Cultural Competency: A Critical Element of Health Care and Health Research

1. Cultural Competency: A Critical Element of Health Care and Health Research Ronny A. Bell, PhD, MS Professor of Epidemiology and Prevention Director, Maya Angelou Center for Health Equity Wake Forest University School of Medicine

2. WHO ARE YOU?

3. What are the factors that make you “you”? • Family/friends • Where you grew up • Where you live • Religious beliefs • Education • Entertainment • Employment • Travel experiences • Tastes in Foods and Beverages • Race/Ethnicity

4. What is “Culture?” • “An integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for symbolic thought and social learning” • “The set of shared attitudes, values, goals, and practices that characterizes an institution, organization or group” Source: Wikipedia

5. What is Cultural Competence? • Having a defined set of values and principles, and demonstrated behaviors, attitudes, policies, and structures that allow for effective work cross-culturally. National Center for Cultural Competence, 1998

6. What is Cultural Competence? • Having the capacity to: • (1) value diversity, • (2) conduct self-assessment, • (3) manage the dynamics of difference, • (4) acquire and institutionalize cultural knowledge, and • (5) adapt to diversity and the cultural contexts of communities they serve. National Center for Cultural Competence, 1998

7. What is Cultural Competence? • Incorporate the above components in all aspects of policy-making, administration, practice and service delivery, systematically involve consumers, families and communities. National Center for Cultural Competence, 1998

8. Cultural Competence in Health Care • “The ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs.” (Betancourt, 2002)

9. Cultural Competence in Health Care • “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, 2001)

10. Cultural Competence in Health Care • At a systems, organizational or program level, cultural competence requires a comprehensive and coordinated plan that includes interventions on levels of: • policy making; • infra-structure building; • program administration and evaluation; • the delivery of services and enabling supports; and • the individual. Denboba, MCHB, 1993

11. Cultural Competence in Health Care • At the individual level, cultural competence means an examination of one’s own attitude and values, and the acquisition of the values, knowledge, skills and attributes that will allow an individual to work appropriately in cross cultural situations. Denboba, MCHB, 1993

12. Cultural Competence in Health Care • Cultural competence mandates that organizations, programs and individuals must have the ability to: • value diversity and similarities among all peoples; • understand and effectively respond to cultural differences; • engage in cultural self-assessment at the individual and organizational levels; • make adaptations to the delivery of services and enabling supports; and • institutionalize cultural knowledge.

13. Cultural Competence in Health Research • Asking the right questions • Asking the right questions the right way • Answering the right questions the right way

14. Institute of MedicineUnequal Treatment Report

16. Why is Cultural Competence Important in Health Care? • Excess rates of diabetes, hypertension and stroke among African Americans and Latinos relative to whites will cost the health care system $23.9 billion dollars in 2009. • Medicare alone will spend an extra $15.6 billion, and private insurers will spend an extra $5.1 billion. • Over the next decade, the total cost is approximately $337 billion. • Left unchecked, these annual costs will more than double by 2050 as the representation of Latinos and African Americans among the elderly increases. Waidman, The Urban Institute, http://www.urban.org/publications/411962.html

17. Racial and Ethnic Health Disparities in North Carolina REPORT CARD 2006 Office of Minority Health and Health Disparities And State Center for Health Statistics North Carolina Department of Health and Human Services

18. Current Smoking Rates in North Carolina, by Race/Ethnicity, 2004 State Center for Health Statistics

19. Smoking During Pregnancy, by Race/Ethnicity, 1996 - 2000 State Center for Health Statistics

20. Percentage of Middle Schoolers who Ever Smoked, by Race/Ethnicity 1999 - 2000 State Center for Health Statistics

22. Cultural Competence and Tobacco Prevention • Understanding the unique patterns of initiation and use of tobacco • Understanding the cultural and economic value attached to tobacco • Recognizing the symbols/images that convey messages important for tobacco prevention • Utilizing the forms of communication that are important to communities

23. www.aaip.org, www.diabetes.org

24. www.lumbeetribe.com

25. The People’s Clinic • African American • 7 African American owned newspapers in NC • American Indian • 6 Tribes • Latino • 1 Latino Media Enterprise

26. Summary • Cultural competency is a critical but often elusive component of delivering health care and conducting health related research • Effort should be made enhance the cultural competency of individuals and systems that provide health care and conduct health research • Providing cultural competency makes business sense, but, more importantly, it’s THE RIGHT THING TO DO!