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more likely to postpone obtaining health services until it may be too late for effective
treatment. These differences have been called health disparities. Moreover, the need
to decrease health disparities has been documented in the professional literature. For
example, the Racial and Ethnic Approach to Community Health (REACH) project
found that members of minority populations were more likely to report being in a con-
dition of poor health and were less likely to seek health care than non - Hispanic whites
were (Centers for Disease Control and Prevention [CDC], n.d.). Special efforts are
needed to reach underrepresented groups that have traditionally had lower levels of
education and income and that are more likely to be poor than members of the white
population are.
One of the two goals presented in Healthy People 2010 is the elimination of health
disparities among the different segments of the population, including disparities that
occur by race or ethnicity, gender, disability, or sexual orientation, among others (U.S.
Department of Health and Human Services [USDHHS], 2000). Healthy People 2010
and its health indicators provide a clear mandate for improving the health status of
underrepresented groups in the United States.
Although several studies have provided excellent suggestions for improving the
health status of underrepresented groups, Healthy People 2010 is the first document of

the new millennium that challenges us to better incorporate prevention and treatment
into health promotion and health care services and thereby not only improve the health
status of the U.S. population but also help to decrease soaring health care costs.
Nonetheless, the elimination of health disparities is a challenge as there is no one
single cause of the problem (Health Resources and Services Administration [HRSA],
HIV/AIDS Bureau, 2002). Health disparities are caused by a myriad of factors includ-
ing lack of health information, lack of health insurance, individuals ’ beliefs and attitudes
about accessing health care, a shortage of diverse health care providers, comorbidity
involving other serious health problems such as addiction and mental illness, and pov-
erty (HRSA, HIV/AIDS Bureau, 2002). There are, however, also several broadly

applicable and unifying factors that have been identified in the literature, including
income, race or ethnicity, and language competence. An overwhelming amount of
evidence suggests that both cultural and linguistic competence could play a signifi -
cant role in decreasing health disparities. For example, the lack of background infor-
mation about different ethnic groups, the lack of culturally competent health care
providers and health educators, the small percentage of racial and ethnic minorities

working in the health care and health promotion fields, the inadequate number of
health professionals with skills for working with diverse groups, and the fact that cur-
rent health care services are culturally biased toward the majority population have all
been identified as detrimental factors for the health status of nonwhite populations

(Brach & Fraser, 2000; USDHHS, 2003; Diversity Rx., 2003; King, Sims, & Osher,
n.d.). Thus culturally and linguistically competent health interventions have been
described as an approach to achieve the second goal of Healthy People 2010 (Denboba,
Bragdon, Epstein, Garthright, & Goldman, 1998; National Center for Cultural Compe-
tence [NCCC], 2002), to eliminate health disparities among segments of the popula-
tion (USDHHS, 2000).

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