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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