What does cultural competence look like?

I have long maintained that teaching cultural competence through the use of fact-learning about specific populations is deeply flawed and limits thinking.  You know, those books with the special sections on “African Americans,” “Asian Americans” and “Hispanic Americans.”

There are times when I think some facts about specific cultures are useful.  For example, I think it’s helpful to know that some people don’t wear shoes inside the house.  But you wouldn’t need to know that little factoid if you were an observant sort.  And even if you were not, you could simply gracefully remove your shoes when asked.

I used to naively believe that educated people were less racist.  Instead I found they are simply representative of the population at large.  In fact, sometimes they are more racist simply because power and privilege blind them.  Similarly, cultural competence has little to do with formal education.  I used to think that cultural competence has to do with exposure, but now I don’t believe that either.

This article is about a UCF professor who was allegedly terminated because she objected to the stereotypes in a book about culturally competent care.  The authors of the text defended their work, saying as follows:

Paulanka said she believes the statements mostly hold true to new immigrants and their native culture, and said she can see how others who have lived in the U.S. for a long time would take offense to the material.

“I can see it because if I was totally Americanized and I grew up in a very American neighborhood and people were saying this is what I thought, I would find that offensive,” Paulanka told Reuters. “But it’s true if you go back to the native culture.” She added that the material was written by either an expert of the culture or a native of the group.

Purnell, the book’s co-author and a faculty member of the University of Delaware’s nursing department echoed Paulanka’s defense of the material, telling Reuters, “Culture is very sensitive. The statement may be true but that doesn’t mean they like it. It’s true for the group, not for the individual.”

Ooookay. In addition, the book won an award in 2005! The American Association of Colleges of Nursing uses part of the text! And of course, it’s a best seller! Because everybody knows the majority endorses anti-racism and cultural competence. Uh huh.

Edited to add: You can read some of the text excerpts here (pdf link).

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26 thoughts on “What does cultural competence look like?

  1. I am always taken back by the fact that some of the most “enlightened” and educated people I know are also quite prejudice and say some of the most racially questionable things. Many of them comfortably live within and freely reaping the benefits of their privilege and get defensive when someone asks them to take responsibility and be accountable for their inherited privilege. It’s not as overt and is often couched in benevolent behavior, which is why I think it often goes unnoticed or we give “benefit of the doubt” where it really isn’t warranted. I think it’s precisely these individuals who need to be called out for their attitudes, words and behaviors, because they truly believe they are doing good things, when they are actually part of the problem.

  2. I as assigned similar reading in my med school cultural competence class, and I complained because they were basically just asking us to learn stereotypes and act accordingly, instead of actually engaging with people. I found it reductive and offensive.

  3. Ok. If “the statements mostly hold true to new immigrants and their native culture”, wtf does that mean for African Americans??? (Who are “largely the descendants of African who were forcibly brought to this country as slaves”)

    Seriously – WTF does THIS mean?
    Food may be negatively perceived in the context of witchcraft. It is thought that witchcraft promotes intentional poisoning of food.

    I am so blown, I have no words.

    Cultural competence is clearly akin to watching fish in a tank and ascribing attributes based on visual cues, and the inventive dialogue supplied by an observer with an overactive imagination and the idea that they can communicate with fish.

  4. I just came back from the holy mouth man. ;-D

    I wonder how long it will take to move away from this model of “cultural competence” training. What’s worse, this is often what people expect and demand.

  5. I love the story of the Nacirema! I remember being in class with people who truly believed in them as an ancient backward people, trusting in medicine men, above all else, going to the latipso to die…

  6. “According to Nacirema mythology, their nation was originated by a culture hero, Notgnihsaw, who is otherwise known for two great feats of strength – the throwing of a piece of wampum across the river Pa-To-Mac and the chopping down of a cherry tree in which the Spirit of Truth resided.” LOL!!!Pa-To_Mac!!!!

    I wish something could be written, for educator’s too, that doesn’t read like describing people in a zoo. Notice how that book has a section for European=Americans and then special sections for the “other” whites, Irish, Italian, Jewish, Greek, this book reads like it was written by Stormfront types.
    I still can’t believe some of the stuff in that excerpt. Wow, what a disaster.

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  8. I am currently engaged in collaborating with a group of organizations that is working to develop training modules and support tools that break this mold. If any of you know of resources for training on diversity and cultural competence that does NOT look like this, please share them with me. Thanks!

  9. “She [Paulanka, one of the book's authors] added that the material was written by either an expert of the culture or a native of the group.”

    The linked excerpt about African Americans was terribly simplistic. “Terrible” is the word that best describes it. (Btw, I’m African American. So by the author’s viewpoint, I’m at least a “native of that group” if not an expert on that group).

    I wonder what in those authors’ opinion makes a person an “expert of the culture”? And just because a person is “a native of the group” doesn’t mean that she or he knows much of anything about the group, or that she or he is able to convery information about the groups’ customs and beliefs in culturally competent ways.

    From the excerpts I read, it seems to me that those authors treated groups as monoliths, without regard to geographical region, age, gender, gender orientation, religious affiliation etc. Also, the authors seem to have an either/or mindset. For example, according to them only young African Americans use the referent “African American”, older African Americans use the referent “Negro or Colored”, and middle age African Americans call themselves “black”. Hmm.

    First of all, I didn’t see any notation of which age range the authors think comprises “older”, “younger”, and “middle age”. But what gets me is that the authors act like race and/or ethnicity cause people to be fixed in their language use (and in their behaviors & beliefs). I’m an older African American who remembers when “Negro” (with a capital “N”) and “Colored people” (with a capital “C”) were the appropriate referents. I now use both Black (with a capital “B”, though I recognize that capitalization is optional) and (more formally) African American (always with capital A’s). And I’m aware (if the authors aren’t ) that the category “Black” can include many more people than the category “African American” does (Have the authors ever heard of Africa and the African Diaspora?) . As I said before “Hmm”.

    That’s just one example of how much of a FAIL that text is. I wonder who previewed this book? If it was a bunch of “experts of the group” or “natives of the group”, they need to hang their heads in shame forever and ever more.

  10. “many tend to be high-keyed, animated, and confrontational” this document is some of the most racist shit I have ever read. It is like they studied black people by analyzing Sha Nay Nay from the tv show Martin.

    “Being overweight is seen as positive” UM NO

  11. First off, it’s “cross-cultural competence”. I understand the anger and the bemusement expressed here, but this post and comments completely omit the key distinction between archetypes and stereotypes, which is caveat #1 with this kind of learning/training.

    We can use the example of African Americans. African Americans, as a group, TEND to value direct communication (“saying what you mean”) more than Anglo-Americans. Does that mean that ALL African Americans are more direct communicators than ALL Anglos? No, of course not. And if I’m a cultural outsider, I shouldn’t be (or act) “surprised” when an African American doesn’t fit this archetype…. But if I’m a white doctor from Iowa, working in inner-city Chicago, around African Americans for this first time in my life, it might be valuable to know these types of trends and tendencies… particularly the first time that someone is very “blunt”, which to my white Iowan ears might be “rude” or “disrespectful”.

    …Of if you’re an immigrant or exchange student coming to the United States for the first time; it might be beneficial to know that Americans, as a group, TEND to value lots of personal space, and individual freedom over collective welfare. Do ALL Americans share these values? No, of course not, but it’s not “racist” to identify these kinds of trends. We’re talking about culture here, not race or ethnicity. Race and ethnicity DO often correlate with culture, but not always. And there are certainly wide variations along subcultural lines as well. I know Anglos in Chicago who feel much more comfortable around African-Americans, and vice-versa, likely because they find the cultural values of the group more akin to their own personal values.

    Mitch Hammer and Milton Bennet have made whole careers out of surveying and charting the cultural trends of different populations. It’s not racist to acknowledge these kinds of differences; to me, it’s much more damaging to pretend that everyone’s the same, and that we should all be treated the same. The “Platinum Rule” that is talked about in a lot of cross-cultural training programs, is: “treat others they way THEY want to be treated”, not the way YOU want to be treated. Archetypes help us get at what this ideal treatment would be… though of course there’s no substitute for having an actual conversation with folks from other cultures, which is the real goal of cross-cultural training, to build bridges, and work better together.

  12. panvega asked
    “What does lead to cultural competence? (serious question)”

    My partial response to this question is that striving to be culturally competent means assessing oneself and immersing oneself in part/s of culture you want to be competent in. That immersion can be indirect (via online blogs for example). But, for the most part, direct experiences can be much better than indirect experiences.

    For example, I’m an African American who is trying to learn more about jazz. I didn’t grow up with jazz music. I think it’s something that is foreign to me though I know that a lot of jazz musicians/vocalists are Black. But that doesn’t mean that I would feel competent in any interactions with African American jazz musicians/vocalists. First off, I realize that I know that I don’t know.

    Secondarily, I’ve recognized that my thinking about jazz is stereotypical. I think I know it but I realize that I don’t. Also I’ve come to realize that I have negative opinions about jazz. I think (or at least used to think until I really listened to it) that jazz was boring, and too highbrow, too complicated, not something that I could understand, and not at all the type of music that I could identify with.

    But then, for some reason or another, I begin to listen to jazz recordings and watched jazz performances (via YouTube). And I realized that I don’t really know what jazz is and what jazz was (for I saw that in some ways it had changed and in some ways it had stayed the same). I also realized that I had heard examples of jazz-on tv, in the movies, and in my “real life”, and didn’t recognize them as being jazz. I realized that I didn’t know and I also realized that I wanted to know.

    In addition to watching YouTube jazz videos and reading those video’s viewer comment threads, I started to put forth an effort to learn more. I googled online resources on jazz, and read some books on jazz that I borrowed from the public library. I also began introducing the subject of jazz with people I felt comfortable with. And-some of them knew something about jazz-and I began to learn some things from their experiences. And I’ve decided to listen to jazz radio while I’m driving in my car, and even-and this is a big step for me-go to some live shows.

    Early on, I’ve found that there are some jazz categories that I perfer more than others, and some types of jazz that I don’t like at all (at least not at this stage of my experiences). I don’t expect to ever know all there is to know about jazz. I realize that’s not possible even if I were to learn how to play an instrument or sing for myself let alone sing professionally. As I don’t plan to do that, I know that I’ll never REALLY know jazz. But then again, I don’t think that anyone-even the greatest jazz artists or jazz composers can ever fully know all that jazz is about. I’m just being open to learning & experiencing (and enjoying, and being inspired, and not liking, and being real turned off by some facets of jazz). And I think that being so and doing so is at least part of what striving to be culturally competent is all about.

  13. Thanks for the reminder about *cross*-cultural competency. It made me sit and have a little think about how even the language we use to talk about this type of work normalizes the white or mainstream service provider–someone who only needs to gain competence in the “other” culture, while our own culture remains unmarked. I will keep that in mind.

  14. I took a seminar/workshop/thingy with a man named Nehrwr called “Awakening the Intercultural Self” a month or so ago that talked about how cultural competence (or, I suppose, even cross-cultural competence) is a flawed model to begin with, because it assumes that one can ever be fully competent with regards to a single culture, or that any one representative of that culture has the authority to represent all of it. He proposed instead that we work toward intercultural confidence – learning adaptivity, and de-centeredness, fluidity, in order to work meaningfully with one another. His model calls for true acceptance, rather than tolerance, of others.

    I’m probably bungling it all up (which is why I provided the link to his page), but I did rather like where that model was headed; the idea of cultural competence has always bugged me, and his model seems like a wonderful alternative.

  15. As a white American woman who has lived in Japan for about 14 years (yeah, I know that doesn’t make me an expert, it’s just to say where I’m coming from…), I read through the section on Japanese people in the pdf of book excerpts that was linked in the original post…

    The main section had some valuable points about Japanese culture, but was likely not as relevant to Japanese-American culture, and of course the “Japanese” patients encountered by US medical professionals would most likely be Japanese-Americans.

    One part I appreciated and agreed with was the warning to “Be aware of Japanese family sleeping practices and refrain from judgmental evaluation”. This is the sort of area where cross-cultural awareness is really valuable. It’s true that many, many Japanese families (within Japan) sleep all in one room, and I can imagine a US healthcare professional hearing this from a patient, and thinking there was something wrong with that… this could lead to various uncomfortable conversations or worse. However, this is likely not relevant at all to Japanese-American families, which is not mentioned (at least not in the pdf).

    The long paragraph about geisha was pretty bizarre… is this just in case the patient announces that they work as a geisha??? Hmmm… :/

    But on the whole I felt it was a bit stereotypical, but not inaccurate, at least in regards to Japanese culture (NOT Japanese-American).

    The part that really annoyed me was the last part, describing the supposed physical characteristics of Japanese people – that they have a “broad and flat nose”, “‘yellow’ skin” (for some reason yellow is in quotes), and hair that is “straight and naturally black”. This is really going to town with the stereotyping… for one thing, I rarely see people in Japan whose skin could be described as “yellow”. And there is a huge range of nose shapes. And it is not uncommon at all to meet people with naturally brown or dark brown hair, or naturally wavy or even curly hair – I know many such people – and yes I mean people who have NOT chemically altered their hair. Why bother “educating” people on issues like this if you are only “teaching” them the tired old stereotypes they already know, and not informing them that those stereotypes are just stereotypes!!! This part really sounded like it was written by some random person, NOT an expert or “native of the group”.

    Basically, my impression is that this particular book contains way too much rubbish and should be discontinued, but that there IS a need for some of the information in the book to be taught (for example, not to be judgmental of unfamiliar practices such as family co-sleeping throughout childhood) — but it should be taught in a much better-informed and better-written way!! It’s ridiculous when people go to the effort to make a book such as this, but fill it with so many inaccuracies and a lack of qualifying information, etc…

  16. your statement that you no longer believe that cultural competence has to do with exposure is intriguing, if a bit puzzling, to me. i’m wondering if you might expand on this a bit. your assertion is antithetical to what i have come to believe through experience, observation, reflection, and study. perhaps i’m missing something….

    here’s where i’m coming from: i think cultural competence has a lot to do with exposure to cultures and worldviews that differ from one’s own. that exposure can take many forms — travel, reading, living/working in an economically and ethnically diverse environment, even participating or studying ethics or religion practices, such as those of buddhists or quakers, that emphasize ethical relations between humans and other beings. exposure might even come in the form of contact with someone else who has begun to work through their own privilege, racism and ethnocentrism; a teacher, perhaps, or some other mentor who can show them another way of thinking that they had not considered before.

    it seems to me that cultural competence cannot be cultivated in a vacuum, nor can it somehow spring from one’s forehead like athena from zeus. how can cultural competence develop, if not through the painful process of trial and error in interactions with people who see the world differently than one does? in your experience of the world, does cultural competence ever arise without exposure, and if so, what does that process look like?

    thank you for your post.

  17. I got a chance to briefly skim the book, so I looked at the sections about Chinese and Japanese Americans. Neither mentioned how these groups have been in the country for generations. Seriously, I know adult fifth generation Chinese Americans. And recently I heard that there are Japanese American groups self-referred to as “shin-issei” and “shin-nisei” to distinguish from the first generation (who arrived in the early 1900′s) and the second generation born here before the war.

    Anyway, I don’t believe that “exposure” necessarily creates competence. Short answer, I know lots and lots of white people who regularly show up in my cultural groups who are shockingly, horrifyingly non-culturally-competent and racist. Long answer later.

  18. @island girl
    What resistance just said. The problem with having an almost religious faith in ‘exposure’ is that too often, people want to treat cultural exposure as if it were a magical panacea that will overcome all cultural ignorance, obstacles, awkwardness and will above all, ‘transcend’ outsider status; almost as if, once you read a little (or a lot), travel and talk to a few native or locals you’re “set” and you will thereafter move from culture to culture with complete grace, fluidity and ease just like a local or native, thus garnering you insider status. But that is just a childish fantasy (like the white kid who dreams of being embraced and adopted by Native American Indians, marrying the princess and leading ‘the tribe’ to victory)

    Reality simply doesn’t work in this manner.

    It takes a certain degree of humility to realise that no matter HOW much you study or ‘expose’ yourself to another culture, you are still an outsider who didn’t grow up in the culture. (But instead, people pick up a few bits and pieces of a culture then run with it as if it were the sum total.) There is always an important and NECESSARY distance between you and other groups and what true cross-cultural competence involves is having the awareness to realise, accept and *respect* distance while still attempting to communicate and forge bonds.

    But many people – particularly white people – greatly struggle with this because of their overwhelming desire to control all interactions; they fear of having to admit to being ignorant, uncomfortable, alien or at a disadvantage because it clashes so violently with how their white identity is constructed. (i.e. all-knowing, at “home” in any place or clime, ‘innately’ native to everywhere, and perpetually privileged. So they become cultural fetishists or self-proclaimed experts to avoid having to surrender control.

    Cross-cultural competency is not a set test that you can prep for then pass or fail.
    My reading of the OP is: don’t overestimate the benefits of ‘exposure’ to other cultures or feel that it, in and of itself, ‘solves’ everything. If done in a respectful manner, it *can* at best, be helpful; but even then, you still have to be prepared to make missteps, be confident enough to admit to them, not repeat them then recover and continue. But that takes confidence, rather than pride as to how knowledgeable you are and how well-versed or ‘exposed’ you are to other cultures. Too many people who have had a little cultural exposure have such overweening pride that they can’t recover from a gaffe or a mistake.

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  20. “Culture is very sensitive. The statement may be true but that doesn’t mean they like it.” Yeah, maybe it’s because they are based on a bunch of stereotypes.

    “It’s true for the group, not for the individual.” Wow, thanks for homogenizing people of colour by lumping them into a GROUP OF CULTURAL “FACTS” instead of seeing them as individuals. Thanks, really. As if that doesn’t happen in real life already, thank you for SYSTEMICALLY encouraging it.

    Honestly, people shouldn’t need anti-racist training or be “identifying culutral charactertistics” to “understand POC” because let me tell you – treating someone with respect and dignity and treating them as a human being does not require any special skills or knowledge.

    And, to be honest, sometimes these “cultural trainings” screw things up more even more and I see examples of it happening all the time and I’ve also experienced it.

  21. Also, the fact that the UCF TENURED professor got fired over this incident of merely voicing her concern about these books reveals the power of those interested in maintaining white supremacy.

    Seriously, it’s not as if the UCF professor proposed a revolution.

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