Skip to main content
SpringerLink
Log in

The Promise and Paradox of Cultural Competence

  • Published:
HEC Forum Aims and scope Submit manuscript

Going against the grain means by definition accepting extreme responses and insecurities.

(Goldberg and Essed 2002:7).

Abstract

Cultural competence has become a ubiquitous and unquestioned aspect of professional formation in medicine. It has been linked to efforts to eliminate race-based health disparities and to train more compassionate and sensitive providers. In this article, I question whether the field of cultural competence lives up to its promise. I argue that it does not because it fails to grapple with the ways that race and racism work in U.S. society today. Unless we change our theoretical apparatus for dealing with diversity to one that more critically engages with the complexities of race, I suggest that unequal treatment and entrenched health disparities will remain. If the field of cultural competence incorporates the lessons of critical race scholarship, however, it would not only need to transform its theoretical foundation, it would also need to change its name.

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

Access this article

Log in via an institution

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. For a list of the standards and recommendations for cultural competency, see the Office of Minority Health, http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15. Accessed 1 Mar 2012.

  2. In her dissertation on cultural competence, Milam Ponder (2005) links its emergence to the Civil Rights Act of 1964.

References

  • Barker, M. (1982). The new racism: Conservatives and the ideology of the tribe. Michigan: Aletheia Books.

    Google Scholar 

  • Barrett, J. E., & Roediger, D. (2002). How white people became white. In Paula S. Rothberg (Ed.), White privilege: Essential readings on the other side of racism (pp. 35–40). New York: Worth Publishers.

    Google Scholar 

  • Beach, M. C., Price, E. G., Robinson, K. A., Gozu, A., et al. (2005). Cultural competence: A systematic review of health care provider educational interventions. Medical Care, 43(4), 356–373.

    Article  Google Scholar 

  • Beagan, B. (2003). Teaching social and cultural awareness to medical students: “It’s all very nice to talk about it in theory, but ultimately it makes no difference”. Academic Medicine, 78(6), 605–614.

    Article  Google Scholar 

  • Beagan, B., & Kumas-Tan, Z. (2009). Approaches to diversity in family medicine: “I have always tried to be colour blind”. Canadian Family Physician, 55, 21–28.

    Google Scholar 

  • Betancourt, J. (2003). Cross-cultural medical education: Conceptual approaches and frameworks for evaluation. Academic Medicine, 78(6), 560–569.

    Article  Google Scholar 

  • Betancourt, J. R. (2006). Cultural competence and medical education: Many names, many perspectives, one goal. Academic Medicine, 81(6), 499–501.

    Article  Google Scholar 

  • Betancourt, J., Green, A. R., & Carrillo, J. E. (2002). Cultural competence in health care: Emerging frameworks and practical approaches. New York: The Commonwealth Fund.

    Google Scholar 

  • Betancourt, J., Green, A. R., Carrillo, J. E., & Park, E. R. (2005). Cultural competence and health care disparities: Key perspectives and trends. Health Affairs, 24(2), 499–505.

    Article  Google Scholar 

  • Brown, M. K., Carnoy, M., Currie, E., Duster, T., Oppenheimer, D. B., Shultz, M. M., et al. (2003). White-washing race: The myth of a color-blind society. Berkeley, CA: University of California Press.

    Google Scholar 

  • Cross, T. L., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Towards a culturally competent system of care: A monograph on effective services for minority children who are severally emotionally disturbed (Vol. I). Washington DC: Georgetown University Child Development Center.

    Google Scholar 

  • DelVecchio Good, M., James, C., Good, B. J., & Becker, A. E. (2005). The culture of medicine and racial, ethnic, and class disparities in healthcare. In Mary Romero & Eric Margolis (Eds.), The Blackwell companion to social inequalities (pp. 396–423). Malden, MA: Blackwell Publishing.

    Google Scholar 

  • Foucault, M. (1991). Faire vivre et laisser mourir: La naissance du racism. Les Temps Modernes, 46, 37–61.

    Google Scholar 

  • Fox, R. (2005). Cultural competence and the culture of medicine. The New England Journal of Medicine, 353, 1316–1319.

    Article  Google Scholar 

  • Gilroy, P. (1987). “There ain’t no Black in the union Jack”: The cultural politics of race and nation. Chicago: University of Chicago Press.

    Google Scholar 

  • Gilroy, P. (2002). The end of antiracism. In Philomena Essed & David Theo Goldberg (Eds.), Race critical theories (pp. 249–264). Malden, MA: Blackwell Publishing.

    Google Scholar 

  • Giroux, H. (2000). Insurgent multiculturalism and the promise of pedagogy. In E. M. Duarte & S. Smith (Eds.), Foundational perspectives in multicultural education (pp. 195–212). New York: Longman.

    Google Scholar 

  • Gordon, D. (1988). Tenacious assumptions in western medicine. Biomedicine examined (pp. 19–56). Dordrecht: Kluwer Academic Publishers.

    Google Scholar 

  • Graves, D. L., Like, R. C., Kelly, N., & Hohensee, A. (2007). Legislation as intervention: A survey of cultural competence policy in health care. Journal of Health Care Law and Policy, 10, 339–361.

    Google Scholar 

  • Ignatiev, N. (1995). How the Irish became white. New York: Routledge.

    Google Scholar 

  • Jenks, A. (2010). What’s the use of culture? Health disparities and the development of culturally competent health care. In Ian Whitmarsh & David S. Jones (Eds.), What’s the use of race? Modern governance and the biology of difference (pp. 207–224). Cambridge, MA: The MIT Press.

    Google Scholar 

  • Johnstone, M., & Kanitsaki, O. (2009). The spectrum of ‘new racism’ and discrimination in hospital contexts: A reappraisal. Collegian, 16, 63–69.

    Article  Google Scholar 

  • Kai, J., Bridgewater, R., & Spencer, J. (2001). ‘“Just think TB and Asians”, that’s all I ever hear’: Medical learners’ views about training to work in an ethnically diverse society. Medical Education, 35, 250–256.

    Article  Google Scholar 

  • Kumagai, A. K., & Lypson, M. (2009). Beyond cultural competence: Critical consciousness, social justice, and multicultural education. Academic Medicine, 84(6), 782–787.

    Article  Google Scholar 

  • Leach, C. W. (2005). Against the notion of a ‘new racism’. Journal of Community and Applied Social Psychology, 15, 432–445.

    Article  Google Scholar 

  • Lipsitz, G. (2006). The possessive investment in whiteness: How white people profit from identity politics. Philadelphia, PA: Temple University Press.

    Google Scholar 

  • McCarthy, C. (1990). Race and curriculum. Philadelphia, PA: Falmer.

    Google Scholar 

  • Milam Ponder, L. (2005). Improving access to care by determining key elements of culturally and linguistically appropriate healthcare interventions for Hispanic populations in Texas using a Delphi technique. Dissertation, http://repository.tamu.edu/bitstream/handle/1969.1/4908/etd-tamu-2005c-heed-ponder.pdf?sequence=1. Accessed 15 Mar 12.

  • Omi, M., & Winant, H. (2002). Racial formation. In Philomena Essed & David Theo Goldberg (Eds.), Race critical theories (pp. 123–145). Malden, MA: Blackwell Publishing.

    Google Scholar 

  • Price, E. G., Beach, M. C., Gary, T. L., Robinson, K. A., et al. (2005). A systematic review of the methodological rigor of studies evaluating cultural competence training of health professionals. Academic Medicine, 80(6), 578–586.

    Article  Google Scholar 

  • Romm, N. (2010). New racism: Revisiting researcher accountabilities. London: Springer.

  • Sears, E. D. O., Sidanius, J., & Bobo, L. (2000). Racialized politics: The debate about racism in America. Chicago: The University of Chicago Press.

    Google Scholar 

  • Shapiro, J., Lie, D., Gutierrez, D., & Zhuang, G. (2006). “That never would have occurred to me”: A qualitative study of medical students’ views of a cultural competence curriculum. BioMed Central Medical Education, 6(31), 1–7.

    Google Scholar 

  • Sherwin, S. (1992). Feminist and medical ethics. In H. B. Holmes & L. Purdy (Eds.), Feminist perspectives in medical ethics (pp. 17–31). Bloomington, IN: Indiana University Press.

    Google Scholar 

  • Singh, D. (2003). Racism rife in the medical profession, BMA report says. British Medical Journal, 326(7404), 1418.

    Article  Google Scholar 

  • Smedley, B. D., Stith, A., & Nelson, A. R. (2003). Unequal treatment: confronting racial and ethnic disparities in health care, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Sciences Policy, Institute of Medicine of the National Academies.

  • Stoler, A. L. (2002). Racial histories and their regimes of truth. In Philomena Essed & David Theo Goldberg (Eds.), Race critical theories (pp. 369–391). Malden, MA: Blackwell Publishing.

    Google Scholar 

  • Tervalon, M. (2003). Components of culture in health for medical students’ education. Academic Medicine, 78(6), 570–576.

    Article  Google Scholar 

  • Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125.

    Article  Google Scholar 

  • van Dijk, T. A. (2000). New(s) racism: A discourse analytical approach. Ethnic Minorities and the Media (pp. 33–49). Amsterdam: Open University Press. http://dare.uva.nl/record/104799.

  • Wear, D. (2003). Insurgent multiculturalism: Rethinking how and why we teach culture in medical education. Academic Medicine, 78(6), 549–554.

    Article  Google Scholar 

  • Williams, D. R., & Braboy Jackson, P. (2005). Social sources of racial disparities in health. Health Affairs, 24(2), 325–334.

    Article  Google Scholar 

  • Williams, D. R., & Rucker, T. D. (2000). Understanding and addressing racial disparities in health care. Health Care Financing Review, 21, 75–90.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute for the Medical Humanities, University of Texas Medical Branch, Suite 2.104, Primary Care Pavilion, 301 University Boulevard, Galveston, TX, 77555-1311, USA

    Rebecca J. Hester

Authors
  1. Rebecca J. Hester
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rebecca J. Hester.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hester, R.J. The Promise and Paradox of Cultural Competence. HEC Forum 24, 279–291 (2012). https://doi.org/10.1007/s10730-012-9200-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10730-012-9200-2

Keywords

Search

Navigation