"Cultural competence" is not a new idea, nor one native to health care. The business world first translated academic reflections on cultural pluralism into practical diversity programs, and healthcare leaders recognized the need and the wisdom of this approach.
What is new is that cultural competence and the provision of "culturally appropriate care" have become top priority on the healthcare agenda. Provider organizations now acknowledge the need to care for, to serve, and—in market-share terms—to win the loyalty of an ever more diverse clientele.
Further, these organizations have recognized a second, perhaps equally compelling, reason to cultivate cultural competence: their own diverse and diversifying workforces, whose members deserve and, increasingly, expect to be treated with cultural awareness and respect. This vast diversity includes the physicians these organizations employ or credential as members of their medical staffs.
The authors in this issue recognize the importance of cultural competence, even as they press for clarification or modification of the concept itself. Anthropologist Linda Hunt suggests alternatives to standard, perhaps insufficiently reflective, approaches to cultural diversity and the "competencies" needed to address it. Our other authors approach cultural competence by way of religion. In the process they show that religion/spirituality not only deserves but demands to be considered seriously, whether as a substantial aspect of culture or as a reality in its own right even as it intermingles with culture. Linda Barnes, Grove Harris, and Ronald Nakasone offer perspectives on how such a relationship can be approached. Drawing on a case from his medical practice, Javeed Akhter reminds us of the diversity within any religion, a diversity that may in turn reflect the interplay of religion and culture.
In the end, we at the Center judge that genuine cultural competence includes religious competence. Perhaps it is better to speak of "religiously informed cultural competence," a term we are trying on for size in this Bulletin. Moreover, we judge that such competence is not only a legitimate moral aspiration, a desideratum, but also a requirement of justice and hospitality if health care is truly to be "care."
And there is more. We invited Christine Gudorf, Elliot Dorff, Courtney Campbell, and Martin Marty to reflect on how life and the health-faith-ethics landscape have changed since September 11, 2001. In light of their observations, we might ask how we can best learn the moral and religious lessons of our painful exposure to a terrorism ambiguously associated with religion. Surely the competence we consider here is an indispensable, even urgent, part of any answer.
