In the policy statement "Ensuring Culturally Effective Pediatric Care: Implications for Education and Health Policy," the American Academy of Pediatrics (AAP) defines culturally effective care as "the delivery of care within the context of appropriate physician knowledge, understanding, and appreciation of cultural distinctions leading to optimal health outcomes." Such understanding should take into account the beliefs, values, actions, customs and unique health care needs of distinct population groups. Providers will thus enhance interpersonal and communication skills, thereby strengthening the physician-patient relationship and maximizing the health status of patients.
The demographic changes in the United States over the last decades have significantly altered the clinical milieu such that many pediatricians are providing care to an increasingly diverse population. It is estimated that by the year 2050, the percentage of racially and ethnically diverse populations will have increased to a pivotal turning point, such that historically minority populations will exceed 50% of the overall population and will become a majority. In several states in the United States, this transition has already occurred.
Pediatricians strive to provide high-quality clinical services, defined by the Institute of Medicine (IOM) as being patient-centered, effective, efficient, timely, safe, and equitable. The IOM quality pillar, equity, involves "providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status."1 Within this quality framework, physicians in general and pediatricians specifically need to be equipped to deliver health care services to increasingly diverse children and families. The term diversity should be viewed in the broadest sense, extending beyond race and ethnicity to include religion, sexual orientation, disability, geographic location, education status, socioeconomic status, and other factors.
Guiding Principles for Cross-Cultural Health Care Delivery
As pediatricians provide health care services within a medical home to a growing population of diverse patients, general principles can be helpful in cross-cultural encounters. For example, rather than identifying and focusing on patients' culturally-bound beliefs or behaviors, pediatricians can:
- Communicate, by their attitude and behavior, an openness to different cultures.
- Be willing to adapt, if possible, their clinical practice to acknowledge patients' and families'/caregivers' culture.
- Demonstrate a commitment to professional development aimed at acquiring new cultural competence knowledge and skills.
- Consider that often the variability within cultures (eg, between affluent and poor African Americans) may be more pronounced than between cultures. For example, poor inner-city African Americans and poor whites from Appalachia may face more similar socioeconomic barriers and challenges that those faced by wealthy African Americans. There is also significant variability between recent immigrants and those that have been in the United States for one or more generations. Cultural assimilation, to include acquisition of English-language skills, often increases with time spent in the United States.
This toolkit aims to provide practicing pediatricians with resources to deliver culturally effective and linguistically competent heath care services within their medical home. The toolkit was developed in response to a recommendation to the AAP Board of Directors asking for more practical information, resources, and tools for pediatricians in practice. The content is informed by a 2009 AAP needs-assessment survey and the chapters were written based on questions and issues raised by pediatricians.
1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2000
Chapter 1 Tools and Resources
Tool 1A: US Department of Health and Human Services Office of Minority Health: Think Cultural Health. A website dedicated to advancing health equity at every point of contact.
Tool 1B: National Center for Cultural Competence, Georgetown University Center for Child and Human Development: Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs. This Web site provides information about cultural brokers and implementing sustaining cultural broker programs.
Resource 1A: Georgetown University Maternal and Child Health Library: Racial and Ethnic Disparities in Health - Knowledge Path
This Web site provides a bibliography of current, high-quality resources about preventing, identifying, and eliminating racial and ethnic disparities in health.