Cultural Competency and Haitian Immigrants


Cultural Competency, Haitian Immigrants, and
Rural Sussex County, Delaware

Purnell's Model

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Family roles & organization
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Workforce issues

Biocultural ecology

High-risk behaviors

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Death rituals

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Health care practices
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Health care practitioners




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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