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36 Cultural Competence in Health Education and Health Promotion

statistics presented in this chapter and to understand the underlying determinants,
insofar as they are currently known. In particular, theoretical models need to be devel-
oped and tested that can explain how variables interact to contribute to these observed
disparities in health status.
Health educators have an important and pivotal role to play in addressing these
pervasive health disparities. Health educators interact with the patient on a personal
level and are in a unique position to try to overcome the correct perception of many
ethnic minorities that the shadow of racism still looms large in the U.S. health care
system and in the nation ’ s medical and public health institutions. Health educators
need to lead the charge to address the disparities identified in this chapter. The next

generation of health educators and health promotion specialists needs opportunities to
practice and internalize critical skills in culturally competent health education practice
that recognizes and works with the inherent strengths of ethnic minority communities
and patients in a new model of patient - centered care, characterized by more equitable
decision making and power sharing between providers and patients.
In response to this challenge, the Society for Public Health Education (SOPHE)
released special issues of its journals, Health Promotion Practice and Health Educa-
tion & Behavior, focused on themes explored in SOPHE ’ s inaugural summit, held in
the summer of 2005, Health Disparities and Social Inequities: Framing a Transdisci-
plinary Agenda in Health Education. The special issue of Health Education & Behav-
ior also presented ten new priorities for health education and social science research
into racial and ethnic health disparities (SOPHE, 2006). During this summit, eighty
health education leaders, including researchers, academics, practitioners, and students,
came together to ask fundamental questions about health care disparities and to formu-
late a health education research agenda to address them, especially as our society
becomes more diverse and the issues of multiculturalism more complex (Gambescia
et al., 2006).
Although health educators, through the Society for Public Health Education, their
professional association, have recognized this problem, held a summit, and dedicated
special issues of their journals to further scholarship on disparities, it is alarming that
the members of the general U.S. public have not recognized the impact of health care
disparities on their neighbors and communities. Most Americans recognize that prob-
lems exist for many Americans in getting quality health care, but when asked about

disparities for racial and ethnic minorities in specific aspects of health care, the major-
ity of the population does not think that racial and ethnic minorities have worse prob-
lems with obtaining health care than non - Hispanic whites do. Whites in particular
largely do not believe that problems of access or quality are any worse for African
Americans or Hispanics than for whites. The most recent poll, which was conducted
by the Harvard School of Public Health, the Robert Wood Johnson Foundation, and
ICR (2005) and which examined a nationally representative sample of 1,111 adults 18
years of age and over in September 2005, found that only 32 percent of Americans
think the problem of getting quality health care is worse for minorities than for whites.
Another striking finding from this report is that 23 percent of African Americans

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