The topic of cultural competency came up today on the Medical Anthropology listserve. According to the US Office of Minority Health, “cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.”
For many anthropologists, this definition might sound good in theory, but in practice, “cultural competence” often atomizes culture into a set of psychological dispositions and bureaucratic checklists, while competence is too often defined on the institution’s terms, rather than by the actual people running into problems.
The listserve question asked was:
Does anyone know of any literature that discusses the concept of “cultural competency” in healthcare provision, but in reference to groups who are not defined by ethnicity, language or religion? For instance, using the concept of cultural competency to improve healthcare for women, or gay people, or HIV positive people, or young/elderly people?
The recommendations ranged over the topic of cultural competency in general. Here are the citations, with an added snippet so readers have a better sense of each work:
Carpenter-Song, Elizabeth, with Megan Nordquest Schwallie, and Jeffrey Longhofer (2007). Cultural Competence Reexamined: Critique and Directions for the Future. Psychiatric Services 58 (10): 1362-1365.
The authors examine recent calls for culturally competent care in mental health practice and give a brief overview of the context in which demands for such care have arisen. Using select examples from anthropology, the authors provide evidence of the importance of culture in the production, presentation, and experience of psychic distress. Acknowledging the value of culturally appropriate care, the authors synthesize anthropological critiques of cultural competence models.
Del Vecchio Good, Mary-Jo, Sarah S. Willen, Seth Donal Hannah et al., eds. (2011). Shattering Culture: American Medicine Responds to Cultural Diversity New York: Russell Sage Foundation.
Many health professionals would now agree that cultural competence is important in clinical settings, but in what ways? Shattering Culture provides an insightful view of medicine and psychiatry as they are practiced in today s culturally diverse clinical settings.
Fitzgerald, M. H. (2000). Establishing Cultural Competency for Mental Health Professionals. In: Vieda Skultans and John Cox (Eds.), Anthropological approaches to psychological medicine: Crossing Bridges, pp. 184-201.
Cultural competency is a concept involving knowledge, attitudes, behaviors, in particular the application of communication and interaction skills, and a way of being with the world and the people around us. Cultural competency is not just about being competent in situations in which culture is an obvious component but about being professional competent and recognizing that culture is a component of all interactions and all health and illness situations.
Kirmayer, Laurence (2012). Rethinking Cultural Competence. Transcultural Psychiatry 49(2): 149-64.
Cultural diversity poses challenges to mental health services for many reasons. Culture inﬂuences the experience, expression, course and outcome of mental health problems; help seeking and the response to health promotion, prevention or treatment interventions. The clinical encounter is shaped by diﬀerences between patient and clinician in social position and power, which are associated with diﬀerences in cultural knowledge and identity, language, religion and other aspects of cultural identity.
Kleinman, Arthur, and Peter Benson (2006). Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix It. PLoS Med 3(10).
The large claims about the value of cultural competence for the art of professional care-giving around the world are simply not supported by robust evaluation research showing that systematic attention to culture really improves clinical services. This lack of evidence is a failure of outcome research to take culture seriously enough to routinely assess the cost-effectiveness of culturally informed therapeutic practices, not a lack of effort to introduce culturally informed strategies into clinical settings.
Korbin, Jill E. (2002). Culture and Child Maltreatment: Cultural Competence and Beyond. Child Abuse & Neglect 26(6-7), 637.
While attention has been directed to the relationship between culture and maltreatment for more than 20 years, there is a need for further development in this area. Efforts need to be made to “unpack” culture, to promote understanding culture in context, and to enhance research on child maltreatment and culture.
Purnell, Larry (1999). Panamanians’ Practices for Health Promotion and the Meaning of Respect Afforded them by Health Care Providers. Journal of Transcultural Neuroscience 10(4), 331-339.
This study describes and compares Panamanians’ and Panamanian Americans’ practices for health promotion and wellness, disease and illness prevention, and the meaning of respect afforded them by health care providers. Understanding a person’s beliefs and values when planning nursing and health care interventions helps the caregiver provide culturally acceptable care that improves clients’ satisfaction and health status.
Seeleman, Conny, with Karien Stronks, Wim van Aalderen, and Marie-Louise Essink-Bot (2012). Deficiencies in Culturally Competent Asthma Care for Ethnic Minority Children: A Qualitative Assessment Among Care Providers. BMC Pediatrics 12(1), 47.
Asthma outcomes are generally worse for ethnic minority children. Care providers do not consciously recognise all the mechanisms that lead to deficiencies in culturally competent asthma care they provide to ethnic minority children. This study provides keys to improve the quality of specialist paediatric asthma care to ethnic minority children, mainly related to non-adherence.