Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care

Public Health Rep. 2003 Jul-Aug;118(4):293-302. doi: 10.1093/phr/118.4.293.


Objectives: Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care.

Methods: The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers.

Results: Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care.

Conclusions: Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel / ethnology
  • Attitude to Health / ethnology
  • Communication Barriers
  • Cultural Diversity
  • Delivery of Health Care / organization & administration*
  • Delivery of Health Care / standards
  • Ethnicity*
  • Health Services Accessibility / organization & administration
  • Humans
  • Leadership
  • Minority Groups*
  • Professional Competence / standards*
  • Public Health Administration / standards*
  • Quality of Health Care / organization & administration
  • Socioeconomic Factors*
  • United States