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Cultural Competency in Health Care: New MD Law on CLAS

Wednesday, April 29, 2009

  • By: Dr. Oliva Carter-Pokras Marissa Deline
  • Organization: School of Public Health at the University of Maryland

Research has definitively shown the importance of providing culturally and linguistically competent care (Anderson et al. 2003). Culture (as defined by the Department of Health and Human Service's Office of Minority Health, or OMH ) affects many issues related to health care, including how patients and providers understand disease and what steps they think are appropriate to cure or control it. Its broad impact on health beliefs and behaviors has spurred the OMH to state that "cultural competency is one [of] the main ingredients in closing the disparities gap in health care."

As anthropologist and physician Arthur Kleinman and his colleague have pointed out, however, "culture" is not a simple, reducible concept or problem for clinicians to master as a technical skill (Kleinman & Benson 2006).


Issued by OMH in 2001, the 14 Culturally and Linguistically Appropriate Services Standards (CLAS) sought to establish benchmarks for cultural competency, are organized into three themes: Culturally Competent Care, Language Access Services, and Organizational Supports for Cultural Competence. Despite the fact that four of the fourteen standards are based on long-standing civil rights regulations, and that accreditation and licensing processes now incorporate these standards, many health care providers are still not providing these necessary services.

Recent studies have found that a lack of interpreters is a common problem. In a recent study, more than half of Limited-English-Proficient parents with children younger than 14 on Medicaid who needed an interpreter to communicate effectively with their child's health care provider were not always able to get one (Galbraith et al., 2008).


Another study found that only 3% of New Jersey hospitals have full-time interpreters-in fact, most have no "interpreter services department." The study also notes that 80 percent of those hospitals provide no staff training on working with interpreters, 31 percent lack multilingual signs, and 19 percent offer no written translation services (Flores et al., 2008).

Fortunately, many organizations are working on innovative solutions to problems of cultural competency. On April 7, the Maryland legislature passed HB756 to establish a Cultural and Linguistic Health Care Provider Competency Program, (Bill Text: http://mlis.state.md.us/2009rs/bills/hb/hb0756t.pdf) The University of Maryland School of Public Health is one of 18 schools that form the National Consortium for Multicultural Education for Health Professionals funded by the National Heart Lung and Blood Institute to develop cultural competency and health disparities curriculum.

A new School of Public Health website provides links to free online cultural competency curricula, information on language services and requirements, self-awareness exercises, key reports on health disparities and interactive websites to retrieve data and create tables. The site also allows readers to connect with other resources, including the Office of Minority Health's CLAS Standards, and the National Center for Cultural Competence, funded by the Health Resources and Services Administration.

The U.S. is an increasingly diverse country, and given the changes to the health care system that are expected over the next several years, it is crucial that information about health inequities and more specifically cultural competency be inserted into health reform conversations.

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