Page 66 - Cultural Competence in Health Education

44 Cultural Competence in Health Education and Health Promotion
Although the ongoing Healthy People initiative continues to emphasize and
promote the adoption of healthy behaviors for all Americans, the successes of this ini-
tiative are dimming as old problems like obesity and lack of physical activity exacer-
bate poor health and as challenges continue to abound, as measured by the initiative ’ s
longstanding goals. First, gaps in life expectancies and years of quality health still
exist disproportionately; second, access to and availability of health care and services

are still limited for minorities and are being made worse by inflationary health care
costs and a lack of affordable health insurance; and third, health disparities among
Americans remain a major concern.
For at least two decades, according to Braithwaite and Taylor (1992), too little
focus has been given to cultural competence as a strategy for effective health educa-
tion or as a strategy to close the prevailing health gaps and disparities. In 1999, with
the launching of the Reach 2010 project (American Association for Health Education
[AAHE], 2007), greater and growing interest has been directed toward culturally
appropriate and community - driven strategies to address selected diseases and health
problems disproportionately affecting specific racial and ethnic groups. The future

quality of the health and wellness of all cultural groups depends not only on the qual-
ity of U.S. health education in relation to the diversity of the population but also on
how well prepared the new generation of health professionals is for working with that
diverse population. Professional organizations like the American Association for
Health Education are responding to this challenge. The AAHE has published Cultural
Awareness and Sensitivity: Guidelines for Health Educators (1994), and a position
statement on cultural competence (2006). Also, in a joint venture with the Health
Resources and Services Administration (HRSA), AAHE published a supplemental
issue of its journal (the American Journal of Health Education ) that highlighted
cultural competence as a strategy for “ eliminating health disparities for vulnerable
populations ” (see, for example, Montes, Johnston, Airhihenbuwa, & Gotsch, 1998).
Whereas the demographics of health professionals remain rather constant and homo-
geneous, the demographics of their minority clients are growing more and more varied.
Consequently, the demand for cultural skills in the health professional is becoming
more challenging to meet. In the interim, health education programs continue to have
too little regard for culture - specifi c content, for the cultural qualifi cations of the mes-
senger, and for how the message should be delivered. That is, the process of translat-
ing programs has been underused and overlooked as a strategic action plan. Many

community health promotion programs have failed due to lack of financial support, an
inability to reach target populations, especially those of high risk, and of equal con-
cern, an inability to design content that is meaningful in light of the health beliefs,
practices, and behaviors of the community to be served. The future realization of
healthy lifestyles among specific target populations traditionally underserved, or yet

to be served, and underrepresented may depend on this country ’ s ability to effect
changes in currently unhealthy lifestyles and on its efforts to prepare health profes-
sionals for working with racially and culturally diverse individuals and groups. When
we ignore multicultural differences, then a void exists in the health education process.

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