Beyond Cultural Competency: Skill, Reflexivity, and Structure in Successful Tribal Health Care

The growing concern with cultural competency in health care settings is an ironic development from the perspective of tribal health care, where biomedical clinicians and patients have struggled for decades with the challenges of cross-cultural healing.1 Both anthropological and other literatures on minority health have declared cultural competency to be a critical tool requiring both cross-cultural knowledge and specific skills. However, many approaches to this concept, such as brief trainings and cultural inventories for staff in multicultural health care settings, have failed to improve the quality of health care or the skill of health care providers. Cultural competency is built on several assumptions regarding the boundedness and neutrality of “culture” within biomedical practice as well as the authority and power structures through which “competency” is determined. In this chapter, we deconstruct notions of cultural competency, rebuilding this important aspect of medical practice under Bourdieu’s model of reflexivity.2 We outline a critical discourse of cultural competency based on a processual