CDE Appendix 1 Literature Review - Central East Local Health ...

The Culture, Diversity and Equity Project: Literature Review
• To provide “a common understanding and consistent definitions of culturally and linguistically appropriate
services in health care…Ideally, the issuance of national standards for CLAS should result in the
replacement of the patchwork of different definitions and requirements with one universally understood set
of guidance”; and finally
• To “offer a practical framework for the implementation of services and organizational structures that can
help health care organizations and providers be responsive to the cultural and linguistic issues presented by
diverse populations” (Office of Minority Health 2001).
The ‘ultimate aim’ of the standards is “to contribute to the elimination of racial and ethnic health disparities
and to improve the health of all Americans” (Office of Minority Health, 2001);
The 14 CLAS standards are thematically organized around three themes:
Culturally Competent Care (Standards 1-3), Language Access Services (Standards 4-7), and Organizational
Supports for Cultural Competence (Standards 8-14). Federally funded health care organizations are
mandated to meet four of these standards (Standards 4-7) relating to language access services. This
mandate derives from Title VI legislation of the 1964 Civil Rights Act which mandates that all institutions
receiving federal funds provide adequate means of communication between English-speaking
providers and individuals with limited English proficiency (LEP). The federal Office of Civil Rights
defines an LEP individual as “someone who is unable to speak, read, write, or understand the English
language at a level to interact effectively with health and social service agencies and providers” (cited in
Rice 2007; also see Martinez et al., 2004).
Promising state level policies, legislation and/or initiatives include:
• New Jersey Senate Bill S-144, which was introduced in 1999 and signed into law in 2005. It requires that
physicians in New Jersey to take cultural competency training as a condition of licensure by the State
Board of Medical Examiners (see Salas-Lopez et al., 2007; also see Baquet et al., 2004);
• The proposed Illinois Covered Act introduced into Illinois’ state legislature which would, among other
things, establish a State Healthcare Workforce Council to provide an assessment of health care workforce
trends with a focus on cultural competence and minority participation in health professions education
(Smedley, 2008);
• Pennsylvania’s governor, Ed Rendell's, proposed Cover All Pennsylvanians legislation which, if enacted,
would similarly establish a Pennsylvania Center for Health Careers, among whose duties would be to
develop recruitment and workplace tools that aim to improve health professional workforce diversity and
promote the delivery of culturally appropriate care. In addition, this legislation would require charitable
hospitals to produce a community needs assessment in consultation with community groups and local
government officials (Smedley, 2008).
• Various private, governmental, and non-profit organizations in the US have also increasingly come to adopt
cultural competence policies, standards and training. Exworthy & Washington summarize the nature of such
strategies and policies in Table 3.4 below:
Table 3.4: Strategies to improve cultural competence at different levels in the US
Source: Exworthy & Washington, 2006. Adapted from Betancourt et al., 2002.
68