Ronny A. Bell, PhD, MSProfessor of Epidemiology and Prevention

Director, Maya Angelou Center for Health EquityWake Forest University School of Medicine

Family/friends Where you grew up Where you live Religious beliefs Education Entertainment Employment Travel experiences Tastes in Foods and Beverages Race/Ethnicity

“An integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for symbolic thought and social learning”

“The set of shared attitudes, values, goals, and practices that characterizes an institution, organization or group”

Source: Wikipedia

Having a defined set of values and principles, and demonstrated behaviors, attitudes, policies, and structures that allow for effective work cross-culturally.

National Center for Cultural Competence, 1998

Having the capacity to: ◦(1) value diversity, ◦(2) conduct self-assessment, ◦(3) manage the dynamics of difference, ◦(4) acquire and institutionalize cultural

knowledge, and ◦(5) adapt to diversity and the cultural

contexts of communities they serve.

National Center for Cultural Competence, 1998

Incorporate the above components in all aspects of policy-making, administration, practice and service delivery, systematically involve consumers, families and communities.

National Center for Cultural Competence, 1998

“The ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs.” (Betancourt, 2002)

“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.” (Office of Minority Health, 2001)

At a systems, organizational or program level, cultural competence requires a comprehensive and coordinated plan that includes interventions on levels of: ◦ policy making; ◦ infra-structure building; ◦ program administration and evaluation; ◦ the delivery of services and enabling supports; and ◦ the individual.

Denboba, MCHB, 1993

At the individual level, cultural competence means an examination of one’s own attitude and values, and the acquisition of the values, knowledge, skills and attributes that will allow an individual to work appropriately in cross cultural situations.

Denboba, MCHB, 1993

Cultural competence mandates that organizations, programs and individuals must have the ability to:◦ value diversity and similarities among all peoples; ◦ understand and effectively respond to cultural

differences; ◦ engage in cultural self-assessment at the

individual and organizational levels; ◦ make adaptations to the delivery of services and

enabling supports; and ◦ institutionalize cultural knowledge.

Asking the right questions Asking the right questions the right way Answering the right questions the right way

Institute of MedicineUnequal Treatment Report

Excess rates of diabetes, hypertension and stroke among African Americans and Latinos relative to whites will cost the health care system $23.9 billion dollars in 2009.

Medicare alone will spend an extra $15.6 billion, and private insurers will spend an extra $5.1 billion.

Over the next decade, the total cost is approximately $337 billion.

Left unchecked, these annual costs will more than double by 2050 as the representation of Latinos and African Americans among the elderly increases.

Waidman, The Urban Institute, http://www.urban.org/publications/411962.html

Racial and Ethnic Health Disparities in North Carolina

REPORT CARD2006

Office of Minority Health and Health Disparities

And

State Center for Health Statistics

North Carolina Department of Health and Human Services

State Center for Health Statistics

State Center for Health Statistics

State Center for Health Statistics

Understanding the unique patterns of initiation and use of tobacco

Understanding the cultural and economic value attached to tobacco

Recognizing the symbols/images that convey messages important for tobacco prevention

Utilizing the forms of communication that are important to communities

www.aaip.org, www.diabetes.org

www.lumbeetribe.com

African American◦ 7 African American owned newspapers in NC

American Indian◦ 6 Tribes

Latino◦ 1 Latino Media Enterprise

Cultural competency is a critical but often elusive component of delivering health care and conducting health related research

Effort should be made enhance the cultural competency of individuals and systems that provide health care and conduct health research

Providing cultural competency makes business sense, but, more importantly, it’s THE RIGHT THING TO DO!