Cultural Competence and Public Health

1. Cultural Competence and Public Health Denise Herd, PhD School of Public Health University of California Berkeley

2. Culturally Competent Agencies • View minority groups as distinct and as having numerous subgroups. • Hire unbiased employees. • Consult with minority community. • Actively decide what they are capable of proving to minority clients. • Seek out minority staff who are able to negotiate a bicultural world. • Provide support for staff working in cross-cultural situations. • Understand the interplay between policy and practice. • Support policies that enhance services to diverse clients. Cross TL, et al. 1989

3. Culturally Proficient Agencies • Add to knowledge base of culturally competent practice through • conducting research • developing new therapeutic approaches based on culture • publishing and disseminating results. • Hire staff who are specialists in culturally competent practice. • Advocate for cultural competence throughout the system and society. Cross TL, et al. 1989

4. Three basic approaches to cultural competency in public health • Clinical settings • Community based intervention/prevention • Research

5. Clinical settings • Major Goal • To provide optimal service to patients from different cultural backgrounds. • Basic Needs • Language proficiency. • Understand patient explanatory models. • Develop culturally appropriate therapeutic modalities. • Bridge gap between western and non-western medical practices and practitioners.

6. Community based prevention-intervention • Major Goal • Develop culturally appropriate and effective community based intervention programs. • Basic needs • Language proficiency. • Knowledge of history and socio-cultural profile of group. • Understand impact of social determinants on disease (cultural behavior, social inequality, social policies). • Understand social pathways to prevention (e.g. social and political empowerment, economic development, cultural and community strengths). • Knowledge of social organization of community. • Use of culturally appropriate communication strategies. • Understand importance of using participatory approaches to work effectively with communities.

7. Research • Major Goal • Address major research gap on health of multicultural population groups through developing culturally appropriate and valid research instruments, effective data collection methods and appropriate analysis strategies. • Basic needs • Develop cross culturally and linguistically valid research instruments. • Expertise in ethnic minority sampling design issues. • Gaining trust and respect of community members to increase participation in research process. • Skills in using community based participatory research.

8. Common core elements • A. Acknowledging the importance of cultural beliefs and practices (our own and others) in affecting health practices (preventive and treatment approaches), health beliefs and health status. • B. Basic understanding of terms like race, ethnicity and culture. • C. Understanding the concept of acculturation and how it is applied in public health. • D. Awareness of the widespread prevalence of health disparities, causal models to explain them and strategies for culturally appropriate intervention. • E. Understanding the impact of social determinants (e.g. culture, race, ethnicity, socio-economic status, discrimination, social policy, etc.) on health behavior and outcomes.

9. Common core elements (cont) • F. Training on multicultural ethics issues – e.g. Tuskegee experience and role of CDC, sterilization abuse, peer review process. • G. Understanding basic background on the social history and health status of major American ethnic groups. • H. Understanding how to access library and related resources on ethnic minority health. • I. Exposure to legal requirements for language and cultural proficiency standards in healthcare settings. • J. Understanding importance of and strategies for incorporating multicultural (emic) perspectives into the analysis of public health problems and strategies for their prevention and intervention. • K. Basic training on interpersonal and group level interaction processes that embody cultural sensitivity and respect.

10. Format Options • Integration of content for basic cultural competency training across core courses in public health. • Teach basic cultural competency concepts as part of existing required breadth courses. • Require students to take a quarter or semester long course related to cultural competency taught by public health faculty.

11. Integration of content for basic cultural competency training across core courses in public health • Pros • Would ensure that multicultural health issues are integrated within public health curriculum and that all students receive uniform baseline training in cultural competence. • No need to add additional required courses to curriculum.

12. Integration of content for basic cultural competency training across core courses in public health (cont) • Cons • Need for substantive revision of a wide range of courses (involves competition with existing course material). • Need to develop faculty resources and skills for teaching cultural competency topics in a wide range of courses. • Need to coordinate content regarding cultural competency among a wide range of courses. • Students would receive breadth, but perhaps not adequate depth on cultural competence issues. • Potential for fragmentation of cultural competence material if spread throughout curriculum. • Lengthy time period for implementation.

13. Teach basic cultural competency concepts as part of existing required breadth courses • Pros • Would ensure students receive uniform baseline training in cultural competence. • No need to add additional required courses to curriculum. • Relative ease of implementation.

14. Teach basic cultural competency concepts as part of existing required breadth courses (cont) • Cons • Inadequate coverage of basic concepts related to cultural competency unless large portions of the course were devoted to this material. Adding two or three sessions to an existing breadth course would not provide enough breadth or depth for study of cultural competence. • Need for substantial revision of breadth courses and competition with existing material. • Difficulty of teaching specialized knowledge across range of students with different backgrounds and orientations. • Potential for fragmentation of cultural competence material if taught by series of different speakers.

15. Require students to take a quarter or semester long course related to cultural competency taught by public health faculty • Pros • Provides most exposure to breadth and depth on cultural competency material. • Would enhance ability of students to conduct meaningful research and experiential projects related to cultural competency. • Provides most consistent opportunities for mentoring students in area of cultural competency by faculty and practitioners. • Provides opportunities to do specialized work and research related to cultural competency. • Provides a reference group for students to use as resource in developing cultural competency.

16. Require students to take a quarter or semester long course related to cultural competency taught by public health faculty (cont) • Cons • Increase number of required student courses. • Could require substantial increase in number of course offerings that address cultural competency. • Could increase the need for additional faculty with expertise in cultural competency issues

17. Recommendations • Develop a working group with the following charge: • 1. Determine basic standards for cultural competency training public health. • 2. Review current practices regarding cultural competency training in schools of public health. • 3. Determine how many students currently receive training in this area. • 4. Review best practices with regard to teaching cultural competency. • 5. Make recommendations for incorporating cultural competence training into SPH curriculum at various levels from basics to potential minors and majors.