COMPARATIVE RESPONSE PAPER Brach and Fraserirector, in their paper Can Cultural Competency Reduce Racial and Ethnic

Health Disparities? A Review and Conceptual Model, discuss the need for more research into already documented gap in availability, quality, and effectiveness of health care treatment received by ethnic/racial minorities as compared to white Americans. Angela Jenks warns against a reductive understanding of culture and the potential for greater harm to racial minorities in such as approach in her paper, Whats The Use of Culture?: Health Disparities and the Development of Culturally Competent Health Care. How does their work compare and what do they tell us about the provision of just healthcare to racial and ethnic minorities? Brach and Fraserirector pay particular attention to the ways that healthcare falls short for people of color and/or non-English speakers. They cite research that has documented the way in which discrimination results in differential care beginning with the use of diagnostic procedures, misdiagnosis due to prejudice, through uneven application of treatment course, to ultimately disparate death rates between whites and minorities as a result of curable conditions. Jenks addresses the growing popularity of the idea of cultural competency in healthcare work. She argues that cultural competency can decontextualize difference so that it is no longer grounded in the social power dynamics that ultimately drive disparities. Instead, individual personality traits become culture and racism is masked. Jenks assertions are apparent in some of the examples offered by Barch and Fraserirector. For example, while they acknowledge that cultural

attitudes can result in more risk taking behaviors or hinder the efficacy of treatment, they find that linking behaviors to culture can act to perpetuate stereotypes held by care providers and obscure actual causes of poor health behaviors. They cite a study of poor Hispanic women who had trouble accessing preventative care. Difficulty overcoming cultural differences had no relation on this difficulty, rather poverty, lack of medical insurance, and rural isolation were the main contributors. Something that Jenks fails to offer solutions for is the desire expressed by many medical providers to receive cultural competency training or services. She makes an important and valid critique of how those services fall short in practice, but she doesnt address the issue that demand exists for them in the first place. Doctors and nurses apparently, in some way, feel ill equipped to navigate cultural difference in their practices. In one study, cited by Barch and Fraserirector, doctors described African American patients as less educated, less intelligent, less likely to participate in treatment protocols, and more likely to engage in substance abuse than their white patients. Perhaps the desire expressed by health care providers to get help delivering culturally competent care is a subtle acknowledgement of latent prejudices that doctors and nurses would like help in eliminating. Jenks explains how cultural competency, as it is practiced, fails to draw attention to discrimination in care provision, but she doesnt explain how to do it better or explore why its being asked for in the first place. A topic that both papers could have spent more time on is that of healthcare providers who are, themselves, racial and ethnic minorities. How does a doctors lived experience affect his or her work with other minority

populations? Do similar discriminatory thinking patterns appear about particular racial classes that are seen among white doctors? Jenks asks that cultural competency work be careful about expecting change exclusively from the patient. How does a diverse professional environment change or not change the attitudes and expectations of doctors with a group of colleagues. Together, Barch, Fraserirector, and Jenks illuminate quite starkly overt and covert racial and ethinic prejudices at play in the practice of medicine. It is critical to reduce individual and systemic racism in order to improve the likelihood of healthier and longer lives for minorities. However, current efforts to do this through cultural competency training and services does not appear to reduce the racism and may make it worse by reifying stereotypes and power dynamics.

BIBLIOGRAPHY Cindy Brach and Irene Fraserirector, Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model, Medical Care Research and Review 57, no. 4 (December 1, 2000), pp. 181 -217. Angela Jenks, Whats The Use of Culture?: Health Disparities and the Development of Culturally Competent Health Care, in Ian Whitmarsh and David S. Jones, Whats the Use of Race?: Modern Governance and the Biology of Difference (MIT Press, 2010), pp. 207-224.