Cultural Competence 

What is a culture of health? Building a Culture of Health means working together to improve health for all in America. It means placing well-being at the center of every aspect of our lives. In a Culture of Health, Americans understand that we’re all in this together—no one is excluded. Everyone has access to the care they need and a fair and just opportunity to make healthier choices. In a Culture of Health, communities flourish and individuals thrive.

Culturally and linguistically appropriate services (CLAS) is a way to improve the quality of services provided to all individuals, which will ultimately help reduce health disparities and achieve health equity. CLAS is about respect and responsiveness: Respect the whole individual and Respond to the individual’s health needs and preferences.

Health inequities in our nation are well documented. Providing CLAS is one strategy to help eliminate health inequities. By tailoring services to an individual's culture and language preferences, health professionals can help bring about positive health outcomes for diverse populations.

The provision of health services that are respectful of and responsive to the health beliefs, practices, and needs of diverse patients can help close the gap in health outcomes. The pursuit of health equity must remain at the forefront of our efforts; we must always remember that dignity and quality of care are rights of all and not the privileges of a few.

As a public health practitioner, provider, or member of the community, regardless of your belief system, one should always respect the patient/customer’s viewpoints and ideals.

What are beliefs?  Belief is the attitude that something is the case or true. In addition, a state or habit of mind in which trust or confidence is placed in some person or thing. Religion, culture, beliefs, and ethnic customs can influence how patients understand health concepts, how they take care of their health, and how they make decisions related to their health. Without proper training, clinicians may deliver medical advice without understanding how health beliefs and cultural practices influence the way that advice is received. Asking about patients’ religions, cultures, and ethnic customs can help clinicians engage patients so that, together, they can devise treatment plans that are consistent with the patients’ values.

Examples of how religion, culture, and ethnic customs can influence patients and their families:  

  • Health beliefs: In some cultures, people believe that talking about a possible poor health outcome will cause that outcome to occur. For example, some individuals believe in the active “energies” or “karma” surrounding what is vocalized. Professing that you may have a poor outcome will result in it due to the energy that has been released into the atmosphere.
  • Health customs: In some cultures, family members play a large role in health care decision making. For example, a patient’s parents may “make the call” on a specific treatment, regardless of whether or not the spouse agrees on the decision. Legally, this action is approved in some states via an official surrogacy agreement.
  • Ethnic customs: Differing roles of women and men in society may determine who makes decisions about accepting and following through with medical treatments.
  • Religious beliefs: Religious faith and spiritual beliefs may affect health care-seeking behavior and people’s willingness to accept specific treatments or behavior changes. For example, some individuals of specific religious faiths will not agree to receive a blood transfusion, regardless of their chances of survival.
  • Dietary customs: Disease-related dietary advice will be difficult to follow if it does not conform to the foods or cooking methods used by the patient.
  • Interpersonal customs: Eye contact or physical touch will be expected in some cultures and inappropriate or offensive in others.

Helpful Resources:

EthnoMed is a Web site containing information about cultural beliefs, medical issues, and other related issues pertinent to the health care of recent immigrants.

Culture Clues are one-page tip sheets that offer insight into the health care preferences and perceptions of patients from 10 different cultures and special needs groups (including the deaf and hard-of-hearing). The Web site also covers end-of-life issues.

The Culture, Language, and Health Literacy Web site provides an exhaustive list of resources regarding cultural competence issues for specific ethnicities, religions, and special populations.

Robert Wood Johnson Foundation “Culture of Health: