Culture, Medicine, and Psychiatry

, Volume 35, Issue 2, pp 236–261 | Cite as

The Ethical Self-Fashioning of Physicians and Health Care Systems in Culturally Appropriate Health Care

  • Susan J. Shaw
  • Julie Armin


Diverse advocacy groups have pushed for the recognition of cultural differences in health care as a means to redress inequalities in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims on both the state and health care providers. These efforts led to federal regulations developed by the U.S. Office of Minority Health requiring health care organizations to provide Culturally and Linguistically Appropriate Services. Based on ethnographic research at workshops and conferences, in-depth interviews with cultural competence trainers, and an analysis of postings to a moderated listserv with 2,000 members, we explore cultural competence trainings as a new type of social technology in which health care providers and institutions are urged to engage in ethical self-fashioning to eliminate prejudice and embody the values of cultural relativism. Health care providers are called on to re-orient their practice (such as habits of gaze, touch, and decision-making) and to act on their own subjectivities to develop an orientation toward Others that is “culturally competent.” We explore the diverse methods that cultural competence trainings use to foster a health care provider’s ability to be self-reflexive, including face-to-face workshops and classes and self-guided on-line modules. We argue that the hybrid formation of culturally appropriate health care is becoming detached from its social justice origins as it becomes rationalized by and more firmly embedded in the operations of the health care marketplace.


Health disparities Cultural competence Minority health Physician training 



This research was supported by the Wenner-Gren Foundation Hunt Postdoctoral Fellowship, and by the University of Arizona Junior Faculty Development program. Special thanks are due to Angela Jenks and Seth Holmes, organizers of this special issue and of the Society of Medical Anthropology panel where this article was first presented; to Janelle Taylor, for her critical feedback at that panel; and to audience members for their constructive questions. The authors wish to acknowledge the very productive comments of our anonymous reviewers for CMP, and also to recognize Amy Stamm for her feedback on an earlier version of this article.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.School of AnthropologyUniversity of ArizonaTucsonUSA
  2. 2.School of AnthropologyUniversity of ArizonaTucsonUSA

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