Cultural Competency in Healthcare: What Is It and Why Do We Need It?

I was walking along a crowded street when a skinny, darkly colored man entered the flow of traffic in front of me. Looking back to see where he came from, I noticed a seemingly insignificant door at the base of a tall, weathered building. The scene wouldn’t have caught me off guard – a man simply exiting his workplace or home, perhaps – except for the blue and white NHS sign that was displayed on the brick exterior. I was in London, visiting a Bangladeshi community to learn about the social environment of this marginalized population. The man I had seen enter the street was most likely of Bangladeshi nationality given the brown color of his skin and his dark eyes. I was more interested in the building where he came from, though. The NHS label stood for National Health Service, the governing body that provides healthcare for the United Kingdom’s residents. My tour guide later explained that the building housed a free clinic for the homeless and low-income people in the area. Government-funded dollars provided access to healthcare, and I thought that was incredible. This ordinary scene on a rainy day in London, surrounded by people that look and speak very differently than me, started a cascade of thoughts on culture, health, and medical practice. I wanted to learn more about how culture influences healthcare. So, I did some research.

During my time in London, UK, and Dublin, Ireland, I was immersed in some less glamorous realities. I interacted with homeless populations, toured original orphanages, visited social housing, and studied public health policies. One major theme that kept surfacing was the impact of diversity. In addition to my studies, I simply saw diversity. As a future physician, I began to ask how this would impact patient care. The implications of diversity aren’t isolated to the urban cities of London, Dublin, or New York City but are applicable everywhere. The world is becoming increasingly globalized; doctors, nurses, and healthcare professionals must be equipped to interact with people from different cultures. We must practice cultural competency so that all people, regardless of race, religion, sexuality, socio-economic status, and language, receive equal and effective healthcare. This a huge, complex topic that deserves more than my voice can express, but I think it is important to get the conversation started and welcome input on how we can harness cultural competency to improve healthcare.

Culturally informed practice

There are many similarities between the United States, the United Kingdom, and Ireland with respect to healthcare. There are also many differences. The UK is predominantly a government-funded healthcare system, meaning that people pay taxes that fund their outpatient, inpatient, prescription, and associated healthcare costs. The US is a primarily privatized healthcare system. Most patients are on private insurance (though some may qualify for federal aid and many have no insurance at all) and seek healthcare in a free market system. Ireland is situated (literally and figuratively) between the US and UK when it comes to healthcare. They have a combination of government-funded policies and privatized options. These systems impact who has access to care. Many people desire to live in these democratic nations, and this encourages a large inflow of immigrant people. As the fabric of our world changes, we begin to realize that we must practice culturally informed medicine. Practically though, what does this mean?

It is important to acknowledge such a need first. Cultural competency, according to Laurie Anderson of the American Journal of Preventative Medicine, is a set of ideas and beliefs that enable cross-cultural relationships to flourish. Physicians from all backgrounds must be open to exploring other cultures and allowing cultural competency to infiltrate the healthcare system. As we strive toward ensuring a culturally diverse healthcare workforce, through great initiatives funded by the federal government, we must congruently work to practice culturally competent medicine. As a white female that grew up in culturally homogenous, rural Tennessee, I could let my own cultural identity define my perspective entirely, holding a closed fist on what affects my world view. Instead, though, I have visited places of great diversity and have opened my hands and my mind to letting other cultures shape how I view the world. I believe this is the first step to facilitating a culturally competent medical practice. It begins with individuals, like those physicians that welcomed the Bangladeshi man in London, that are willing to make a change. Cultural competency is a skill that is learned. Once we acknowledge the need for such a concept, we can begin to ask how to implement it.

Doctors are trained in the practice of medicine and are knowledgeable about how to diagnose, treat, and prevent disease. The culture of medicine is changing, though, and there is an additional need for education on diversity. How can I, as a white female, show my future patients that are African American, Hispanic, homosexual, Native Indian, Muslim, and any other aspect different from me, that I hear their needs and celebrate their differences? How do I develop trust that I will care for them at all costs, no matter what they believe or practice outside of the walls of clinic? I think it requires knowledge on my part of cultural practices and beliefs. It requires sensitivity towards differences. This is cultural competency. I’ve traveled the world only to find that issues on diversity are rampant in the country I call my own. The implication that this has for medical care both frightens and motivates me. First, though, we must recognize the need for cultural competency. We must define it, talk about it, and share it with our colleagues, policy makers, and leaders. Then, we must live it out in practice. This post is dedicated to opening the conversation, welcoming suggestions for moving forward, and serving as an introduction to cultural competency in healthcare. We live in a diverse nation and globalized world, and physicians are called to be culturally aware to protect their patients and to ensure equal, high-quality healthcare.

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Mary Barber

Mary Barber studies Chemistry and English Literature at Belmont University in Nashville, TN. An average day for her includes running from microbiology lecture to having discussions on the writings of Nabokov to designing experiments in the lab – she says it’s a little crazy but always fun. Her passions (currently) include studying cardiovascular disease caused by cancer therapies, writing, and monthly dates baking cupcakes with cancer patients. One day when she grow up Mary hopes to be a physician researcher, treat patients with heart problems, write books, and do yoga every day.