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This month, we welcome Juneteenth, an important African American cultural holiday. But culture is more than celebrations. Cultural sensitivity refers to the doctor's ability to understand and accept the importance of cultural differences, and how they profoundly affect how effectively he or she cares for patients. The need to develop cultural proficiency and competence is critical and will become more so in the future. Today, 35 million African Americans constitute 13 percent of the population. By 2050, ethnic minorities will make up nearly half of all Americans. Because of the disparities in medical education opportunities, most will be cared for by doctors who are not members of their own minority group. Even today, despite many advances, African Americans make up less than 7 percent of the health care physician work force. The disparities are even greater in the specialty and subspecialty areas of medicine. Among
all minorities this creates even greater cultural, language and ethnic discordance in the health care environment.
Today, a good doctor needs more than medical skills. He or she must know enough about each patient's culture to anticipate barriers to effective delivery of care. For example, the folk beliefs of some African Americans about health and illness can affect medical care and treatment. According to Loudell Snow in Traditional Health Beliefs and Practices Among Lower Class Black Americans, the elements of African American folk medicine and beliefs form "a coherent medical system and not a ragtag collection of isolated superstitions." To those who follow these beliefs, the system "makes just as much sense … as the principles of orthodox medicine do to the graduate of an accredited medical school."
Health care providers also must recognize other aspects of cultural competence: how their own culture affects their behavior, because misinterpretations can occur when a doctor interacts with patients from a different culture. Research indicates that African Americans are much less likely to get appropriate testing and treatment for serious
illnesses such as heart disease. This failure of cultural sensitivity can potentially widen the health care gap.
According to a 1998 Association of American Medical Colleges survey, 67 percent of medical schools offer courses in cultural competence and 15 more plan to introduce them. In 1999, to encourage such positive trends, President Clinton's budget included $30 million for culturally appropriate interventions for preventable illnesses such as infant mortality, HIV and diabetes. |
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