I am Elizabeth Williams, assistant professor in the Department of Public Health, Health Administration and Health Sciences at Tennessee State University. As a scholar/practitioner of color who teaches emerging public health leaders and works as a health equity researcher, I think a lot about cultural competence and what it means in research and practice. In particular I have been thinking about what it means to be “culturally competent” and whether it is enough to promote health equity.
Lesson Learned: A Note on Competence
The word “competence” suggests the mastery or acquisition of skills and ability to demonstrate what one knows. With diverse populations there are skills researchers can acquire. Competence in qualitative and quantitative methods, like conducting focus groups, surveying, & statistical analysis all lend fairly easily to measurement and evaluation. With these skills, scholars can assess health-related beliefs, behaviors and outcomes in diverse contexts. Yet, acquiring skills to document cultural difference does not guarantee that one will respect, value or appreciate the people or cultural contexts one works in. Being proficient and skilled can make one competent, but not automatically culturally competent.
Cultural Competence: Is it Enough?
Some argue that cultural competence requires more. It requires critical consciousness and cultural humility. Critical consciousness necessitates honesty about power differences between us as professionals, the institutions we represent and our interactions with the people and communities we work. It calls for interrogating how race, class, gender and history intersect making it possible for some groups’ health to be scrutinized (i.e., non-White, poor, LGBTQ, etc.), while others are normalized (i.e., white, heterosexual, etc.). Paired with consciousness, cultural humility is about our self critique as professionals. Cultural humility challenges that we recognize ourselves as cultural beings, whose beliefs are shaped by places and experiences. Acknowledging that culture shapes professional epistemologies in helpful and detrimental ways to practice (and changing what does not work) becomes the basis for understanding how others’ life-ways are also shaped by culture.
This orientation makes it possible for us to realize that while our training equips us with professional skills this does not mean we know everything. Cultural humility should move us from being “experts” to lifelong learners. Those we interact with have as much to teach (perhaps even more) then what we can offer through our service. When cultural humility is our practice then achieving health equity becomes a collaborative exchange with others. That’s when cultural competence really happens.
Rad Resources: Check out Tervalon and Murray-Garcia’s article Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education in the Journal of Health Care for the Poor and Underserved (1998)
Kumagai and Lypson’s article Beyond Cultural Competence: Critical Consciousness, Social Justice and Multicultural Education (2009)
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This is a document from Canada that I see fitting for this entry.
Great topic in terms of seeing who else is talking about cultural competency.
http://www.stmichaelshospital.com/crich/reports/first-peoples-second-class-treatment-report/
Love this! Love this! Love this! I have an MA in Intercultural Communication and have been talking with others for years about the inadequacy of cultural “competence.” I latched onto a model that came out of Southern California that talked about a stage beyond competence–cultural “proficiency.” Although it did expand on the notion that there’s something better than just being satisfied with competence, it really didn’t go far enough. And it certainly wasn’t a more inspiring or genuinely useful concept, although it was better. A couple of years ago, our county passed a “Compassionate Communities” resolution and this is really moving us in the direction of cultural humility. I am so thankful for your post in focusing on just how compelling and paradigm-shifting this is. Another great resource focusing on this work is the Cultural Humility Task Force at Zuckerberg San Francisco General Hospital and Trauma Center. They have develop a number of posters that focus on cultural humility. I’d love to adapt some of these for our lobby, since visuals are so powerful. Here’s a web reference: http://psych.ucsf.edu/sfgh/chtf/
When someone, anyone is Racist,
Look them in the eye and say to that person.
“You are better than that”
And truely mean it.
People are aware of right and wrong.
So don’t try to put out a fire with fire.
Just let them know that you believe in them regardless
Of their comment. Because deep down inside that comment is coming
From a place that wants to belong and feel connected to someone.
Throughout history our species has made other feel sub human to feel superior about it self. We have done shocking things to each other that need never be repeated.
Because by knowing we can be “better than That” we can change how we see each other and love each for the kindred spirits we all are.
“We are Better than this”
We need to start believing it.
Thanks.