links to additional reports in the MedEdPORTAL® system (http://www.mededportal.org), detailed core competencies, and a roadmap for the future of cultural competency education in the health sciences.
Many authors have begun to tackle the frequent clash between Western and Indigenous medical understandings and practices in the popular press. Anne Fadiman (1997) wrote a compelling book about the interaction, disconnection, and eventual consequences of a Hmong family’s journey through the treatment process in Western medicine. Geri Galanti (2008) also wrote a volume of case studies for the nursing field, which again provides often poignant revelations about the interaction between Indigenous and Western medical beliefs and practices. Authors in the medical field have begun addressing cultural competency in the classroom with textbooks from a wide range of disciplines. (Edberg, 2013; Samovar, Porter, & McDaniel, 2012; Sobo & Loustaunau, 2010)
There is no shortage of voices in the debate and there are certainly no absolutes. However, the medical and public health field, along with other health science disciplines, are tackling this issue with gusto and there is a growing body of literature and research to support the necessity of integrating cultural competency into both the educational process and the clinical process. If you would like further information, please contact David at firstname.lastname@example.org.
Association of American Medical Colleges. (2012). New Report Offers Recommendations for Educating More Culturally Competent Physicians and Public Health Practitioners Retrieved Feburary 5, 2013, from https://www.aamc.org/newsroom/newsreleases/299110/120720.html
Edberg, M. C. (2013). Essentials of health, culture, and diversity : understanding people, reducing disparities. Burlington, MA: Jones & Bartlett Learning.
Fadiman, A. (1997). The spirit catches you and you fall down : a Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus, and Giroux.
Galanti, G.-A. (2008). Caring for patients from different cultures. Philadelphia: University of Pennsylvania Press.
Landers, S. J. (2009). Mandating cultural competency: Should physicians be required to take courses? American Medical News. Retrieved from amednews.com website: http://www.ama-assn.org/amednews/2009/10/19/prsa1019.htm
Office of Minority Health. (2005). What is Cultural Competency? Retrieved February 5, 2013, from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=11
Samovar, L. A., Porter, R. E., & McDaniel, E. R. (2012). Intercultural communication : a reader. Boston, Mass.: Wadsworth Cengage Learning.
Sobo, E. J., & Loustaunau, M. O. (2010). The cultural context of health, illness, and medicine. Santa Barbara, Calif.: Praeger.