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Providing Care to Diverse Populations
What is Cultural Competence?
Establishing a Link Between Cultural Competency and Racial and Ethnic Health Disparities
Robert Like, M.D., M.S., Associate Professor, Departmenet of Family Medicine, and Director, Center for Healthy Families and Cultural Diversity, University of Medicine and Dentistry, Robert Wood Johnson Medical School, New Brunswick, NJ.
Joseph Betancourt, M.D., M.P.H., Associate Director, Center for Multicultural and Minority Health, Cornell Medical Center, New York, NY.
Though the term "cultural competence" is used frequently in discussions about the desired attributes of health care delivery systems most individuals are likely to have different ideas about what that term actually means and how it can be operationalized. These perspectives also vary depending upon individuals roles within the health care system.
Dr. Robert Like from the Center for Healthy Families of the Robert Wood Johnson Medical School and the University of Medicine and Dentistry of New Jersey used a number of situational examples of cultural competence and cultural incompetence to clarify the concepts of cultural competence, while identifying key policy and operational issues related to providing improved health care.
Dr. Like also described national demographics, organizational models and strategies, and described the rationale for culturally and linguistically competent service provision.
Most policymakers and program administrators seek to foster health care delivery systems that effectively meet the needs of diverse populations because it is important for cultivating an environment in which patients of diverse backgrounds can be understood, diagnosed, and treated appropriately.
Dr. Joseph Betancourt, M.D., M.P.H., the Associate Director for the Center for Multicultural and Minority Health at the Cornell Medical Center, synthesized the data and health services research findings that highlight the relationships between:
- Health status disparities that exist across racial and ethnic populations.
- Differences in health care access and treatment outcomes across population groups.
- The characteristics of health care delivery systems that relate to the cultural competency of these systems and providers.
In doing so, Dr. Betancourt presented information in the context of a framework that "connects the dots" between the role of cultural competence in heath care and eliminating racial and ethnic health disparities. Dr. Betancourt also argued that disparities in health care result from barriers to care for minority populations that exist as a result of two primary factors:
- Social determinants: Factors outside of the control of the health care system (i.e., socioeconomics, racism, violence, education, employment).
- Health care determinants: Factors that can be addressed by the health care system (i.e., access to care, systematic barriers, and medical encounter/communication barriers).
Dr. Betancourt and Dr. Like worked together to synthesize the health disparities research and to share anecdotal evidence to support that overcoming barriers is crucial to the development of a culturally competent system of care. They shared information that indicates that improved communication between doctors and patients improves patient satisfaction and that a positive relationship exists between improved communication, patient satisfaction, and adherence to medical treatments.
Additionally, there are many studies that indicate that improved adherence to medical regimens improves medical outcomes, strengthening the case for the delivery of culturally competent care.
U.S. Department of Health and Human Services. Health Care Rx; Access for All. Health Resources Administration. Washington, DC, 1998.
Racial and Ethnic Disparities in Health. Response to the President's Initiative on Race by the United States Department of Health and Human Services. Washington, DC, Feb. 1998.
Carrillo JE, Green AR, Betancourt JR. Cross-Cultural Primary Care: A Patient Based Approach. Ann Intern Med 1999 May 18;130(10):829-34.
Langer N. Culturally Competent Professionals in Therapeutic Alliances Enhance Patient Compliance. J Health Care Poor Underserved 1998 Jun;10(1):19-26.
Like RC, Steiner RP. Medical Anthropology and the Family Physician. Fam Med 1986 Mar/Apr;335(2):87-92.
Like RC, Steiner RP, and Rubel AJ. Recommended Core Curriculum Guidelines on Culturally Sensitive and Competent Health Care. Fam Med 1996 Apr;28(4):291-7.
Chesnow N. The Versatile Doctor's Guide to Ethnic Diversity. Medical Economics 1998 Sep;135-46.
Cohen E, Goode TD. Policy Brief 1. Rationale for Cultural Competence in Primary Health Care. Washington, DC: National Center for Cultural Competence, Georgetown University, 1999.
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