Ronny A. Bell, PhD, MS Professor of Epidemiology and Prevention Director, Maya Angelou Center for Health Equity Wake Forest University School of Medicine

 Family/friends  Where you grew up  Where you live  Religious beliefs  Education  Entertainment  Employment  Travel experiences  Tastes in Foods and Beverages  Race/Ethnicity

 “An integrated pattern of human knowledge, belief, and behavior that depends upon the capacity for symbolic thought and social learning”  “The set of shared attitudes, values, goals, and practices that characterizes an institution, organization or group” Source: Wikipedia

 Having a defined set of values and principles, and demonstrated behaviors, attitudes, policies, and structures that allow for effective work cross-culturally. National Center for Cultural Competence, 1998

 Having the capacity to: ◦ (1) value diversity, ◦ (2) conduct self-assessment, ◦ (3) manage the dynamics of difference, ◦ (4) acquire and institutionalize cultural knowledge, and ◦ (5) adapt to diversity and the cultural contexts of communities they serve. National Center for Cultural Competence, 1998

 Incorporate the above components in all aspects of policy-making, administration, practice and service delivery, systematically involve consumers, families and communities. National Center for Cultural Competence, 1998

 “The ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs.” (Betancourt, 2002)

 “Having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs presented by consumers and their communities.” (Office of Minority Health, 2001)

 At a systems, organizational or program level, cultural competence requires a comprehensive and coordinated plan that includes interventions on levels of: ◦ policy making; ◦ infra-structure building; ◦ program administration and evaluation; ◦ the delivery of services and enabling supports; and ◦ the individual. Denboba, MCHB, 1993

 At the individual level, cultural competence means an examination of one’s own attitude and values, and the acquisition of the values, knowledge, skills and attributes that will allow an individual to work appropriately in cross cultural situations. Denboba, MCHB, 1993

 Cultural competence mandates that organizations, programs and individuals must have the ability to: ◦ value diversity and similarities among all peoples; ◦ understand and effectively respond to cultural differences; ◦ engage in cultural self-assessment at the individual and organizational levels; ◦ make adaptations to the delivery of services and enabling supports; and ◦ institutionalize cultural knowledge.

 Asking the right questions  Asking the right questions the right way  Answering the right questions the right way

Institute of Medicine Unequal Treatment Report

 Excess rates of diabetes, hypertension and stroke among African Americans and Latinos relative to whites will cost the health care system $23.9 billion dollars in  Medicare alone will spend an extra $15.6 billion, and private insurers will spend an extra $5.1 billion.  Over the next decade, the total cost is approximately $337 billion.  Left unchecked, these annual costs will more than double by 2050 as the representation of Latinos and African Americans among the elderly increases. Waidman, The Urban Institute,

Racial and Ethnic Health Disparities in North Carolina REPORT CARD 2006 Office of Minority Health and Health Disparities And State Center for Health Statistics North Carolina Department of Health and Human Services

State Center for Health Statistics

 Understanding the unique patterns of initiation and use of tobacco  Understanding the cultural and economic value attached to tobacco  Recognizing the symbols/images that convey messages important for tobacco prevention  Utilizing the forms of communication that are important to communities

 African American ◦ 7 African American owned newspapers in NC  American Indian ◦ 6 Tribes  Latino ◦ 1 Latino Media Enterprise

 Cultural competency is a critical but often elusive component of delivering health care and conducting health related research  Effort should be made enhance the cultural competency of individuals and systems that provide health care and conduct health research  Providing cultural competency makes business sense, but, more importantly, it’s THE RIGHT THING TO DO!