The Compelling Need for Cultural and Linguistic Competence
The reasons for incorporating cultural competence into organizational policy are numerous. The National Center for Cultural Competence has identified six salient reasons for review:
To respond to current and projected demographic changes in the United States.
The makeup of the American population is changing as a result of immigration patterns and significant increases among racially, ethnically, culturally and linguistically diverse populations already residing in the United States. Health care organizations and programs, and federal, state and local governments must implement systemic change in order to meet the health n
eeds of this diverse population.
Data from the 1990 census reveal that the number of persons who speak a language other than English at home rose by 43 percent to 28.3 million. Of these, nearly 45 percent indicate they have trouble speaking English.
The results of a March 1997 survey conducted by the Census Bureau reveal that one in every 10 people in the United States was born in another country. Currently, the U.S. foreign-born population comprises a larger segment than at any time in the past 50 years. This trend is expected to continue.
The Children's Defense Fund predicts that early in the first decade following the year 2000, there will be 5.5 million more Latino children, 2.6 million more African-American children, 1.5 million more children of other races and 6.2 million fewer white, non-Latino children in the United States.
To eliminate long-standing disparities in the health status of people of diverse racial, ethnic and cultural backgrounds.
Nowhere are the divisions of race, ethnicity and culture more sharply drawn than in the health of the people in the United States.
Despite recent progress in overall national health, there are continuing disparities in the incidence of illness and death among African Americans, Latino/Hispanic Americans, Native Americans, Asian Americans, Alaskan Natives and Pacific Islanders as compared with the U.S. population as a whole. In recognition of these continuing disparities, the President of the United States
has targeted six areas of health status and committed resources to address cancer, cardiovascular disease, infant mortality, diabetes, HIV/AIDS and child and adult immunizations aggressively.
To improve the quality of services and health outcomes.
Despite similarities, fundamental differences among people arise from nationality, ethnicity and culture, as well as from family background and individual experience. These differences affect the health beliefs and behaviors both patients and providers have of each other.
The delivery of high-quality primary health care that is accessible, effective and cost efficient requires health care practitioners to have a deeper understanding of the socio-cultural background of patients, their families and the environments in which they live. Culturally competent primary health services facilitate clinical encounters with more favorable outcomes, enhance the potential for a more rewarding interpersonal experience and increase the satisfaction the individual receiving health care services.
Critical factors in the provision of culturally competent health care services include understanding of the:
- beliefs, values, traditions and practices of a culture;
- culturally defined, health-related needs of individuals, families and communities;
- culturally based belief systems of the etiology of illness and disease and those related to health and healing; and
- attitudes toward seeking help from health care providers.
To meet legislative, regulatory and accreditation mandates.
As both an enforcer of civil rights law and a major purchaser of health care services, the Federal government has a pivotal role in
ensuring culturally competent health care services. Title VI of the Civil Rights Act of 1964 mandates that no person in the United States shall, on grounds of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.
To gain a competitive edge in the market place.
The provision of publicly financed health care services is rapidly being delegated to the private sector. Issues of concern in the current health care environment include the marketing of health services and the cost-effectiveness of health care delivery. The potential for improved services lies in state managed-care contracts that can increase retention and access to care, expand recruitment and increase the satisfaction of individuals seeking health care services.
To reach these outcomes, managed care plans must incorporate culturally competent policies, structures and practices to provide services for people from diverse ethnic, racial, cultural and linguistic backgrounds.
To decrease the likelihood of liability/malpractice claims.
Lack of awareness about cultural differences may result in liability under tort principles in several ways. For example, providers may discover that they are liable for damages as a result of treatment in the absence of informed consent. Also, health care organizations and programs face potential claims that their failure to understand health beliefs, practices and behavior on the part of providers or patients breaches professional standards of care. In some states, failure to follow instructions because they conflict
with values and beliefs may raise a presumption of negligence on the part of the provider.