CULTURAL COMPETENCY IN HEALTH
Cultural competency is more than awareness of difference
As you progress through your degree, you will learn about cultural competency and how it relates to
healthcare generally and to your particular discipline.
You will see from this infographic provided by the Australian Commission on Safety and Quality of
Healthcare, that knowing your patients is one of the key elements of health literacy for clinicians.
The systemic ways in which dominant culture is embedded means that cultural competence needs to
go beyond the individual willingness and ability to recognise and respond sensitively to cultural needs;
it needs to have a methodical approach that allows health professionals, communities, organisations
and policy makers to build cultural competence into every level.
So, it’s more than awareness of difference, it’s about culturally competent approaches to the delivery
of health services to provide high quality care that improves the health of our communities.
Cultural competency goes beyond just knowing your patients, to the “behaviours, attitudes and
policies that enable systems, organisations, professions and individuals to work effectively in cross-
cultural situations” (National Health and Medical Research Council, 2006, p.15).
HLTH1000 1
CULTURAL COMPETENCY IN HEALTH
A cultural competency model for health
Australia is a diverse country and everyone who lives in it has a right to healthcare that meets their
needs. What can you do? Understanding your patients and clients and taking culturally-appropriate
approaches to your practice will ensure that you are contributing to the provision of culturally-
competent healthcare.
The National Health and Medical Research Council (2006) has developed a model for cultural
competency in health that covers four domains - systemic, organisational, professional and
individual. At an individual level, as a health professional you can develop your knowledge of cultural
competence and adopt behaviours and attitudes that put this knowledge into action. Even at a basic
level, you should understand the possible impact of the cultural and linguistic diversity of your patients
and clients on your practice - as part of being health literate - and adapt what you do to meet the
needs of the diverse people you will be treating and supporting.
Student Notes
2006 National Health and Medical Research Council:
If you are interested in examining the 2006 National Health and Medical Research Council model
for cultural competency further you can click on this link: www.nhmrc.gov.au
A wide range of cultures and subcultures
We know that Australia is a multicultural country. In addition to the range of cultures that are
represented in our country, there are cultures and subcultures that are non-ethnic based which may
have their own significant and unique needs, such as the deaf community or the LGBTQI community.
It's important therefore to consider how different cultures may approach their health, the challenges
that may be present in addressing the health needs of diverse people, and how their past experiences
with the health system may impact on how they interact with you as a health professional. This is all
part of person-centred care and health literacy.
It is also of value to recognise that groups of people are rarely homogeneous. There are many
variations possible within any one cultural perspective. This is true even if other core beliefs or traits
are held in common. Differences within a cultural group can include those created by generation,
education, class, wealth, ethnicity biases within the cultural group, attachment to traditional versus
modern belief systems, and language proficiency (including fluency of English). Each person must
then be considered individually rather than with any preconceived notions of identity. In addition, a
person may identify with more than one culture with varying degrees of interplay between the
cultures. Or he or she may not identify with their culture at all.
As health professionals, it is essential that you are able to understand not just how these lenses may
affect your patients and clients, but also how you are affected by your own lens.
HLTH1000 2
CULTURAL COMPETENCY IN HEALTH
Here are some key areas where culture may have an effect on the way that you approach your
practice:
1. Trust in health professionals
Some cultures have a high regard for health professionals while others have historical and
ongoing precedence that creates mistrust. Low trust reduces likelihood of access to community
and health services. In 2013, 30% of Indigenous and Torres Strait Islander Australians said they
avoided access to healthcare when they needed it. Reasons for this included discrimination and
mistrust of the service or provider (Department of the Prime Minister and Cabinet, 2014). Newly-
arrived migrants often have a lack of knowledge of how the Australian health system works and
may fear that their specific cultural needs may not be acknowledged or supported. Be aware that
refugee pre-migration experiences may include war, torture, trauma, political instability, all of
which may affect an individual's trust of health professionals and heighten the range of special
needs for this population (Russell et al, 2013).
For LGBTQI people, the history of maltreatment by health professionals and the medicalisation of
sexual and/or gender orientation has left a traumatic legacy. The National LGBTI Health Alliance
has outlined a range of strategy principles to deal with the overrepresentation of LGBTQI people
in suicide and mental health statistics. This includes the concept of lived experience in which
LGBTQI people and communities are acknowledged as the experts in their own lives. It accepts
that these lives have been shaped by personal and cultural history of both stigma and resilience
(National LGBTI Health Alliance, 2016).
Student Notes
Terminology:
We have highlighted earlier the importance of words and their effect on health and wellbeing. This
also applies with the letters included (or not included) in the acronyms used by people who identify
as lesbian, gay, bisexual, transsexual, queer, questioning, intersex or asexual. If you would like to
explore this further you can click on these links, which include University of Queensland links.
• ABC News, LGBTQIA glossary: Common gender and sexuality terms explained
• Huffpost, Why We're Adding the Q to LGBT
• UQ links:
o UQU Queer Collective
o Ally Resources
2. Causes of illness and ideas of health
Ideas about what causes illness can vary greatly across cultures. In traditional Chinese medicine,
the concept of balance of yin and yang forces and the consequences upon life energy or chi are
central tenets. The concept of karma in Hinduism can also be linked to attitudes to illness or
disease. In Indonesia, spiritual or magical influences may be seen as causing disease or
wellbeing issues. There is also a common concern about ‘masuk angin’ or the amount of wind
trapped in a body.
These underlying beliefs may cause a person to seek traditional treatments alongside or instead
of modern Western medicine. Beliefs can also cause treatment to be delayed if the person
doesn't immediately interpret their symptoms as being something solvable by Western
medicine. Effort instead may go into bringing spiritual or other culturally defined forces into
balance. In some countries those with disease or disability may be maltreated or neglected if
these symptoms are seen as a sign of something induced by the person themselves.
Where possible, it is important to build non-judgmental awareness of traditional remedies and
illness origin beliefs used by a patient or client.
3. Lack of representation
Lack of representation of various cultural groups can affect that group's engagement with health
professionals. For example, the number of registered medical practitioners in Australia in 2015
HLTH1000 3
CULTURAL COMPETENCY IN HEALTH
was 102 805. Statistics from 2014 record only 205 Indigenous medical practitioners. This lack of
representation can have a serious effect in a group who may already have a mistrust of health
professionals (The Australian Indigenous Doctors’ Association, 2015).
In response to this, the Australian Indigenous Doctors’ Association has created a cultural toolkit
on their website which provides a list of educational online resources designed to increase
cultural safety. They define cultural safety as “the accumulation and application of knowledge of
Aboriginal and Torres Strait Islander values, principles and norms.” (The Australian Indigenous
Doctors’ Association, 2015)
This concept of cultural safety could be applied and extended to other cultures who may not have
representation in your field, but who may be represented in your patient groups or clientele.
4. Language and literacy barriers
Lack of representation is even further impacted when there are language and or literacy barriers.
As we mentioned in the topic on individual health literacy, culture, language and general literacy
all have an impact on health literacy and this extends to the way in which health professionals
interact with patients and clients generally.
Vocabulary: Discussions concerning disease and physiology have a specialised vocabulary that
may elude even a person fluent in conversational English. This can lead to patients or clients to
either appear to not understand the language used to describe their illness or to have the patient
or client appear to understand in an effort to hide the misunderstanding. Support to deal with this
issue may come from a family, friend or translator who is able to ensure clear communication
received by both the health practitioner and the client.
5. Complexity of language
Language is more than simply being able to speak the words of another language. It is the ability
to use a system of communication of which words are only a part. Gestures, sounds and
symbology all have the capacity to create meaning in a language system.
For example, curling the pointer finger with the palm facing up is considered rude and aggressive
in many countries including the Philippines, China and Singapore. Prolonged eye contact, while
seen as a sign of attentiveness in many European cultures, can be considered a sign of bad
manners in a variety of Asian, African, Latin America and some Australian Indigenous
cultures. Using your left hand to shake hands, eat or pass something is highly offensive in many
Muslim and Hindu-based cultures. These non-verbal communication cues can unintentionally
create friction between a health professional and a client.
6. Literacy
Any printed transmission of information relies on a level of literacy. If a client is not literate in the
language that the health information is being transmitted within this can have an impact on
compliance (it’s hard to follow instructions you cannot fully understand them), comprehension of
documents, confidence (both in self and in the health professional) and trust.
It’s important that health professionals be able to recognise illiteracy and to tailor communication
for people with limited literacy. Where possible communicate plainly in the person’s language via
a translator, family or friend; use words and examples that make the information understandable;
find a way of checking if this information is received fully.
HLTH1000 4
CULTURAL COMPETENCY IN HEALTH
7. Gender and family roles
In some cultures gender division may create specific needs. For example, Middle Eastern women
may feel concern that they could be treated by a male health professional. Some practices now
highlight the genders of their practitioners to make this easier on the client.
Student Notes
The 10 myths of cultural competency:
If you are interested in following up a bit more on this cultural competency and diversity topic you
may like to read this list of 10 myths. Each myth is clearly outlined and then busted. This gives you
good clear knowledge of how to speak to these myths and even to see if you believe any of them
yourself. Although this is a link to a US federal agency, the National Council on Disability, the
myths easily apply in Australia as well: www.ncd.gov
Cultural toolkit:
If you would like to read more about cultural safety you can click on this link to access the
Australian Indigenous Doctors’ Association cultural toolkit: https://www.aida.org.au/wp-
content/uploads/2015/03/Cultural-Safety-Toolkit1.pdf
Closing the gap:
It is also worth taking a look the paper on cultural competency in the delivery of health services for
Indigenous people from the AIHW: www.aihw.gov.au/ClosingTheGap
HLTH1000 5
CULTURAL COMPETENCY IN HEALTH
Sources:
• Health literacy for clinicians. (Australian Commission on Safety and Quality of Healthcare,
2015).
• National Health and Medical Research Council, Australian Government. (2006) Cultural
Competency in Health: A guide for policy, partnerships and participation. Retrieved from
https://www.nhmrc.gov.au/guidelines-publications/hp19-hp26
• National Health and Medical Research Council, Australian Government. (2006) Cultural
Competency in Health: A guide for policy, partnerships and participation. Retrieved from
https://www.nhmrc.gov.au/guidelines-publications/hp19-hp26
• Department of the Prime Minister and Cabinet. (2014) Closing the Gap: Prime Minister’s
annual report to Parliament on progress in Closing the Gap. Retrieved from Closing the Gap
website http://closingthegap.pmc.gov.au/
• Russell, G. et. al. (2013). Coordinated primary health care for refugees: a best practice
framework for Australia. International Journal for Equity in Health, 12:88. doi: 10.1186/1475-
9276-12-88
• National LGBTI Health Alliance. (2016). 2016-2020 Strategic Plan: Health and wellbeing for
lesbian, gay, bisexual, trans, intersex [LGBTI] people and sexuality, gender, and bodily
diverse people, and communities throughout Australia. Retrieved
from http://lgbtihealth.org.au/about/our_strategic_plan/
• Australian Indigenous Doctors’ Association. (2015) Cultural safety factsheet [Factsheet].
Canberra:, ACT. Retrieved from https://www.aida.org.au/wp-
content/uploads/2015/03/Cultural-Safety-Factsheet1.pdf
• Australian Indigenous Doctors’ Association. (2015) Cultural safety toolkit1 [Toolkit].
Canberra:, ACT. Retrieved from https://www.aida.org.au/wp-
content/uploads/2015/03/Cultural-Safety-Toolkit1.pdf
• Common Myths About Diversity and Cultural Competency. (2006). Retrieved from
https://ncd.gov/publications/2006/june2006
HLTH1000 6
