Foreword

This book is the product of a unique collaboration between the Health Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Office of Minority Health (OMH), and the National Alliance for Hispanic Health (formerly known as the National Coalition for Hispanic Health and Human Services Organizations).

HRSA, SAMHSA, OMH, and the Alliance share missions of providing high quality accessible health care for the underserved and uninsured and are consequently at the forefront of providing culturally and linguistically appropriate care through their networks of community HIV/AIDS programs; community and migrant health centers; state primary care offices; state primary care associations; maternal and child health programs; state alcohol, drug abuse, and mental health administrators; and community-based substance abuse prevention, treatment, and mental health programs. At the same time through their programs to develop a diverse pool of health professionals, HRSA, SAMHSA, and the Alliance are advocates for increasing the number of Hispanics who enter the health professions.

In 1985, the Alliance began Proyecto Informar to improve communications between health care providers and their patients. This effort involved all of the major health professional organizations and helped to popularize the concept of cultural competence. As a result, today there are numerous organizations that have taken cultural competence as their mission if not their mandate.

This book reflects the cumulative experience of our respective community programs with the art and science of cultural competence. Communicating compassion and caring is difficult within cultures and more so across cultures. As there can be no “cookbook” for cultural competence we have worked jointly to provide a framework which can be used by providers either at the individual or organizational level.

We acknowledge the importance of cultural competence in the provision of care and at the same time understand that cultural competence is complex. There is no easy recipe to follow as cultural competency necessitates grappling with issues that are sometimes intangible and oftentimes may make some providers feel uncomfortable.

At the same time we know that cultural competency is not an endpoint but one element in the continuum of quality care. To have true quality care we need to make sure that other partners in health are part of the solution. We also need research that includes diverse groups, consumers that are active participants in their role in the new health care systems, reimbursement systems that acknowledge the importance of provider-patient interactions, and technology that is used for the benefit of the patient rather than the convenience of the provider.

There is much to be done. We look forward to working together to improve the health of the Nation.