Cultural Competence in Heath Care Policy & Law

Instructor: Patricia Jankowski

Patricia has a BSChE. She's an experienced registered nurse who has worked in various acute care areas as well as in legal nurse consulting.

Since a person's cultural background may affect whether or not he or she benefits from healthcare, cultural competence is an important aspect of healthcare delivery. This lesson will discuss cultural competence in healthcare policy and law.

Love What We Are

''People of different religions and cultures live side by side in almost every part of the world, and most of us have overlapping identities which unite us with very different groups. We can love what we are, without hating what - and who - we are not. We can thrive in our own tradition, even as we learn from others, and come to respect their teachings.'' - Kofi Annan, Former Secretary-General of the United Nations

There may not be a more crucial time to recognize the importance of cultural differences in people than when they are ill. A patient may suddenly find himself forced into an environment of strangers from a world very different than his, yet upon whom his life may depend. Whether or not this patient can heal in this strange new world depends a lot on the cultural competence of the healthcare that is delivered to him.

Culturally competent healthcare is effective healthcare
cultural competence

What Is Cultural Competence In Healthcare?

Cultural competence in healthcare refers to the ability of practitioners in the system to address the health issues of people from diverse backgrounds effectively by applying knowledge, empathy, and insight into the views on health that those backgrounds present. The term ''culture'' refers to many different things, and it can include race, ethnicity, gender or transgender status, age, economic status, or disability status. The language spoken by a patient or his literacy status can also be factors the effectiveness of treatment delivery.

Part of the insight that is required to create a culturally competent healthcare system is the recognition of cultural and/or racial bias among practitioners. An objective, respectful approach to patients is crucial to cultural competency, and both practitioners and healthcare delivery organizations must be willing to provide enough access to healthcare for members of minority groups.

Ensuring Cultural Competency in Healthcare

Laws, accreditation standards and advocacy groups have been created to develop a more culturally competent healthcare system.

Federal and State Laws

Laws have been written to aid in resolving the healthcare disparities that exist in the U.S. for people of minority ethnic and racial backgrounds. These laws, both state and federal, often extend into the area of cultural competence, and some specify how practitioners and institutions should increase healthcare access and improve its quality for these minority groups.

Title VI Of The Civil Rights Act of 1964

Title VI of the Civil Rights Act of 1964 stipulates that no citizen may be denied the benefits or services of any program, healthcare or otherwise, that receives federal funding, because of discrimination based on color, race, or national origin. Programs that are in any way funded by the Department of Health and Human Services, or HHS, must also provide interpreters for patients who do not speak or understand English.

New Jersey Senate Bill 144

New Jersey has led the way in creating cultural competence in healthcare. Senate Bill 144 was passed in March of 2005, requiring doctors to have training in cultural competence as part of their curriculum before they can be licensed. Other states have followed since then, with similar legislation.


Medicare is a national health insurance program designed to cover health services for the elderly, or those age 65 and over. Medicaid is also a national program that delivers health care services to low income people and their children. Historically, Medicare and Medicaid have not covered culturally competent services such as language interpreters, but as of 1999, some states did start to offer written materials in different languages and some interpreters.

In April of 2011, more progress was made. As stated in a report from the National Center for Benefits Outreach and Enrollment, the Centers for Medicare and Medicaid Services ''adopted a final rule that requires Medicare health and prescription drug plans to translate marketing materials into any language that is the primary language of at least 5% of individuals in a plan benefit package service area.''

The OMH National Standards for CLAS In Healthcare

The National Standards for Culturally and Linguistically Appropriate Services, or CLAS, in Health and Healthcare is a set of standards compiled by the Office of Minority Health that are designed to provide a template for delivering culturally competent healthcare. These standards, to be adopted by organizations in each state, are not technically laws but are in sync with legislative requirements. They specify how the leadership and employees of an organization can work toward delivering this type of care, with an emphasis on education. The final standards became available in 2013.

Although these laws may often be difficult to enforce, efforts are ongoing to increase awareness of them, and program funding is withheld when it is found that they have been violated.

Professional and Accrediting Organizations

Professional and accrediting organizations have also adopted policies with the goal of helping providers to be culturally competent.

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