“There is no tolerance without respect — and no respect without knowledge.”

—Professor Henry Louis Gates, Jr.

“Cultural humility is an ongoing process that requires humility as individuals continually engage in self-reflection and self-critique, as lifelong learners and reflective practitioners.”

—Melanie Tervalon, M.D.

“One opinion holds that ignoring race, or skin color, is the best avenue to social justice.

“Critics of the color-blind approach argue that it ignores research showing that, even among well-intentioned people, skin color (and other identifiable physical features such as ethnicity, gender, and physical disability) figure prominently in everyday attitudes and behavior. Thus, to get beyond racism and other similar forms of prejudice, we must first take the differences between people into account.”

—American Psychological
Association, 1997


There are many compelling reasons why faculty must improve their capacity to teach culturally responsive care including:
  • the elimination of health disparities
  • a reversal of a long history of racism and oppression in the U.S. health care system
  • improved physician-patient communication
  • enhanced patient adherence to negotiated treatment plans with improved outcomes
  • improved patient satisfaction with care provided
  • physician satisfaction with their own work

According to the 2010 census, the percentage of persons of Hispanic or Latino origin in 2010 was 37.6% in California and 16.3% in the United States; similarly the percentage of foreign-born persons was 26.8% in California and 12.4% in the United States. An additional challenge to providers is that languages other than English are spoken in the home in over 40% (42.2%) within California and in almost 20% (19.6%) of homes across the nation. There is also an economic divide with a disproportionate number of ethnic minorities living in poverty and an equally disproportionate number living without health insurance. Thus training young physicians to provide culturally and linguistically appropriate services has never been more relevant.

In the 2010 Carnegie Report Educating Physicians: A Call for Reform of Medical School and Residency, the authors noted that trainees tended to have a poor understanding of non-clinical and civic roles of physicians including those of advocacy and teaching. Further, it stated that “practitioners must be prepared to take a role in their community and work to improve health and the health care system.”

Culturally responsive health care must also be delivered in accordance to federal CLAS Standards’ mandates, and is thought to lead to business development with increased patient satisfaction. However, perhaps the most compelling reason comes from the U.S. health disparity statistics. The IOM Report, Unequal Treatment, the video series, Unnatural Causes, the book Multicultural Medicine and Health Disparities edited by Satcher and Pamies, and the book An American Health Dilemma by Byrd and Clayton all serve to document the powerfully destructive racial and ethnic disparities in health and health care in this country. From AIDS to diabetes, from motor vehicle accidents to access to care, grows an overwhelming list of health variables that exude injustice. While health disparities are complex in origin, developing from inequality in patient factors, health care system factors and societal factors, health care provider factors also play an important part, as was evidenced by Schulman’s research presented in the New England Journal of Medicine, and as articulated in the federal CLAS Standards. Both the ACGME and the AAMC require that medical learners be effectively instructed in awareness, knowledge and skill components of culturally responsive care, yet most faculty are underprepared to teach this complex aspect of health care provision.

The February 2010 Issue Brief from the Center for Studying Health System Change entitled Modest and Uneven: Physician Efforts to Reduce Racial and Ethnic Disparities documents how less than half of surveyed physicians have received training in minority health issues. The Cultural Medicine Training Center aims to help rectify these findings.

References