Introduction

While racial and ethnic disparities in health were originally documented more than a century ago, these disparities have been poorly defined and inadequately researched until recently. Now, a large and growing body of research has documented disparities in the incidence of illness and death, and in the quality of health care among African Americans, Latinos, Native Americans, Asian Americans, Alaskan Natives and Pacific Islanders as compared with the United States population as a whole, after controlling for socioeconomic factors such as income and health insurance. The reasons for these disparities are not well understood; however, the Institute of Medicine report, Unequal Treatment, found contributing factors to include discrimination at the personal level, even among well-intentioned health care professionals, combined with the failure of health care organizations and programs to provide culturally and linguistically competent health care to diverse racial, ethnic and cultural populations.1

The notion that culture and health are connected has appeared in the literature since the 1940s; however, the concept of addressing cultural and linguistic competency as a strategy to address racial and ethnic disparities in health is relatively new. A number of different terms for this concept have been proposed, such as cultural sensitivity, responsiveness, effectiveness, proficiency and humility. A review of the literature reveals general agreement on use of the term “cultural competence.”

In the fields of public health and health care, cultural and linguistic competency refers to a prevailing systemic culture, including behaviors, attitudes and policies, that respects and takes into account each person’s cultural background, cultural beliefs and values, and incorporates these elements of identity into the way health care and services are delivered to that person. Often seen as an endpoint, cultural and linguistic competency are best viewed instead as an ongoing process with multiple points of intervention.2-5

Historically, cultural and linguistic competency interventions have focused on changing attitudes and knowledge, especially those of health care professionals. In general, components of these interventions are limited to understanding a client’s “superficial” characteristics (e.g., language, music, clothing) rather than the deep structural forces (e.g., cultural values; social, historical, environmental and psychological forces) that may influence health status. Much of the current thinking, however, encourages a focus not only on individuals, but also on indicators at the organizational, community and systemic levels needed to enhance communication and effective interaction between health care providers and consumers. With systemic change in mind, health care and social service institutions also need to take into consideration how the historic and contemporary social and economic inequalities of our society affect health status and contribute to health disparities. In fact, some argue that, to truly affect health and health care disparities, interventions should focus on institutionalized racism rather than just cultural and linguistic competency.

The field of cultural and linguistic competency is young, but growing. This annotated bibliography provides a resource for people interested in developing an understanding of health disparities, as well as cultural and linguistic competency. Herein are easily accessible and commonly cited articles and reports that highlight recommendations, benchmarks, best practices, assessment tools and training resources for Colorado organizations working toward social change, with the ultimate goal of eliminating racial and ethnic disparities in health.

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