Spiritual_Wellness_Holistic_Health_and_the_Practic

Lessons From Developing Countries 339
(1989) listed six major steps professionals should take toward achieving cultural proficiency.
These steps have been depicted in a graphical representation in the form of a
ladder. In the first step, called “ cultural destructiveness, ” one cultural group is seen as
superior to others. Professionals in this step adopt attitudes and practices that dehumanize
those who are seen as inferior. The second step is called “ cultural incapacity. ”
In this step, practitioners promote racist policies and perpetuate the maintenance of
stereotypes about particular groups. The third phase is called “ cultural blindness, ”
and it is characterized by an oversimplified attitude of treating everybody in the same
way without acknowledging historical and cultural specificities. The fourth step is
“ cultural precompetence. ” In this phase, practitioners become aware that they have
gaps and weaknesses in regard to providing services to culturally and ethnically
diverse groups. The following step is “ cultural competence ” in which health care personnel
actively engage in learning processes and adopt practices that denote respect
for others who are “ different ” from them. The last step, called “ advanced cultural
competence ” previously known as “ cultural proficiency, ” is characterized by an attitude
that values difference and by an action - oriented lifestyle in which respect and
high esteem are provided to ethnically and culturally diverse populations (Cross et al.,
1989).
I have found this ladder very useful in understanding the complexity of multicultural
issues involved in health education. Practitioners in health education have the
responsibility to move up this ladder and to achieve a state of advanced cultural competence.
In this context it is also very important that those of us who have been seen as
“ minorities ” actively strive to become culturally competent, too. We need to learn
how to respect and appreciate the value of those called “ majority. ” Many times I have
seen how someone of my own ethnicity treats a White person in a disrespectful way
just because that person is White. I have seen many White people who are very culturally
competent and who are trying very hard to acquire a proper level of cultural proficiency
in their personal and professional lives. Culturally diverse populations need to
give credit to them. We cannot continue to cover ourselves with the “ shield ” of the
past. We cannot continue to generalize about how we have been mistreated. It is
important to recognize the historical events that document the mistreatment of certain
ethnic and cultural groups and may serve as the basis for distrust, but we need to move
beyond. We need, however, to realize that cultural competency is a two - way street.
We ought to become examples of cultural acceptance and respect for others who are
different from us. Health educators need to fight discrimination, but we need to fight it
in our own homes, through educating our children, through promoting cultural competence,
and through advocating for social justice here in the United States and around
the world. Our behavior can teach more than our words.
I am very glad to have been given the opportunity to share my personal perspective
on these issues. This represents an attempt to provide a small contribution to the
development of our profession. Opening this dialogue is, in my view, a healthy way to
ensure prosperity in our profession.