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From “Lists of Traits” to “Open-Mindedness”: Emerging Issues in Cultural Competence Education

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Abstract

The incorporation of “culture” into U.S. biomedicine has been increasing at a rapid pace over the last several decades. Advocates for “cultural competence” point to changing patient demographics and growing health disparities as they call for improved educational efforts that train health providers to care for patients from a variety of backgrounds. Medical anthropologists have long been critical of the approach to “culture” that emerges in cultural competence efforts, identifying an essentialized, static notion of culture that is conflated with racial and ethnic categories and seen to exist primarily among exotic “Others.” With this approach, culture can become a “list of traits” associated with various racial and ethnic groups that must be mastered by health providers and applied to patients as necessary. This article uses an ethnographic examination of cultural competence training to highlight recent efforts to develop more nuanced approaches to teaching culture. I argue that much of contemporary cultural competence education has rejected the “list of traits” approach and instead aims to produce a new kind of health provider who is “open-minded,” willing to learn about difference, and treats each patient as an individual. This shift, however, can ultimately reinforce behavioral understandings of culture and draw attention away from the social conditions and power differentials that underlie health inequalities.

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Notes

  1. The term “cultural competence” is only one phrase that has been used in this movement. Calls for “culturally appropriate care,” “cultural sensitivity,” “cultural humility,” “multicultural health care,” and “cross-cultural health care” are also common. This shifting language reflects in part an uncertainty over what exactly “culture” means, how it relates to medical care, and what the goals of increasing attention to culture in medical care should be. I have found, however, that references to “cultural competence” or “cultural competency” (the terms are often used interchangeably) are most common in recent educational efforts. The Office of Minority Health (OMH) uses one of the more widely accepted and cited definitions of cultural competence, stating that:

    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. “Culture” refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. “Competence” implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities. [OMH 2001, adapted from Cross et al. 1989]

  2. See Gilbert (2003) and Graves et al. (2007) for overviews of position statements from a variety of other health-related organizations.

  3. See Elliott (2006), Hobgood et al. (2006), and Beach et al. (2005) for overviews of the variety of instructional methodologies used; see Gilbert (2003) for an extensive collection of guidebooks, manuals, videos, websites, and other resources that have been developed for use in cultural competence training.

  4. Carolyn’s comment raises questions not just about the conflation of race and culture in discussions of health disparities, but about the possible biological significance of race in clinical care. While increasing numbers of scholars in the second half of the twentieth century have argued that race is a socially constructed rather than biologically meaningful category, notions of biological race continue to have an important effect on health research, pharmaceutical development, and clinical care. For further discussions of these issues, see Livingston (1962), Duster (1990, 2003), Marks (1996), Graves (2001), Wailoo (2001), and Whitmarsh and Jones (2010).

  5. Taylor takes this term from Sharon Traweek’s (1988) study of high-energy physicists.

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  1. Los Angeles Southwest College, Los Angeles, CA, USA

    Angela C. Jenks

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Jenks, A.C. From “Lists of Traits” to “Open-Mindedness”: Emerging Issues in Cultural Competence Education. Cult Med Psychiatry 35, 209–235 (2011). https://doi.org/10.1007/s11013-011-9212-4

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