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What is it? Why do we need it? What does it do? Who is responsible?

What is cultural competency?

Behaviours, attitudes and policies that enable systems, organisations, professions and individuals to work effectively in cross-cultural situations

What is cultural competency?

improves health and wellbeing by integrating culture into delivery of health services focuses on capacity of health systems more than awareness of difference everyones responsibility - not special interest groups

its not new !! good health policy & services meet consumers needs

Why do we need cultural competency in health?

Everyone has a right to health care that meets their needs Australias diversity is increasing

Health system not always responsive

Health inequalities experienced by many groups Health services, managers and practitioners are accountable for meeting needs of all consumers World-wide pressure to improve

Bangkok Charter 2005, WHO World Health Report 2006


Improves equity & access for all groups Good business practice

More effective service for health consumers and carers Better use of health resources

A culturally competent health system

Acknowledges benefits of diversity Achieves best, most appropriate care for each consumer Ensures self-determination for consumers and communities

Holds governments, health organisations and managers accountable for meeting needs of the communities they serve

Whos responsible?
Governments all levels Policy decision-makers
all agencies / all levels of government (not just health!)

CEOs, finance, operational managers of health &

related services

Professions professional bodies and their members Workers & practitioners in health & related organisations Individuals Everyone can learn and contribute

New NHMRC guide Aim Target audience

NHMRC Guide Cultural competency in health: a guide for policy, partnerships and participation
National focus Complements existing work Generic approach
Applies to wide range of groups not specialised

Provides model 4 domains for action

systemic, organisational, professional & individual

Focus on healthier living & environments, obesity & overweight Recognises gaps, identifies next steps Based on research, consultation & feedback Prepared by experts /researchers in public health

Support development of health care services that meet needs of culturally & linguistically diverse communities

Target audience High level policy & decision-makers Impact on-the-ground health services Anyone interested in health & related policy

Stimulate broader discussion Ownership of issues Begin nationally supported, sustained change Provide ideas for next steps

Principles Four Dimensional Model Developing Competency

Systems, organisations, professions can

Adopt principles that underpin cultural competency in health Take action on infrastructure & human resources that support cultural competency Set standards establish specific competencies at system, organisation, professional and individual level

Principles for cultural competency


Engaging consumers & communities and sustaining reciprocal relationships

Leadership and accountability for sustained change Building on strengths know the community, know what works A shared responsibility creating partnerships and sustainability




Principle 1
Engaging consumers & communities and sustaining reciprocal relationships

Promotion of healthier living and environments is a reciprocal relationship CALD background communities and health services engage, learn & exchange at all stages of health care research, development and delivery

Principle 2
Leadership and accountability for sustained change Begins at highest levels of systems, organisations and professions Continues to individual development and practice

Principle 3
Building on strengths know the community, know what works Population health approach Use data, information on diverse communities Acknowledge CALD experience successful practice Understand risk factors & protective behaviours

Principle 4
A shared responsibility creating partnerships and sustainability Partnerships between health and human services, education and research sectors Find systematic and long-term approaches

The Model
Four dimensions for action

Source: Research and consultation report commissioned for NHMRC project

Action at Systemic Level

Fosters culturally competent behaviour through:

Effective policies and procedures Mechanisms for monitoring Sufficient resources Policies that support involvement of culturally diverse communities in health matters

Action at Organisational Level

Cultural competency is valued, integral to core business, supported and evaluated Skills and resources to support diverse clients are in place Management committed to diversity management

e.g. training for staff, cultural and linguistic diversity in staffing

Action at Professional Level

Makes cultural competency important part of education & professional development Professions develop cultural competence standards Guidance provided for working lives of individuals

Action at Individual Level

Individuals develop optimum knowledge, attitudes, behaviours re cultural competence Individual health professionals are supported to work with diverse communities Individuals develop relevant, appropriate, sustainable health promotion programs

Develop competencies

Competency = knowledge, conviction, capacity for action Systems, organisations, professional groups & individuals can develop cultural competencies in specific areas

Specific competencies

Policy / Evaluation

e.g. a policy framework that directs & supports cultural competency across health system e.g. high priority areas are specifically budgeted for staff training, interpreter & language skills e.g. reps of diverse communities are included at all stages of service development & delivery

Budgeting & resources

Consumer participation

Specific competencies


e.g. performance agreements hold managers accountable e.g. professions consider cultural / linguistic diversity in communication & health practice e.g. individuals understand potential impact of cultural & linguistic diversity on clients, & adapt practice to meet cross-cultural requirements



Competence = knowledge conviction capacity for action

Case study scenarios Next steps

Resources, contacts & more info

Case Study Scenario 1: Media campaign

Research shows poor nutrition and low fitness affect some CALD background groups more than others

How would cultural competency principles guide a media campaign to promote healthy eating and improve fitness?

Culturally competent approaches

Use research
identify issues & key groups

work with relevant community leaders, share knowledge

Community engagement
get communities involved from planning onward use consumer advisory group, focus groups

select media outlets used by the CALD background group/s you want to reach

before & after data to assess impact

Case Study 2: Community group fitness

A Muslim community leader notices low physical activity / reduced fitness among Muslim women in her local area

What culturally competent strategies would help find a solution?

Culturally competent strategies .

Community involvement
Muslim women initiate action, identify solutions

Culturally appropriate community consultation,

informal discussion, discuss barriers within community & with local authorities

Identify culturally appropriate solutions that have

ongoing support, e.g. women-only exercise classes, appropriate venues Think about wider factors e.g. child care, transport etc.

Share success
Evaluate & document outcomes, share learning with

other cultural groups

Next Steps
Suggestions for projects & action at all levels




Next steps for individuals

Access toolkits or other material to develop self-awareness & competencies Take part in cross-disciplinary forums to share information & skills, promote support & awareness Look for opportunities to introduce or improve cultural competence discuss with colleagues

Next steps for organisations

Participate in partnership forums with govts to apply the Model locally Budget strategies mobilise resources, prioritise cultural competence Management competencies and performance measures HR strategies

recruitment, succession planning, education

Context-specific competencies for your organisation, its community & health workers

Next steps: professional groups

Demonstrate leadership

raise profile of cultural competency, recommend strategies for professional practice

Participate in partnership forums with govts / other agencies on applying the model Reflect principles of cultural competency in ethical & other professional conduct codes Develop policies and context-specific competencies for specific health professional group Promote information to members

Next steps across systems

A specific resource for Aboriginal and Torres Strait Islander Peoples National collaboration on framework for culturally competent health practice Address gaps in research, information and evidence base Promote best practice diversity organisations

How to find out more

Institute for Health and Diversity Cultural Competency for Healthy Living: a guide for policy, partnerships and participation Multicultural Mental Health Australia Centre for Culture, Ethnicity and Health

Whos responsible? Everybody