• Race: The concept of dividing people into populations
or groups on the basis of visible traits and beliefs about
• Ethnicity: Large groups of people who are classified
according to common racial, national, tribal, religious,
linguistic, or cultural origin or background.
• Ethnocentric: When a person believes that his or her
culture is superior to that of another.
• Cultural Competence: The ability to interact effectively
with people of different cultures; a set of congruent behav-
iors, attitudes, structures and policies that come together to
work effectively in intercultural situations.
• Cultural care: In terms of health care, cultural care is the
delivery of services that are culturally sensitive and culturally appropriate; it involves the provision of health care
across cultural boundaries, taking into account the context
in which the patient lives as well as the situations in which
the patient’s health problems arise.
• Acculturation: The process of adapting to another culture
and/or acquiring the majority group’s culture.
All of these terms are important to consider and understand
when investigating the vast array of variables associated with
attaining cultural competence.
Culture and Health
There is a seemingly endless collection of factors that influence
culture. Race and ethnicity are only part of a person’s cultural
heritage. As shown in Figure 2, everything from a person’s
age and gender to place of birth, length of time living in this
country, and socioeconomic status greatly influence a person’s
culture. Culture is analogous to a rich tapestry, intricately woven with religious beliefs, personal and shared values, actions,
communication nuances, laws, and other variables. Learning
about cultures can be difficult and inconsistent, as is the artwork of a tapestry—it is beautiful on one side, but when turned
to reveal the underside, imperfections and inconsistencies can
be observed in the workmanship of the piece. The caveat that
accompanies learning about cultures is the recognition that
there is as much variation within cultures as there is between
them7 and this should always be part of the thought process
when learning about cultural groups.
As with culture, the concept of health itself can also have
Cultural Competence in
different meanings for different population groups. The World
Health Organization (WHO) defines health as “a state of com-
plete physical, mental, and social well-being and not merely the
absence of disease.”
4 Who we are and our beliefs about health
often have much to do with our personal world view, which refers
to one’s basic assumptions about the nature of reality and human
behavior. People from different cultures view the world, health,
and illness with different sets of beliefs, values, and attitudes,
with multiple ways of attempting to achieve a healthful state. A
nonjudgmental, open-minded approach is necessary in the quest
for cultural competence as health
care providers care for patients with
differing perceptions regarding what
constitutes their own healthful state.
As in all of society, cultural competence has become of utmost importance in our health-care system,
discussed in landmark works and
documents such as “Healthy People
2020,” the report on disparities by
the Institute of Medicine and the
oral health report by the Surgeon
8, 9, 10 The emphasis is not
the attempt to know all of the health
practices and cultures of all groups of
people but the awareness of general
differences as the starting point to
build insight and provide appropriate
health services. The Office of Minority Health within the US Department
Figure 1: Definition of race categories used in the 2010 Census.
White refers a person having origins in any of the original peoples of Europe, the
Middle East, or North Africa. It includes people who indicated their race(s) as “white”
or reported entries such as Irish, German, Italian, Lebanese, Arab, Moroccan, or
Black or African American refers to a person having origins in any of the black
racial groups of Africa. It includes people who indicated their race(s) as “Black,
African Am., or Negro” or reported entries such as African American, Kenyan,
Nigerian, or Haitian.
American Indian or Alaska Native refers to a person having origins in any of
the original peoples of North and South America (including Central America) and
who maintains tribal affiliation or community attachment. This category includes
people who indicated their race(s) as “American Indian or Alaska Native” or reported
their enrolled or principal tribe, such as Navajo, Blackfeet, Inupiat, Yup’ik, or Central
American Indian groups or South American Indiangroups.
Asian refers to a person having origins in any of the original peoples of the Far
East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia,
China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and
Vietnam. It includes people who indicated their race(s) as “Asian” or reported entries such as “Asian Indian,” “Chinese,” “Filipino,” “Korean,” “Japanese,” “Vietnamese,”
and “Other Asian,” or provided other detailed Asian responses.
Native Hawaiian or Other Pacific Islander refers to a person having origins
in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. It
includes people who indicated their race(s) as “Pacific Islander” or reported entries
such as “Native Hawaiian,” “Guamanian or Chamorro,” “Samoan,” and “Other Pacific
Islander” or provided other detailed Pacific Islander responses.
Some other race includes all other responses not included in the White, Black or
African American, American Indian or Alaska Native, Asian, and Native Hawaiian
or Other Pacific Islander race categories described above. Respondents reporting
entries such as multiracial, mixed, interracial, or a Hispanic or Latino group (for
example, Mexican, Puerto Rican, Cuban, or Spanish) in response to the race question are included in this category.
Source: 2010 Census Briefs, US Census Bureau, 2011.
Figure 2: Factors
that influence culture.
• Place of birth
• Religious beliefs
• Sexual preference
• Socioeconomic status
• Power relationships
• Educational attainment
• Length of US residency/
• Individual experiences