The Promise and Paradox of Cultural Competence
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The Promise and Paradox of Cultural Competence Rebecca J. Hester
Published online: 31 October 2012 Springer Science+Business Media Dordrecht 2012
Abstract Cultural competence has become a ubiquitous and unquestioned aspect of professional formation in medicine. It has been linked to efforts to eliminate racebased health disparities and to train more compassionate and sensitive providers. In this article, I question whether the field of cultural competence lives up to its promise. I argue that it does not because it fails to grapple with the ways that race and racism work in U.S. society today. Unless we change our theoretical apparatus for dealing with diversity to one that more critically engages with the complexities of race, I suggest that unequal treatment and entrenched health disparities will remain. If the field of cultural competence incorporates the lessons of critical race scholarship, however, it would not only need to transform its theoretical foundation, it would also need to change its name. Keywords Cultural competence Health disparities Race Racism Multiculturalism United States Going against the grain means by definition accepting extreme responses and insecurities. (Goldberg and Essed 2002:7).
Introduction In this paper, I examine a little discussed and possibly counter-intuitive cause of the persistence of entrenched health inequities, one that goes directly to the issue of professional formation in medicine. Specifically, I want to interrogate the field of cultural competence and ask whether it supports or hinders efforts to eliminate R. J. Hester (&) Institute for the Medical Humanities, University of Texas Medical Branch, Suite 2.104, Primary Care Pavilion, 301 University Boulevard, Galveston, TX 77555-1311, USA e-mail: [email protected]
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unequal treatment in health care (Smedley et al. 2003). Drawing from critical race scholarship, I contend that the field of cultural competence fails to adequately deal with the race-based causes of health disparities because it fails to adequately understand and address the ways that race and racism work in U.S. society today. While there is much scholarship and educational activity to support the practice of cultural competency, the theoretical foundations of this approach need to be reconstructed with a contemporary understanding of race relations if it is to fulfill its promise of equalizing health care treatment and outcomes for all. Using the concept of ‘‘new racism’’ I argue that racist dynamics are produced through the use of ‘‘culture’’ as a catchall category to define and essentialize minority populations. While the use of culture as a means to racially categorize groups is not new, many people understand racism as an individual response to physically observable, biological characteristics such as skin color and other phenotypical markers. This understanding has led to attempts at ‘‘color-blindness’’ and to a focus on ‘‘multiculturalism’’ in which less attention is paid to skin color and the focus
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