CULTURAL COMPETENCE IN
AEROSPACE MEDICINE
Rebecca J Hester, MA, PhD
Jerome W Crowder, PhD
Institute for the Medical Humanities
University of Texas Medical Branch
November 22, 2011
Objectives
Explain the ethical importance of adopting a culturally competent approach in Aerospace Medicine
Recognize opportunities and challenges for becoming a more culturally competent medical provider
Integrate culturally competent and ethical approaches in the practice of Aerospace Medicine
Emergence of CULTURAL COMPETENCE
Civil Rights movements in the United States
Global movement for Primary Health Care Increased knowledge of and attention to the link between social inequities and health care
Report of the Secretary’s Task Force on Black and Minority Health, 1985
Institutionalized by congressional mandate in 1994 with the creation of the Office of Minority Health
Continued Salience in the U.S.
Increase in chronic diseases
Rise in health care costs
Patient‐centered care and satisfaction (Crossing the Quality Chasm 2001)
Continued health disparities (Unequal Treatment 2002)
Globalization/Population mobility
Defining CULTURE COMPETENCE
A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively in cross‐cultural situations (Cross, Bazron, Dennis & Isaacs 1989). What does CC look like in practice?
Operationally defined, Cultural Competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of health care; thereby producing better health outcomes (Davis 1997).
Ethics of CULTURAL COMPETENCE
What is the underlying agenda of Cultural Competence?
Acknowledgement of the importance of culture
Respect for cultural differences
Minimize negative consequences of differences
(Paasche‐Orlow 2004)
Various Approaches
Cultural Sensitivity/Awareness
Cultural Competence (Cross, et. al. 1989)
Transnational Competence (Koehn 2006)
Cultural Humility (Tervalon & Murray‐Garcia 1998)
Cultural Safety (Papps & Ramsden 1996)
Critical Consciousness/Insurgent Multiculturalism (Kumagai, et. al. 2009; Wear 2003)
National Standards on CULTURALLY
& LINGUISTICALLY APPROPRIATE SERVICES (CLAS)
There are 14 standards, 4 of these are mandates
CLAS mandates are current Federal requirements for all recipients of Federal funds: language accessibility
Other standards focus on respectful care, staff diversity, record keeping, transparency, policies for meeting CLAS, self‐assessment
More information can be found at: minorityhealth.hhs.gov
Why focus on CULTURAL COMPETENCE?
Prejudice, stereotypes and biases inform health inequities in U.S. society‐often arise around cultural issues
There are many medical systems, health practices and biomedicines in the world
Medical pluralism, complimentary alternative medicine
Not all people have the same understanding of health, well‐being, sickness, illness, disease and the body
Why focus on CULTURAL COMPETENCE?
People have different expectations of health institutions, policies and practitioners
Increased mobility and migration of people all over the world
Diagnostic Procedures
Treatments
Why is CULTURAL COMPETENCE
important for AEROSPACE MEDICINE?
Professionalism
Documented cultural challenges in Aerospace
Different orientations to time, space, and the body can be interpreted differently with research and health implications Why is CULTURAL COMPETENCE
important for AEROSPACE MEDICINE?
Science community is diversifying:
 STEM program
 equal opportunity and diversity inclusion initiatives
 more international partners
Long‐duration and commercial space flight bring new challenges
The stakes are high in Aerospace
National Diversity within ISS crews
Country
Fliers
Women
Tourists
USA
138
27
5
Russia
37
0
0
Canada
7
1
1
Japan
6
1
0
Italy
3
0
0
France
3
1
0
S. Africa
1
0
1
S. Korea
1
1
0
Countries not represented include: Germany, Belgium, Brazil, Sweden, Malaysia, Spain and the Netherlands
A Variety of CULTURES at NASA






National
Scientific
Military / Civilian
Institutional
Ethno‐linguistic
Commercial
OPPORTUNITIES & CHALLENGES
for NASA
 On the ground
 Research ethics
 In‐flight
ON THE GROUND Issues
Aerospace Medicine is concerned with the health and well‐being of ALL NASA employees
Many “traditional” concerns, higher stakes
o Access to care
o Effective and respectful treatment
o Racial concordance
o Under/over‐treatment
ON THE GROUND ISSUES
Special Issues related to Research Ethics:
Potentially harmful research practices on the ground to improve space flight Flight crews participating in research and countermeasure development (Shepanek 2005)
Confidentiality‐HIPPA
IN‐FLIGHT Issues
National cultures and languages
Orientations to time, space, the body Space Fog, adaptation rates
Interpersonal issues
Crew tension, cohesion, leadership, displacement (Kanas, et. Al. 2000)
Medical models
Eastern vs. Western influence
Issues of POWER: Translated through a CULTURAL LENS
Social hierarchies – gender, race, class, management styles, etc.
Politics
– national political agendas and political models
Economics
– funders/customers, resource allocation
*Exacerbated by environment, observers, duration
How to Become a More CULTURALLY COMPETENT Practitioner?
Recognize that there are multiple cultures being negotiated simultaneously
 Both practitioners and patients operate in many cultures
Ask yourself what your cultures have taught you
(Lock, Kleinman & Taylor 2003)
How to Become a More CULTURALLY COMPETENT Practitioner?
Cultivate continual, critical, self‐reflection
What are my assumptions about what humans should know or how they should act?
How do I use Science to avoid dealing with complex social, cultural and economic issues?
How much of my patients’ behaviors are individual? Cultural? Structural?
How to Become a More CULTURALLY COMPETENT Practitioner?
Do I have commonalities with my patient?
Can I live with uncertainty and try to avoid negative stereotyping?
How to Become a More
CULTURALLY COMPETENT Institution?
Value and promote diversity Have the capacity for cultural self–assessment
What are the cultures operating in Aerospace
Medicine? How do they work?
Be conscious of the "dynamics" inherent when cultures interact
What happens when someone from a collectivist
culture interacts with someone from an individualist
culture?
How to Become a More
CULTURALLY COMPETENT Institution?
Institutionalize cultural knowledge by developing adaptations to service delivery that reflect an understanding of diversity and dynamism between and within cultures. Best Practices in CULTURAL COMPETENCE
 Collect and track data on the populations you serve
 Educate yourselves about heath disparities and cultural challenges in your institution
 Make all of your policies at every level Culturally Competent
Things to Think About
Enthusiasm, curiosity and engagement
patient‐centered
Trust, communication, and relationship‐
building are key to providing C.C. care Some cultural issues cannot be translated and may not be able to be overcome
What are the ethical issues related to cultural differences? value of time, respect for authority, belief systems
THANK YOU!
rjhester@utmb.edu
jw.crowder@utmb.edu
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