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In some instances culture may be perceived as an adverse partner in health educa-
tion efforts. Cultural practices involving the use of alternative medicine, a different time
orientation, or a family rather than an individual orientation present challenges that many
health educators are ill prepared to address. Moreover, culture cannot be discounted, no
matter how assimilated a target group may seem, because the health educator who fails
to identify the cultural factors that shape an individual ’ s health status may have little suc-
cess in achieving the desired outcome. Furthermore, culture may in fact have a positive

impact on the health status of individuals and this needs to be identified as well.
Mar í n and Mar í n (1991) address the positive impact of some cultural practices
among Hispanics in the United States. Also, although the tradition of machismo among
Hispanic men is often viewed in a negative light, it can have a positive impact on the
health status of families (Ingoldsby, 1991). Similarly, cultural factors such as a diet

rich in omega - 3 fatty oils from fish have been identified as a contributing factor to
lower rates of cardiovascular disease among the Japanese (Hino et al., 2004). And the
practice among the French of ingesting wine on a daily basis has also been identifi ed
as a factor in lower rates of cardiovascular disease among that population group.
However, despite the fact that culture undoubtedly plays a positive role at times in
enhancing the health status of individuals, it can also have a negative impact. Long -
held beliefs and practices may prevent individuals from obtaining needed health care
services or modifying behaviors that may be negatively affecting their health. Reli-
gious beliefs may also prevent people from adopting health behaviors when the behav-

iors conflict with those religious beliefs (Brooks, 2004). Similarly, past negative expe-
riences with health education or the health care system may prevent people from
following advice that might assist them in obtaining their optimal health status.

CULTURAL DIVERSITY AND HEALTH EDUCATION

The challenges and opportunities faced in attempts to reach diverse populations con-
tinue to be a struggle for the field of health education as a whole. For instance, none of

the seminal documents in the field of health education, including the framework pro-

duced in 1985 by the Role Delineation Project (Breckon, Harvey, & Lancaster, 1998;
National Commission for Health Education Credentialing, 1985; Clearly, 1997); the
competencies for health education, Standards for the Preparation of Graduate - Level
Health Educators (Society for Public Health Education, 1997); and A Competency -
Based Framework for Health Educators – 2006 (National Commission for Health Edu-
cation Credentialing, Society for Public Health Education, & American Association
for Health Education, 2006) specifically address cultural competence.

The leading professional organizations in the field of health education have made
efforts to address multicultural issues among their members. The American Association
for Health Education (AAHE) has published documents concerning cultural diversity,
including its 1994 publication Cultural Awareness and Sensitivity: Guidelines for Health
Educators. In that document AAHE called for health educators to become culturally
aware and sensitive in their dealings with members of diverse groups. Despite the wide
dissemination of this document, there is no published evidence that the guidelines
were widely adopted by health education preparation programs or by health educators in

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