While understanding and being empathetic toward different cultures are all well and good, the realities of today’s – and tomorrow’s – world make cultural competency a requirement. For example:
- In approximately 30 years, half of the people in the United States will be of color.
- The fastest-growing demographic group in America is biracial individuals.
- Nearly 100,000 African-Americans die every year who otherwise wouldn’t if their disease and mortality rates were roughly equal to those of whites. Given expected population trends, if those disparities persist, the nation won’t be able to function.
That third point was emphasized by Tim Wise, a prominent anti-racist writer and educator who in December kicked off DMU’s cultural competency series (see sidebar). The series is part of DMU’s increased efforts to help students better understand diverse cultures in ways that enhance patient-provider interactions and health outcomes, create respectful and productive workplace relationships, and address and eliminate health care disparities.
“We have to reduce these gaps as a matter of professional responsibility for certain, but also as a matter of practical necessity,” Wise said during his presentation.
Driving DMU’s cultural competency efforts is Rich Salas, Ph.D., who became the University’s director of multicultural affairs last summer. Previously, he was the associate director of El Centro Student Services and Greek Life Affairs offices at Colorado State University, where his primary duties were to assist Hispanic/Latino graduate and undergraduate students and to work with fraternities and sororities with members of diverse backgrounds.
Salas brings to campus more than 20 years’ experience in diversity programming and cultural competency training. Such training, he told The Des Moines Register, will equip the health care workforce to “deliver better treatment, promote wellness and establish trust and positive relationships with patients.”
Salas says developing students’ cultural competency “has to be an ongoing process” in which individuals gain knowledge, hone skills and become aware of their own biases.
“The word ‘compassionate’ is in our mission as a university. If we fail to prepare students to learn and embrace diversity, we’ve failed them and our mission,” he says. “We can hold on to the personal beliefs and values that guide our lives, but when we become health care professionals, we sign a code of ethics and integrity to serve all patients with respect and dignity.”
Minority health disparities: “social and public health problem”
Tim Wise has no patience with white people who believe they’re not responsible for the “wholesale deaths” of African Americans and Latinos due to health disparities.
“We rationalize that we’re not to blame, but those mortality rates are a social problem,” he said. “Every citizen needs to ask, ‘What role do I play?’”
During his talk at DMU in December, Wise – the author of six books on race-related issues who has lectured on more than 800 college and high school campuses – debunked three “schools of thought” used to explain the disparities. The first one blames minorities’ lifestyles, but Wise said “the data simply do not support it.” He noted, for example, that black women who have never smoked have higher infant mortality rates than white women who smoke every day, and higher rates than foreign-born blacks.
The second rationalization, the “genetic” school of thought, “is even more pernicious, more disgusting and more thoroughly unscientific,” Wise said. The third “liberal theory,” which blames economics and access to health care, has some truth but does not hold up in comparisons of whites and non-whites of equivalent income and education.
Wise said more than 100 studies point to other causes of health disparities among persons of color. They include frequent experiences with racism, the resulting stress on mind and body, and strong evidence that clinicians, especially those who are white, “are less likely to order the same medical procedures, medical interventions and even the same treatment regimens for patients of color as for white patients.” Implicit biases rather than overt bigotry are largely to blame.
The “good news,” Wise said, is that research shows when people are cognizant of their tendency to stereotype others, they can “make a conscious decision to short-circuit that tendency if not in our brains, at least in our actions.” That requires ongoing cultural competency training, self-reflection and an understanding of dominant culture norms that perpetuate stereotypes.
“Unless that’s part of our training, we’re not going to be culturally competent in the way that really counts,” Wise said.