Racial Disparities in Health Care and Cultural Competency
![handle is hein.journals/stlulj48 and id is 87 raw text is: RACIAL DISPARITIES IN HEALTH CARE AND CULTURAL
COMPETENCY
LISA C. IKEMOTO*
I. INTRODUCTION
The basic premise of cultural competency is that the near monoculture of
the health care system interferes with the care of the growing number of
patients who are not part of that culture.' Cultural competence efforts aim at
changing the institutional culture of health care and accompanying social
services. The efforts include enabling health care and social service workers to
provide effective access and care to patients with diverse values, beliefs, and
practices. A primary and oft-stated goal of cultural competence is to contribute
to the elimination of racial and ethnic gaps in health outcomes.
Race-based health data show that health outcomes, including disease
incidence rates, disease mortality rates and infant mortality rates, vary
significantly among racial groups. Research shows that social determinants
external to health care account for most of that variation, but to a frightening
degree, the way that health care is delivered impairs the health of racial and
ethnic minorities. The recent Institute of Medicine report, Unequal Treatment:
Confronting Racial and Ethnic Disparities in Healthcare (Unequal
Treatment),2 uses the term disparities to capture this problem. Unequal
Treatment defines disparities as racial or ethnic differences in the quality of
healthcare that are not due to access-related factors or clinical needs,
* Professor of Law, Loyola Law School. This article benefited from the valuable contributions of
all the other speakers at the St. Louis University School of Law Health Law Symposium on April
It, 2003. I would also like to thank the editors of the St. Louis University Law Journal. Finally
and particularly, I thank Beatriz Garcia and Kurt Dedrick for their research assistance, Sean Scott
and Soo-Young Chin for their thoughtful input, and Marjorie Kagawa Singer for sharing her
knowledge.
1. See Cindy Brach & Irene Fraser, Can Cultural Competency Reduce Racial and Ethnic
Health Disparities? A Review and Conceptual Model, 57 MED. CARE RES. & REV. 181, 183
(2000).
2. COMM. ON UNDERSTANDING AND ELIMINATING RACIAL AND ETHNIC DISPARITIES IN
HEALTH CARE, INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES, UNEQUAL
TREATMENT: CONFRONTING RACIAL AND ETHNIC DISPARITIES IN HEALTHCARE 3-4 (Brian D.
Smedley et al. eds., 2003) [hereinafter UNEQUAL TREATMENT].](ViewImageLocal?handle=hein.journals/stlulj48&div=12&collection=journals&method=preview&ext=.png&size=3)
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Racial Disparities in Health Care and Cultural Competency
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