Embracing cultural humility in clinical and public health settings: a prescription to bridge inequities.

Abstract

Culture matters. This is not a new concept and not even something that is debatable. In fact, ‘traditional expressions of any culture influence everyday decisions, both big and small. They are reflected in the choice of the cake people make for their children’s birthdays, and also in major decisions related to child rearing. They influence the slang children and doctors and handymen use to address their peers or others. They are recalled when grandparents come to visit through the stories they transmit to the next generation. They are verbal and nonverbal cues that affect how information on any topic is received, accepted, and elaborated’. They live through performing and visual arts, through stories and narratives, and are key to providing comfort at times of crisis. The importance of such cultural expressions has been long integrated in public agendas and policies, both formally and informally. For example, the American Folklife Preservation Act (P.L. 94–201) passed by the United States Congress in 1976 recognizes the importance of preserving cultural diversity, as ‘a resource worthy of protection’, and defines ‘folklife’ as following: ‘American folklife means the traditional expressive culture shared within the various groups in the United States: familial, ethnic, occupational, religious, regional; expressive culture includes a wide range of creative and symbolic forms such as custom, belief, technical skill, language, literature, art, architecture, music, play, dance, drama, ritual, pageantry, handicraft; these expressions are mainly learned orally, by imitation, or in performance, and are generally maintained without benefit of formal instruction or institutional direction’. Similarly, in establishing a dedicated department, the Department of Canadian Heritage Act of 1995 pledges to promote multiculturalism and ‘a greater understanding of human rights, fundamental freedoms and related values’. While these and other national and global policies are essential tools for progress, we all know that policies are merely a starting point for sustainable interventions to promote and embrace cultural preservation and humility within government agencies, public and private institutions, our communities and networks. In clinical and public health settings, understanding the cultural values of the people with whom we interact and communicate – and embracing cultural humility – are essential to improving a general feeling of belonging, reducing bias and inequities in the healthcare system, building trust and encouraging adherence to clinical and public health recommendations, and contributing to positive patient experiences and health outcomes. In fact, cultural ‘traditions, habits and beliefs... influence ideas of health and illness’, as well as the way people should be treated at vulnerable times as patients, caregivers, concerned citizens, or members of any group interacting with their health and social systems. Ultimately, ‘culture mediates both care-giving and care-receiving,’ and is a key social determinant of health, and health equity. Among others, culture influences the language that is used to define or frame health issues, the way in which solutions are designed and implemented, and the choice of suitable measures of success. Given the many implications of culture, ‘cultural humility’ should be systematically embraced in clinical and public health settings and interactions – both to strengthen health systems and to effectively connect with those these systems serve. But what is ‘cultural humility’? First, cultural humility goes beyond ‘cultural competence’ (a set of skills that may help individuals and organizations function ‘within the context of the cultural beliefs, behaviors and needs presented’ by those they serve and their communities). ‘Cultural humility’ assumes that no one can become an expert in all kinds of cultural values but, yes, everyone can learn about the humility and empathy that are needed to truly understand other people’s values and experiences, to avoid