Understanding the lifelong process known as cultural humility
As we continue our journey to expand our knowledge and understanding of diversity, equity and inclusion, I encourage you to become familiar with the concept of cultural humility, which was developed by Drs. Melanie Tervalon and Jann Murray-Garcia in 1998 to address inequities in the health care field. They originally described cultural humility as a tool to educate physicians to work with culturally, ethnically and racially diverse populations. Since then, the concept has spread beyond health care.
Without thinking about it, we experience and participate in different cultures every day. Individuals from the same culture experience that culture differently with people outside the culture. A person’s family culture will likely have distinctly different qualities and behavioral expectations than their work, school or social group culture.
The National Institutes of Health defines cultural humility as a lifelong process of self-reflection and self-critique whereby one not only learns about another’s culture, but starts with an examination of one’s own beliefs and cultural identities.
What is the difference between cultural humility and cultural competency? Cultural competency falls short of the lifelong process of self-reflection that is identified with cultural humility. The goal of cultural competency is to learn about another person’s culture rather than reflect on one’s own background in relation to that culture. Cultural competency is a tool for leveling imbalanced power dynamics. There is a power imbalance when one person can dominate decision-making or assert power over the other. People in power are often oblivious to its implications in their daily lives. Through the practice of cultural humility, one could assess the power they bring to a relationship and adjust their language and actions accordingly to restore balance.
Patient-focused interviewing and care (instead of physician-focused) is an example of cultural humility. It does not automatically assume the physician has all the knowledge or power and is therefore the expert on the situation. The patient leads the conversation about their health concerns since they have the most intimate knowledge of their condition. The physician brings value to the relationship with their medical knowledge, and together they can equitably collaborate to provide the best care. Clinicians and staff must not only be culturally competent to care for our diverse populations and strive for health equity, but also culturally humble.
To practice true cultural humility, a person must also be aware of and sensitive to historic realities, like legacies of violence and oppression against certain groups of people. To build trust, the historic reasons for mistrust and skepticism, such as the history of slavery, racism, segregation, and lived experience of disrespect must be made visible.
Self-awareness is central to the concept of cultural humility. Psychologists Shelley Duval and Robert Wicklund define self-awareness as the ability to focus on yourself and how your actions, thoughts, or emotions do or do not align with your internal standards. Those who are highly self-aware can interpret their actions, feelings, and thoughts objectively.
Self-critique is vital in achieving cultural humility. When we understand our beliefs, identities and biases, the projection of those ideas onto others becomes clearer. Self-critique requires us to accept that it is not possible to know all things about any given culture.
Simply put, we can start practicing cultural humility by being curious about cultural differences, being humble, showing interest in another person’s experiences, and being sensitive to existing power imbalances. Starting a conversation in a way that genuinely attempts to understand a person’s identities related to race, ethnicity, gender, sexual orientation, socioeconomic status, education, social needs, geographic location, and others is cultural humility.
It is a wonderful time of the season, so do not forget to share your smile with others. It is a gift that spreads positivity!
Alexies Samonte, M.D., MBA, FAAP (She/Her)
Sponsoring Institution Diversity, Equity and Inclusion