Chapter 64: Cultural & Linguistic Competence

INTRODUCTION

Family physicians deliver care across the lifespan from infancy to the end of life, all within increasingly diverse communities. Many of these communities face existing and persistent health and healthcare disparities. Growing diversity and persistent disparities are among several arguments for the provision of care and services, which are patient-centered as well as culturally and linguistically appropriate. This may include decisions and actions that are congruent with the patient’s value systems and orientation to health and illness.

Every patient interaction is a unique cultural experience; each encounter is an opportunity to overcome the potential impediments in the exchange of information between physicians, patients, and their families. The American Academy of Family Physicians (AAFP) recognized the importance of culturally proficient and linguistically competent care in a 2008 position paper: Principles for Improving Cultural Competency and Care to Minority and Medically-Underserved Communities. The AAFP is not alone in its recognition of the crucial role of cross-cultural health in the effective delivery of healthcare. The list includes other influential groups such as the American Association of Medical Colleges (AAMC), Liaison Committee on Medical Education (LCME), the Center for Medicare and Medicaid Services (CMS), and national, international bodies, such as The Joint Commission, The Commonwealth Fund, and the World Health Organization (WHO).

The Institute of Medicine (IOM) produced a landmark report entitled Crossing the Quality Chasm, which crystallized the failures of the American medical system and asserted that the system must be changed to one that is equitable, patient-centered, safe, and effective. The following year the IOM released Unequal Treatment, Confronting Racial and Ethnic Disparities in Health Care, which identified cross-cultural education as a possible intervention in the reduction of healthcare disparities. The documentary Unnatural Causes continued this narrative by examining how social determinants of health, including racism and class distinctions, created health inequalities within communities of color across the nation.

WHY CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES ARE NECESSARY

Emergent Diversity in American Communities

The changing demographics of the United States provide one of many compelling reasons for healthcare ...