Posted by: Tina M | 16 November , 2009

Term of the day: “Cultural Humility”

Today was wholly unremarkable, except that it was a shitty day at work and I learned a new term. Cultural Humility. It’s apparently the next step in the lingo of a capitalist version of anti-racism. You know what I mean. It was the Cultural “sensitivity”, then it was Cultural “competency,” and here is the new solution to the same problem of good intentions and very little positive output. . . Cultural Humility. . .

So I’m interested in what impact this linguistic twist might have on the state of our communities.

Cultural sensitivity was doomed from the start. Don’t get me wrong, it was a good start. The goals that were defined seemed appropriate-

“Cultural sensitivity means being aware that cultural differences and similarities exist and have an effect on values, learning, and behavior.”

Stafford, Bowman, Eking, Hanna, & Lopoes-DeFede (1997)

When you consider that it’s framed within the field of medicine it seems like a noble pursuit. People aren’t getting the treatment they deserve because there are cultural differences that grant privileges to one group over another.  An easy example would be language barriers – If a community can’t understand your resources or your staff- they aren’t going to be able to access those services.

What the authors of Cultural Sensitivity didn’t take into account was that people didn’t hear “Cultural  Sensitivity” as defined above. They heard “Cultural” “Sensitivity.” This would be the combination of cultural and sensitive which is either characterized by being touchy about culture, being a wussy when people make jokes, being delicate in regards to anything having to deal with those uncomfortable topics, or some other combination full of heavy meaning assigned by mainstream oppressive society. How are you going to really get anyone to invest seriously in understanding their experience of privilege and power in the world, if they’re going to become a “sensitive” person. In our capitalist society of eat or be eaten, why would you want to be any more vulnerable?

Cultural Competency: The next attempt to wrap our heads around the complexities of culture, racism, and xenophobia. Suddenly there was an easy to use instruction manual! Sure, you’re incompetent now, but with a little bit of studying you’ll be on the path of being cool cross-culturally!

I think that this was doomed because there simply is no way to become “competent” in someone’s culture. If you think you’re competent, just stop and ask yourself how many assumptions you’re making and what (if any) critical thought you’ve put into this characterization, and why you’re making this characterization in the first place (If it’s for their benefit, consider yourself incompetent and start listening more!)

So here we are, with Cultural Humility.

“Cultural humility has been described by Melanie Tervalon and Jann Murray-Garcia as a lifelong process of self-reflection and self-critique. Cultural humility does not require mastery of lists of “different” or peculiar beliefs and behaviors supposedly pertaining to certain groups of patients. Rather, the provider is encouraged to develop a respectful partnership with each patient through patient-focused interviewing, exploring similarities and differences between his own and each patient’s priorities, goals, and capacities. In this model, the most serious barrier to culturally appropriate care is not a lack of knowledge of the details of any given cultural orientation, but the providers’ failure to develop self-awareness and a respectful attitude toward diverse points of view.”

I think that this is really well written, but I think it’s only the beginning of the discussion. we need to explicitly say that “failure to develop self-awareness and a respectful attitude toward diverse points of view”  is not an option as a responsible member of our global community.  The conversation fails to honestly engage with the power dynamics at play in these situations and the direct impact it has on the patients life.

If you are a white doctor and you don’t have an understanding of the way that whiteness affords you many privileges already and that compounded with the inherent power you have as a medical professional- you won’t know how to treat the patient. (pun intended)

If you don’t understand the way that your privilege has allowed you to navigate the world easier than someone of a different “culture” [read: class, race, physical ability, gender, age, sexuality, body size] then you are actively participating in a destructive system that kills members of our communities.

And it’s not a slow death, it’s a death of deterioration caused by chronic societal abuse. It’s the slow internalization of prejudice, the lonely disempowerment of “otherness,” and it leads to health inequalities that result in far too many early deaths.

I know it’s a bit extreme to describe it as such, but how else are you going to get the profiteers to help destroy the system that supports them?

Cultural Humility, I appreciate the progress you will make during your reign in our business lexicon. . . but I’m sticking to Anti-Racism and Anti-Oppression, because there is a system that needs to be dismantled. And THAT is the future that I dream of.



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