REFORM: The Human Element: Health Policy and Cultural Competency

In a diverse country such as the United States, "cultural competency" in medical practice and policy has a growing and important role in reforming a system that serves us all — and as the AP reported last week, many states are beginning to make it a mandatory part of medical training and continuing education for health professionals. What is cultural competency and hows does it connect with some of the more familiar health reform goals of providing coverage and cutting health care costs, you ask? Let us explain.

The AAMC defines cultural competency as the following:

Cultural and linguistic competence is a set of congruent behaviors, knowledge, attitudes, and policies that come together in a system, organization, or among professionals that enables effective work in cross-cultural situations. "Culture" refers to integrated patterns of human behavior that include the language, thoughts, actions, customs, beliefs, and institutions of racial, ethnic, social, or religious groups. "Competence" implies having the capacity to function effectively as an individual or an organization within the context of the cultural beliefs, practices, and needs presented by patients and their communities.

 

 

 

 

At least 6 states have now enacted laws that require medical schools and licensing bodies to provide course work in cultural competency, medical anthropology, and alternative healing. (We happen to have a medical anthropologist in residence this summer, adding to our diversity!) The goal, according to those interviewed in the AP article, is not to know everything about everyone, but to develop the sensitivity and understanding that not every culture responds to medical providers in the same way, or even sees medicine in the same way. States enacting regulations include New Mexico, New Jersey, and Ohio.

The same health care approach will not fit all. In the best-selling book by Anne Fadiman, The Spirit Catches You and You Fall Down, we see a collision between culture, medicine, and the American health care system. A good amount of uncompensated care, un-necessary procedures, and county tax dollars spent on the young child at the center of the saga, could have been avoided if there was more knowledge of how to appropriately deal with patients from a variety of cultural backgrounds. California, where the story plays out, now makes it mandatory that all health professionals take part in a cultural and linguistic competency program.

Various private, state, and federal organizations such as the IHS (check out their Navajo Area health service for example) recognize the importance of combatting stereotypes and biases—acknowledging that there are differences in beliefs and understandings that can affect the delivery and outcomes of health care. Improving cultural competency in medical practice can help people access and naviagte our complex health care system in ways that both save money and improve outcomes. Ultimately, it's about moving health care toward a more patient-centered system that can appropriately deal with challenges of heart disease, cancer, diabetes, and other chronic conditions.

Just like it is our moral obligation to cover all Americans, it is our human obligation to approach health care with a sense of humility and respect. Including cultural competency as part of an American system where medicine, and economics, and people can coexist will save time, and money, and frustration, and lives!