Cultural Competence vs. Cultural Humility and Why We Need a Shift

This lack of educational programming adversely affects the health and medical care of a population that requires specialized knowledge and exceptionally skilled services.

While many individuals may understand the basics of another’s culture or stereotypes to avoid, culture is a complex, multifaceted tapestry that can’t be learned overnight – or even throughout a lifetime. 

Let’s take a closer look at cultural competence vs. cultural humility and where healthcare professionals should strive to be.

The Layers of Affirming Care

How does a practitioner gauge their skills related to culturally responsive and affirmational care? 

A clinician’s knowledge, skill, and practices can fall into one of five layers of culturally affirming care. 

1. Awareness

A person with cultural awareness understands and recognizes cultural differences but doesn’t seek a deeper understanding. 

Awareness results in very little behavioral or perceptual change in the learner. 

2. Sensitivity

A person with cultural sensitivity understands there are different ways of perceiving the world. They are often aware that culture impacts perspective and behavior. 

These learners may integrate some changes into their practices. 

3. Competency

A person seeking cultural competency wants to understand and adjust their mindset and practices. 

However, “competency” suggests a level of mastery, limiting the learning experience to a finite goal that can be achieved. 

4. Humility

A person with cultural humility is committed to lifelong learning, self-reflection, and adjustment. They understand that their experiences and perceptions differ from those of others and often reflect on their personal values, beliefs, and biases. 

These learners are aware of their own culture’s impact on their practices and make considerations for the cultures of their patients. 

5. Affirming

A person who provides affirming care actively validates their patients’ identity, culture, and beliefs. They seek to create a safe environment within the healthcare system for their patients and incorporate cultural aspects into the care process. 

This highest level of care profoundly impacts patient health outcomes, access to appropriate care, and participation in regular preventive care. 

It’s important to note that this should not be confused with a ladder of learning. Providers can “skip” between these layers of affirming care. Competency is not required in order to begin working toward cultural humility and affirming care.

Affirming Care: More Than Meets the Eye

When it comes to cultural competence vs. cultural humility, healthcare professionals may assume competency is the goal. After all, who wouldn’t want to have a complete understanding of a patient’s unique needs in order to provide competent care?

However, competency is no simple task. The depth of a culture’s complexity layered with the individual’s various intersections creates a near-infinite number of possibilities. 

The Cultural Iceberg

The cultural iceberg model, first depicted by Edward T. Hall (1976), describes culture as having visible (surface) and non-visible (deep) components. According to Hall, only about 10% of cultural elements are readily observable, leaving the other 90% underneath difficult to ascertain. 

While some elements of culture are easily seen, other characteristics and learned behaviors are implicitly woven through the fabric of the culture, making them difficult to observe and identify. Some components of culture, like perceptions and assumptions, are even subconscious. 

Hall’s analogy is still widely used today to describe categorizing cultural elements.

Intersectionality

Culture is part of the human experience and, as such, is rarely black and white. Each part of an individual’s culture can interact with other components like a complex Venn diagram. 

For example, attitudes toward relationship dynamics can directly impact marriage and child-rearing. However, they can also indirectly influence the division of home management duties, lifestyle priorities, and career patterns. 

Communication styles and body language clearly intersect with language patterns and literature but indirectly influence relationships, socialization, and perception of manners.

It would be difficult to tease apart the different elements of a person’s culture. Each component weaves together the bigger picture of an individual’s cultural experience, affecting how they interact with others and the world around them.

Where Should Healthcare Providers Aim to Be?

With so much to consider about each patient’s unique background and situation, is cultural mastery even possible? 

Rather than mastery, we feel that in order to be an inclusive provider, the sweet spot is achieving cultural humility.

Aiming for a finite level of mastery falls short when addressing the complexities of culture. Cultural humility, on the other hand, represents a commitment to lifelong learning and self-reflection, acknowledging the infinite depth and changing nature of cultural experiences.

Culture is an endlessly diverse and multi-layered topic. It’s also a living, breathing thing that changes over time. There is no finish line – rather, practitioners should continuously evaluate their own understanding and embrace a lifelong journey toward cultural humility.