The Health Care

Professional’s Guide to
Cultural Competence
2nd edition
Rani H. Srivastava
 Chapter 1

Cultural Competence in Health Care: Overview of Issues

Key Terms
• Biomedical

• BIPOC • Everyday Racism

Chapter 1
• Cultural Bias/Unconscious Bias • Health equity, inequality, inequity
• Cultural
• Implicit Bias
• Blindness
• Competence • Institutional Racism
• Competence Continuum • Intersectionality
• Humility
• Marginalization
• Imposition
• Incapacity • Microaggressions
• Pre-Competence • Minority (visible minorities)
• Proficiency
• Racism • Prejudice
• Safety • Race
• Culture • Racism (structural, systematic)
• Discrimination • Stereotype
• Diversity • Western Culture
• Ethnicity
• Worldview
• Ethnocentrism

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 Learning Objectives
• Recognize the need for cultural competence in health care
• Describe culture as a determinant of health
• Define the terms culture, cultural competence, cultural safety, cultural imposition, diversity, ethnicity,
ethnocentrism, health equity, and worldview
• Identify the similarities and differences between cultural competence, cultural safety, and patient-
centred care
• Discuss the interdependence between the micro, meso, and macro levels of cultural competence

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 Impact of Culture on Health
• Inextricably linked
• Culture influences health and illness behaviour
 Culture influences how illness is perceived and experienced, what symptoms are reported, what
remedies are sought, and who is consulted in the process
• Ethnocentrism
• Cultural Bias

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 Cultural Imposition

Culture and Ethnicity

Health
Cultural considerations
in care
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 • Diversity exists based on gender
identification, sexual orientation, disability, social
class, religion, and many other variables

Changing • Cultural clashes and racialization not limited

Demographics to individuals from foreign lands

• Can occur across a wide number of

communities perceived as minorities

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 Culture as a Determinant of
Health (1 of 2)
• Culture is acknowledged as a key determinant of health

• Mediates impact of social factors such as:

 Perceptions of social status
 Ability to secure stable employment and housing
 Family roles and obligations
 Historical legacies of discrimination, disadvantage, and
trauma

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 Culture as a Determinant of
Health (2 of 2)

• Three levels of social determinants are recognized:

(1) proximal determinants
(2) intermediate determinants
(3) distal or structural determinants

• Language barriers pose a major threat to patient

safety and quality of care

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 Health inequality

• Differences in health status between

different groups

Health inequity

Health Equity (1 • Subset of factors that are deemed to be

“unfair or unjust”
of 2)
Health equity

• Absence of unfair and avoidable or

remediable differences in health among
population groups defined socially,
economically, demographically, or
geographically

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 • Health Equity Impact Assessment tool (HEIA)

Health Equity (2 of • Health care providers can promote health equity by

recognizing cultural needs and strengths,
2) understanding vulnerability, removing unnecessary
barriers in care, and supporting informed choices

• “Healthy immigrant effect”

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 Race and Racism
Race
• A group of people who share physical characteristics such as skin tone, hair texture and
facial features
• Where race is used as an identifying variable, important to be cautious and explore
meaning and intention of term to determine its utility and appropriateness

Racism
• Preconceived, adverse judgement or opinion (prejudice) is formed based on
characteristics such as skin colour, facial features, or ethnicity
• Can be defined as an organized social system
• Dominant group uses its power and privilege to devalue, disempower, and differentially
allocate social resources and opportunities across racial or ethnic groups
• Leads to a lack of opportunities and resources to those deemed to be inferior and less
deserving
• Microaggressions
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 Types of Racism
Types of racism:
Institutional racism
Systemic racism
Structural racism
Cultural racism
Everyday racism
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Stereotype, Prejudice,
and Discrimination
Related terms  lead to exclusion and inequities

Stereotype
 A preconceived generalization of a group of
people
Prejudice
 A belief, feeling, or attitude, usually negative and
lacking in legitimacy, towards another person
Discrimination
 Actions or behaviours, based on stereotypes and
prejudices, that reflect unequal, unfair access and
unequal, unfair treatment of people, that leads to
inequitable outcomes

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 Confine people to outer Questioning right to
limit or edge (the belong and be full
margins) participants

Implicit bias leads to

Marginalization A result of unconscious
or implicit bias
marginalization and
subtle acts of exclusion

Marginalization, leads to
a continuation of social
“Vulnerable
and structural inequities
populations”
with harmful health
effects

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 Minority and Ethnicity

Minority Ethnicity
• Group status is associated with • Broader term than race
marginalized status, meaning that such • Characteristics can include ancestry,
groups have limited access to language, kinship, family rituals, food
opportunity, power, and resources preferences, clothing, and particular
including health care services celebrations
• BIPOC (Black, Indigenous, People of
Colour)

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 Intersectionality and Diversity

Intersectionality
• Approach or framework for understanding how multiple
social identities such as race, gender, sexual orientation,
and disability, interact with each other and influence
individual experience

Diversity
• Broad term related to culture
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 • Difficult concept to define

• Complex, elusive, and at times paradoxical

Culture (1 of 2)
• Definitions of culture generally refer to values,
norms, and traditions that are shared, to varying
degrees, amongst a group of people that are used to
guide behaviours in everyday life

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 Constitute
Culture as
s several
a pattern
layers
Culture (2
of 2)
Culture as
Worldview
power

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Description of
Culture
Description of Culture is …
Commonly
Understood
Learned
Traditions and
Unconscious
Rules of
Engagement

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 • Main focus  impact of colonialism and
power imbalances that disregard the ways of
being and knowing (including health and
illness beliefs) of Indigenous people and
Cultural Safety deny self-determination
• Considered an outcome of cultural
competence
• Predominately applied to health care for
Indigenous people
• A key aspect is it must be understood from
the perspective of the person being served
or cared for
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Cultural Competence (1 of 2)

• A set of congruent behaviours, attitudes, and policies that come together in a system, agency, or
among professionals and enable [them] to work effectively in cross-cultural situations
• Recognizes need for adapting assessment and treatment approaches to achieve equity in health
quality and outcomes
• Described as a process or journey
• Not a destination or an outcome
• Culture refers to integrated patterns of human behavior and competence implies having the requisite
knowledge, skills, and judgement to function effectively

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Cultural Competence (2 of 2)

Levels of cultural Cultural

competence Cultural
competence
• Macro, meso, micro proficiency
continuum

Cultural Nine themes of

competency self- person-centred
assessment care
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 Watch:
https://www.youtube.com/watch?v=ZahtlxW2CIQ
• Reflect:
• Discuss your thoughts and feelings. Can
you give examples of everyday racism that
you have observed in your daily life?
• Have you witnessed examples of
microaggressions directed at another
person?
Now What??? • Have you experienced microaggressions
personally? What was your response?
• List examples of microaggressions
experienced or personally observed by
members of your group.
• Reflect on ways that you and your group
members could increase awareness of
these unconscious assumptions.

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