Skip to main content
Log in

Diversity competence in medicine: equity, culture and practice

Diversität und Kompetenz in der Medizin: Gerechtigkeit, Kultur und Praxis

  • review article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Diversity in medicine is a concept that aims at improving the health care of patients and at enhancing health equity. Ethnic and racial disparities have been documented in many contexts, thus diversity competence is specifically relevant when regarding the health of migrants, ethnic minorities and other vulnerable groups. Diversity competence considers socio-economic factors in health care, as well as the influence of ethnic and cultural background on how health and illness are perceived. It should therefore be a core concern for all health practitioners and a central focus in any health institution.

Zusammenfassung

Das Konzept von Diversität in der Medizin hat zum Ziel, die Gesundheitsversorgung von PatientInnen zu verbessern und Chancengleichheit zu ermöglichen. Kompetenz im Bereich Diversität ist besonders relevant, wenn es um die Gesundheit von MigrantInnen, ethnischen Minderheiten und anderen vulnerablen Gruppen geht, weil sich gezeigt hat, dass gerade diese Gruppen im Gesundheitssystem oft benachteiligt sind. Dieses Konzept ermöglicht es sowohl sozio-ökonomische Faktoren zu berücksichtigen, als auch mögliche Einflüsse des ethnischen und kulturellen Hintergrunds auf Vorstellungen von Gesundheit und Krankheit. Die Berücksichtigung von Diversität sollte deshalb ein zentrales Anliegen aller Akteure und Institutionen im Gesundheitsbereich sein.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. https//aamc.org/members/gdi/.

  2. http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=15.

References

  1. AAMC Association of American Medical Colleges. Cultural competence education. 2005. https://www.aamc.org/download/54338/data/culturalcomped.pdf. Accessed 23 July 2012.

  2. Albrecht N-J. Implementierung vonSprach- und Kulturmittlung am Universitäts-Krankenhaus Eppendorf als Beitrag zur Qualitätssicherung in der Kommunikation mit fremdsprachigen Patienten. In: David M, Borde T, Kentenich H, editors. Migration und Gesundheit. Zustandbeschreibung und Zukunftsmodelle. Frankfurt a. M.: Mabuse-Verlag; 1998. pp. 185–7.

    Google Scholar 

  3. Beagan BL. Neutralizing differences: producing neutral doctors for (almost) neutral patients. Soc Sci Med. 2000;51(8):1253–65.

    Article  CAS  PubMed  Google Scholar 

  4. Beagan BL, Kumas-Tan Z. Approaches to diversity in family medicine. “I have always tried to be colour blind”. Can Fam Physician. 2009;55:e21–8.

    PubMed  Google Scholar 

  5. Betancourt JR. Cross-cultural medical education: conceptual approaches and frameworks for evaluation. Acad Med. 2003;78(6):560–9.

    Article  PubMed  Google Scholar 

  6. Betancourt JR. Cultural competence—marginal or mainstream movement? N Engl J Med. 2004;351(10):953–5.

    Article  CAS  PubMed  Google Scholar 

  7. Bischoff A, Perneger TV, Bovier PA, Loutan L, Stalder H. Improving communication between physicians and patients who speak a foreign language. Br J Gen Pract. 2003;53:541–6.

    PubMed  Google Scholar 

  8. Bollini P, Siem H. No real progress towards equity: health of migrants and ethnic minorities on the eve of the year 2000. Soc Sci Med. 1995;41(6):819–28.

    Article  CAS  PubMed  Google Scholar 

  9. Bradby H. Race, ethnicity and health: the costs and benefits of conceptualising racis and ethnicity. Soc Scie Med. 2012;75:955–8.

    Article  Google Scholar 

  10. Breslau J, Aguilar-Gaxiola S, Borges G, Kendler KS, So M, Kessler RC. Risk for psychiatric disorder among immigrants and their US-born descendants: evidence from the National Comorbitiy Survey Replication. J Nerv Ment Dis. 2007;195(3):189–95.

    Article  PubMed  Google Scholar 

  11. Bundesamt für Gesundheit (Sektion Chancengleichheit und Gesundheit) (BAG). Migration und Gesundheit. Strategische Ausrichtung des Bundes 2002–2007. Bern. 2006. http://www.bag.admin.ch. Accessed 14 Sept 2010.

  12. Bundesministerium für Gesundheit und Frauen (BMGF). Interkulturelle Kompetenz im Gesundheitswesen. Wien: BMGF. 2005. http://www.bmg.gv.at/cms/site/attachments/6/5/0/CH0772/CMS1126253889077/bericht_interkulturelle_kompetenz_im_gesundheitswesen.pdf. Accessed 14 Sept 2010.

  13. Burchard EG, Ziv E, Coyle N, et al. The importance of race and ethnic background in biomedical research and clinical practice. N Engl J Med. 2003;348(12):1170–5.

    Article  PubMed  Google Scholar 

  14. Carballo M, Divino JJ, Zeric D. Migration and health in the European Union. Trop Med Int Health. 1998;3(12):936–44.

    Article  CAS  PubMed  Google Scholar 

  15. Cohen S, Moran-Ellis J, Smaje C. Children as informal interpreters in GP consultations: pragmatics and ideology. Sociol Health Illn. 1999;21(2):163–86.

    Article  Google Scholar 

  16. Cross TL. Cultural competence continuum. 1988. http://www.casbrant.ca/files/upload/oacas/Reference_Material/Agency_Culture/Cultural_Competence_Continuum.doc. Accessed 23 July 2012.

  17. Crowley-Matoka M, Saha S, Dobscha SK, Burgess DJ. Problems of quality and equity in pain management: exploring the role of biomedical culture. Pain Med. 2009;10(7):1312–24.

    Article  PubMed  Google Scholar 

  18. Dimsdale JE. Stalked by the past: the influence of ethnicity on health. Psychosom Med. 2000;62:161–70.

    CAS  PubMed  Google Scholar 

  19. Eisenberg L. Disease and illness. Distinctions between professional and popular ideas of sickness. Cult Med Psychiatry. 1977;1:9–23.

    Article  CAS  PubMed  Google Scholar 

  20. Enterprise for Health. Diversity: Herausforderung für Unternehmungskultur und -gesundheit. Bertelsmann Stiftung, Bundesverband der Betriebskrankenkassen. 2003. http://www.enterprise-for-health.org. Accessed 27 Feb 2012.

  21. Fonds Soziales Wien. Gesundsein in Wien. Handbuch für nicht-deutschsprachige PatientInnen und KlientInnen. 2005. http://www.fsw.at/export/sites/fsw/fswportal/downloads/broschueren/frauengesundheit/GesundseinInWien.pdf. Accessed 17 Sept 2010.

  22. Freund KM, Jacobs AK, Pechacek JA, White HF, Ash AS. Disparities by race, ethnicity, and sex in treating acute coronary syndromes. J Womens Health. 2012;21(2):126–32.

    Article  Google Scholar 

  23. Gregg J, Saha S. Losing culture on the way to competence: the use and misuse of culture in medical education. Acad Med. 2006;81(6):542–7.

    Article  PubMed  Google Scholar 

  24. Haderer P. Sprache und medizinische Qualität. Eine Analyse zu Auswirkungen von Sprachbarrieren auf die Qualität der Gesundheitsversorgung von MigrantInnen im Wiener Spitalswesen. Masterthese Donau-Universität Krems; 2011.

  25. Hadziabdice E, Heikkilä AB, Hjelm K. Migrants’ perceptions of using interpreters in health care. Int Nurs Rev. 2009;56:461–9.

    Article  Google Scholar 

  26. Ingleby D. European research on migration and health. Brussels: International Organization for Migration (IOM); 2009.

    Google Scholar 

  27. Juhász J, Makara P, Taller Á. Possibilities and limitations of comparative research on international migration and health. Working Paper No. 09, EC Project Promoting Comparative Quantitative Research in the Field of Migration and Integration in Europe (PROMINSTAT). 2010. http://ec.europa.eu/ewsi/UDRW/images/items/docl_17583_823896939.pdf. Accessed 21 June 2010.

  28. Karliner LS, Jacobs EA, Hm Chen A, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. HSR Health Services Res. 2007;42(2):727–54.

    Article  Google Scholar 

  29. Karmali K, Grobovsky L, Levy J, Keatings M. Enhancing cultural competence for improved access to quality care. Healthc Q. 2011;14:52–7.

    PubMed  Google Scholar 

  30. Kirmayer LJ. Culture and the metaphoric mediation of pain. Transcult Psychiatry. 2008;45:318–38.

    Article  PubMed  Google Scholar 

  31. Kleinman A. Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley: University of California Press; 1981.

    Google Scholar 

  32. Kleinman A, Benson P. Anthropology in the clinic: the problem of cultural competency and how to fix it. PLoS Med. 2006;3(10):1673–6.

    Article  Google Scholar 

  33. Klimont J, Ihle P, Baldaszti E, Kytir J. Sozio-demographische und sozio-öokonomische Determinanten von Gesundheit. Auswertungen der Daten aus der Österreichischen Gesundheitsbefragung 2006/2007. Statistik Austria, BMGFJ, Wien; 2008.

  34. Kutalek R. Migration und Gesundheit. In: Six-Hohenbalken M, Tosic J, editors. Anthropologie der Migration. Wien: Facultas; 2009. pp. 302–21.

    Google Scholar 

  35. Lo MM, Stacey CL. Beyond cultural competency: bourdieu, patients and clinical encounters. Sociol Health Illn. 2008;30(5):741–55.

    Article  PubMed  Google Scholar 

  36. McDougle L, Lu F, Castro I. Answering the question of the year with faculty diversity. Acad Med. 2011;86(11):1344.

    Article  PubMed  Google Scholar 

  37. Mladovsky P. Migrant health in the EU. Eurohealth. 2007;13(1):9–11.

    Google Scholar 

  38. Pachter LM. Culture and clinical care: folk illness beliefs and behaviors and their implications for health care delivery. JAMA. 1994;271(9):690–4.

    Article  CAS  PubMed  Google Scholar 

  39. Papic O, Malak Z, Roesnberg E. Survey of family physicians’ perspectives on management of immigrant patients: attitudes, barriers, strategies, and training needs. Patient Educ Counc. 2012;86:205–9.

    Article  Google Scholar 

  40. Paul BD. Introduction: understanding the community. In: Paul BD, editor. Health, culture, and community. Case studies of public reactions to health programs. New York: Sage; 1955. pp. 1–11.

    Google Scholar 

  41. Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008;299(1):70–8.

    Article  CAS  PubMed  Google Scholar 

  42. Pöchhacker F. Language barriers in Vienna Hospitals. Ethn Health. 2000;5(2):113–9.

    Article  PubMed  Google Scholar 

  43. Pöchhacker F. Krankheit, Kultur, Kinder, Kommunikation: Die Nichte als Dolmetscherin. In: Bischoff A, Meyer B, editors. Die fremnde Sprachen, die fremden Kranken: Dolmetschen im medizinischen Kontext. Curare. 2008;31(2–3):133–42

    Google Scholar 

  44. Racial privacy initiative. http://www.racialprivacy.org. Accessed 23 July 2012.

  45. Razum O, Zeeb H, Akgün HS, Yilmaz S. Low overall mortality of Turkish residents in Germany persists and extends into a second generation: merely a healthy migrant effect? Trop Med Intern Health. 1998;3/4:297–303.

    Article  Google Scholar 

  46. Saladin P, editor. Diversität und Chancengleichheit. Grundlagen für erfolgreiches Handeln im Mikrokosmos der Gesundheitsinstitutionen. Bern: Bundesamt für Gesundheit; 2009.

    Google Scholar 

  47. Schmacke N. Migration und Gesundheit: Ist Ausgrenzung unvermeidbar? Gesundheitswesen. 2002;64:554–9.

    Article  CAS  PubMed  Google Scholar 

  48. Schulman KA, Berlin JA, Haress W, Kerner JF, Sistrunk S, Gersh BJ, Dubé R, Teleghani CK, Burke JA, Williams S, Eisenberg JM, Escarce J. The effect of race and sex on physician’s recommendations for cardiac catheterization. N Engl J Med. 1999;340(8):618–26.

    Article  CAS  PubMed  Google Scholar 

  49. Shavers VL, Klein WMP, Fagan P. Research on race/ethnicity and health care discrimination: where we are and where we need to go. Am J Public Health. 2012;102(5):930–2.

    Article  PubMed  Google Scholar 

  50. Smedley A, Smedley BD. Race as biology is fiction, racism as social problem is real. Am Psych. 2005;60(1):16–26.

    Article  Google Scholar 

  51. Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment. Confronting racial and ethnic disparities in health care. Washington: National Academies Press; 2003.

    Google Scholar 

  52. Smith DG. Diversity’s promise for higher education. Baltimore: The Johns Hopkins University Press; 2009.

    Google Scholar 

  53. Spallek J, Zeeb H, Razum O. Prevention among immigrants: the example of Germany. BMC Public Health. 2010;10:92.

    Article  PubMed  Google Scholar 

  54. Taylor JS. Confronting “culture” in medicine’s “culture of no culture”. Acad Med. 2003;78:555–9.

    Article  PubMed  Google Scholar 

  55. Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117–25

    Article  CAS  PubMed  Google Scholar 

  56. Todd KH, Samaroo N, Hoffman JR. Ethnicity as a risk factor for inadequate emergency department analgesia. JAMA. 1993;269(12):1537–9.

    Article  CAS  PubMed  Google Scholar 

  57. Toledo P, Sun J, Grobman WA, Wong CA, Feinglass J, Hasnain-Wynia R. Racial and ethnic disparities in neuraxial labor analgesia. Anesth Analg. 2012;114(1):172–8.

    Article  PubMed  Google Scholar 

  58. Wear D. Insurgent multiculturalism: rethinking how and why we teach culture in medical education. Acad Med. 2003;78:549–54.

    Article  PubMed  Google Scholar 

  59. Weber A, Hörmann G. Migration und Gesundheit—von Defizitanalysen zum Diversity-Ansatz? Gesundheitswesen. 2011;73:298–307.

    Article  CAS  PubMed  Google Scholar 

  60. Wittig U, Lindert J, Merbach M, Brahler E. Mental health of patients from different cultures in Germany. Europ Psych. 2008;23(Suppl 1):28–35.

    Article  Google Scholar 

  61. Wimmer B, Ipsiroglu O. Kommunikationsbarrieren in der Betreuung von MigrantInnen und deren Kindern. Analyse und Löschungsvorschläge anhand von Fallbeispielen. Wien Klin Wochenschr. 2001;113(15–16):616–21.

    CAS  PubMed  Google Scholar 

  62. Zeeb H, Razum O. Epidemiologische Studien in der Migrationsforschung. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz. 2006;49:845–52.

    Article  CAS  PubMed  Google Scholar 

  63. Zeeb H, Baune BT, Vollmer W, Cremer D, Krämer A. Gesundheitliche Lage und Gesundheitsversorgung von erwachsenen Migranten—ein Survey bei der Schuleingangsuntersuchung. Gesundheitswesen. 2004;66:76–84.

    Article  CAS  PubMed  Google Scholar 

  64. Zola IK. Structural constraints in the doctor-patient relationship: the case of non-compliance. In: Eisenberg L, Kleinman A, editors. The relevance of social medicine for medicine. Dordrecht: Reidel; 1981. pp. 241–52.

    Chapter  Google Scholar 

Download references

Conflict of interest

The author declares that there is no actual or potential conflict of interest in relation to this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ruth Kutalek P.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kutalek, R. Diversity competence in medicine: equity, culture and practice. Wien Klin Wochenschr 124 (Suppl 3), 3–9 (2012). https://doi.org/10.1007/s00508-012-0247-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-012-0247-5

Keywords

Schlüsselwörter

Navigation