Examing Cultural Competence in Health Care: Implications for Social Workers

Sep 24, 2013

It’s well established that ethnic and racial minorities bear experience a disproportionate amount of negative health outcomes; this phenomenon is known as “health disparities”. Given that health disparities among ethnic minority groups have been partly attributed to cultural differences between patients and providers, there is an ongoing concerted effort to develop and implement culturally competent health interventions at both the provider and institutional levels. But what constitutes “cultural competence” in health care provision?

In a recent article in Health and Social Work, Elizabeth Horevitz, Jennifer Lawson, and Julian C.-C. Chow examine and unpack the “black box” of cultural competence in health interventions with racial and ethnic minority populations. Their analysis builds on several recent reviews of evidence-based efforts to reduce health disparities, with a focus on how cultural competence is defined and operationalized. The article describes the emergence of cultural competence in the health social work literatures and traces the development of various theoretical models to explain this construct and its practical functions.

A burgeoning research literature on health disparities has shown that individuals from minority racial and ethnic groups are disproportionately likely to develop severe health problems (e.g., diabetes, cancer, asthma, heart disease, etc.) and to experience lower quality care and poor outcomes in relation to health problems even after controlling for multiple other factors such as socioeconomic status, insurance status, etc. The recognition of this problem—that race and ethnicity are social determinants of health—has made reducing these disparities a major focus of health care policy, research, administration and practice in the United States.

With the majority of those in helping professions, including social work, coming from middle-class white backgrounds, to address the role of prejudice and discrimination in producing health disparities, an emphasis on acquisition of cultural competence has become paramount for such professionals. But how is cultural competence defined? The NASW and others have defined cultural competence as:

…a set of congruent behaviors, attitudes, and policies that come together in a system, agency or those professionals to work effectively in cross-cultural situations.

Still, what is actually meant in specific cross-cultural situations has been more difficult to define.

The authors then address several different views of cultural competency, breaking them into two categories: provider-level cultural competency, and agency-level cultural competency. Having looked at these, they stress the need for further research. Indeed, they write:

There have been few head-to-head comparison trials of culturally competent versus “standard” or “neutral” health interventions. The majority of the studies on culturally competent interventions are descriptive, and very few have looked at actual patient outcomes.

They call for more studies of cultural competency in health care provision. Social work practitioners, particularly, can provide practice-based evidence to advance the development of effective and culturally competent techniques. Furthermore, more research can help further define and implement the very notion of cultural competency in health care provision.