Page 70 - Cultural Competence in Health Education

48 Cultural Competence in Health Education and Health Promotion
allows inclusive recognition of the uniqueness of the individual, the shared values and
beliefs of the group, and universal societal attributes. The model also takes multiple
forces (gender, religion, socioeconomic class, and so forth) in addition to race into
account when considering cultural competence in relation to the individual, group,
or society.
Second, the MDCC model uses three groups of components to clarify the meaning
of cultural competence. The culturally competent health professional, organization, or
system is expected to hold a set of beliefs, a knowledge base, and a set of skills that
add to the successful responsiveness of the individual, group, organization, or system.
Inherent to this successful responsiveness is a hint of social justice in that the cultur-
ally competent individual or health professional, group, organization, or system should
provide equal access and opportunity, be inclusive, and remove individual and sys-
temic barriers. With these three groups of components of cultural competence out-

lined, the term cultural competence can be defined more clearly as “ the ability to
engage in actions or to create conditions that maximize the optimal development of
client and client systems ” (Sue, 2001, p. 802).
Third, the MDCC model is useful to the health professional because it advocates
a top - down approach to acquiring cultural competence. In simple terms, the model
recognizes that organizations and systems must be reconditioned to become culturally
competent before their frontline workers, such as health educators, can be similarly
reconditioned. Cultural competence is seen as the thread that links society to the orga-
nization, the organization to the professionals, and the professionals to the individuals
and groups they serve. Without this top - down reconditioning, a clash is imminent
between the professionals who are using cultural knowledge and skills and the cultur-
ally incompetent organization that employs them. With the MDCC model, Sue advises
organizational leaders to proceed through the social reconditioning process in a con-
certed fashion, driving cultural competence downward through the organizational,
professional, and individual levels.
Another model of potential interest to the health educator defi nes cultural
competence within a framework that links communication to health outcomes (Betan-
court et al., 2003). Betancourt ’ s framework establishes three points of intervention —
organizational, structural, and clinical — to represent the many dimensions of cultural
competence at multiple levels useful to the health educator. The complexity of cul-
tural competence is highlighted within each intervention point and in relation to socio-
cultural barriers that affect health education and the adoption of healthy behaviors.
For an organization, the first question raised by this framework is the following:

Does the diversity of the leadership and the workforce representing the health needs of

individuals, groups, and communities reflect the racial and ethnic composition of the
general population? (Betancourt et al., 2003). Further, are the policies, procedures,
and delivery systems suited to serve the intended population? Lastly, do the persons
providing health education serve as role models, and as teachers, do they “ look like
me ” ? The sociocultural barriers that make it necessary to ask these questions also
point to a need for health education that arises from diversity in leadership and in the

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