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References
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What
is Cultural Competence?
One way to address the
challenges of providing health care to differing cultures is to foster the
development of cultural competence in healthcare providers. The United
States Department of Health and Human Services Office of Minority Health
defines cultural competence as "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" (p. 131).1 "Healthy People 2010: Understanding
and Improving Health defines cultural competence as "The design,
implementation, and evaluation process that accounts for special issues
for select population groups (ethnic and racial, linguistics) as well as
differing educational levels and physical abilities" (p. 11-20).2
Because of the increasing diversification of our country, cultural
competence is a necessary skill to help improve public health and
eliminate
ethnic and racial health disparities.
Why Haitians?
Sussex County, Delaware has experienced an influx of Haitian immigrants.
Unfortunately, since there is no specific category for Haitians in the
U.S. Census, it is expected that most Haitians indicate the category
"black" (1990 Census) or "black or African-American" (2000 Census) as
their racial category, making it difficult to capture the actual number of
Haitians living in the county. However, Haiti was the second most prevalent
country of origin for immigrants living in Sussex County in the years 1991
through 1998.3 A local Haitian minister estimates the
population of Haitians in Sussex County and the surrounding areas to be
about 5000. During the 1970s and 1980s, no other immigrant group
underwent more prejudice than the Haitians.4
Why Sussex
County?
The Delmarva Peninsula has experienced an increasing ethnic
diversification in the past decade. According to the U.S. Census Bureau,
the 1990 Hispanic population in Sussex County was 1,476 while by 2000 it
climbed to 6,915.5,6 This demographic shift has necessitated
that health care providers adapt their services to meet this immigrant
population's healthcare needs. For example, the Department of Public
Health in Sussex County now has Spanish interpreters and provides
bilingual written resources for its clients. Other challenges include
gaining an understanding of the healthcare practices of other cultures,
and hesitancy of "illegal" immigrants to seek healthcare for fear they
will be deported. Traditionally, rural culture maintains that outsiders
are unwelcome, therefore creating an immediate barrier to a new culture.
Why is Cultural
Competency important?
Cultural competency is essential to help reduce health disparities between
ethnic groups. There are continuing racial health disparities in the U.S.
in the incidences of some illnesses. The president has targeted for these
six specific areas for improvement: cancer, cardiovascular disease, infant mortality,
diabetes, HIV/AIDS, and child and adult immunizations.7
Cultural competency has also been named as a core competency for public health professionals. Core competencies are defined as
skills necessary to be proficient at the practice of public health.8 In addition, one of the Essential Services of Public Health is to
"assure a competent public health and personal health care workforce." 9
Cultural competency is also mandated by law in some situations. Title VI
of the Civil Rights Act of 1964 states, "No person in the United
States shall, on ground 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".10 Both the Surgeon General and the Joint Commission
on the Accreditation of Healthcare Organizations maintain that
cultural competency is essential to provide adequate care.
How is Cultural
Competency Achieved?
There are many different theories on how to create Cultural Competency.
The U.S. Department of Health and Human Services' Office of Minority
Health has created
14 standards.1 The standards have emerged as either
mandates (must be met to receive federal funds), guidelines (suggested to
become mandates at some point in time) or recommendations.
Purnell has created a "Model for cultural competence" that is a more
practical tool for the use of health care professionals.11
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