FROM THE FIELD Cultural Competence And Health Care Disparities : Key Perspectives And Trends

Cultural competence has gained attention as a potential strategy to improve quality and eliminate racial/ethnic disparities in health care. In 2002 we conducted interviews with experts in cultural competence from managed care, government, and academe to identify their perspectives on the field. We present our findings here and then identify recent trends in cultural competence focusing on health care policy, practice, and education. Our analysis reveals that many health care stakeholders are developing initiatives in cultural competence. Yet the motivations for advancing cultural competence and approaches taken vary depending on mission, goals, and sphere of influence. CULTURAL COMPETENCE has gained perts in cultural competence from managed attention from health care policycare, government, and academe to identify makers, providers, insurers, and edutheir perspectives on the subject. This paper cators as a strategy to improve quality and summarizes key findings from this research and eliminate racial/ethnic disparities in health highlights recent trends in cultural competence care. The goal of cultural competence is to in health care policy, practice, and education, create a health care system and workforce • Emergence of cultural competence. that are capable of delivering the highest' Cultural competence has emerged as an imquality care to every patient regardless of portant issue for three practical reasons. First, race, ethnicity, culture, or language profias the United States becomes more diverse, cliciency. Bringing this to fruition requires acnicians will increasingly see patients with a tion by various health care sectors, each with broad range of perspectives regarding health, different motivations, approaches, and leveroften influenced by their social or cultural age points for advancing this field. backgrounds. For instance, patients may presIn 2002 we conducted interviews with exent their symptoms quite differently from the Joseph Betancourt (jhctancourt@polnet) is senior scientist and program director for multicultural education at the Institute for Health Policy, Massachusetts General Hospital and Partners HealthCarc System Inc., and an assistant professor of medicine at Harvard Medical School in Boston. Alexander Green is a research fellow at Beth Israel Deaconess Medical Center, also in Boston. Emilio Carrillo is president and chief medical officer at the New York Presbyterian Community Health Plan and an associate professor of clinical public health at the Joan and Sanford Weill Medical College of Cornell University, both in New York City. Elyse Park is an instructor of psychiatry at Harvard Medical School and a clinical assistant in psychology at the Institute for Health Policy HEALTH AFFAIRS Volume 24, Number 2 499 DOI 10.1377/hlthaff.24.2.499 ©2005 Project HOPE-Thc People-to-People Health foundation. Inc. H E A L T H T R A C K I N G way they are presented in medical textbooks. They may have limited English proficiency, different thresholds for seeking care or expectations about their care, and unfamiliar behefs that influence whether or not they adhere to providers' recommendations.' Second, research has shown that providerpatient communication is linked to patient satisfaction, adherence to medical instructions, and health outcomes.^ Thus, poorer health outcomes may result when sociocultural differences between patients and providers are not reconciled in the clinical encounter.^ Ultimately, these barriers do not apply only to minority groups but may simply be more pronounced in these cases."• Finally, two landmark Institute of Medicine (IOM) reports—Crossing the Quality Chasm and Unequal Treatment—highlight the importance of patient-centered care and cultural competence in improving quality and eliminating racial/ ethnic health care disparities.' In our previous research we described three operational levels of cultural competence: organizational, systemic, and clinical.* These are the levels that guided our inquiry here. • Perspectives from the field. In 2002 we conducted interviews with thirty-seven experts in cultural competence from managed care, government (the U.S. Department of Health and Human Services, or HHS, and state and county departments of health), and aca' deme (residency programs, medical schools, and professional organizations). Using a structured interview guide with ten open-ended questions, we asked these informants to identify important components of cultural competence on which action was possible; to describe leverage points for action and implementation; and to identify links to quality and the elimination of racial/ethnic disparities in health care.'' Subjects were selected from hsts of nationally recognized experts in cultural competence who had made presentations at one of a series of meetings, members of na"Managed care can