The racial and ethnic diversity of the United States population is increasing, necessitating an inclusive and integrated approach to disaster preparedness, response, and recovery activities. This approach ensures that culturally and linguistically diverse populations are not overlooked or misunderstood, and receive appropriate services as needed.
The National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards), issued by the Department of Health and Human Services, Office of Minority Health (OMH), offer individuals working in the areas of emergency management, public health, and other health-related organizations a framework for developing and implementing culturally and linguistically competent policies, programs, and services. Cultural competency is defined as “the ability of individuals and systems to respond respectfully and effectively to people of all cultures, classes, races, ethnic backgrounds, sexual orientations, and faiths or religions in a manner that recognizes, affirms, and values the worth of individuals, families, tribes, and communities, and protects and preserves the dignity of each.1
Developing cultural and linguistic competency allows public health officials and emergency managers to better meet the needs of diverse populations and to improve the quality of services and health outcomes during and after a disaster. To be effective, however, cultural and linguistic competency must be included in all phases of a disaster or public health emergency – preparedness, response, and recovery.
Five Elements of Cultural Competency within Disaster Preparedness
- Awareness and Acceptance of Difference: Responders and survivors are often different in their racial, ethnic and/or language characteristics. By improving communication skills as well as becoming self-aware of potential biases and stereotypes, however, public health officials and emergency managers can provide quality care to diverse populations in a culturally competent manner.
Example: Not all cultures react to pain in the same way. While the experience of pain is universal, the way of perceiving, expressing, and controlling pain is one of these learned behaviors, that when manifested, is culture-specific.2 An example of cultural competency is a public health official’s and an emergency manager’s self-awareness of expectations associated with how an individual expresses pain or stress.
- Awareness of One’s Own Cultural Values: Examining personal prejudices and cultural stereotypes by performing an individual self-assessment can help public health officials and emergency managers become aware of their own cultural values and biases.
Example: The Valuing Diversity and Self-Assessment questionnaire3 is a widely used self-assessment that allows individuals to identify their own strengths and weaknesses when working with or treating populations with backgrounds different than their own. For example, immigrant and refugee populations may speak a language other than English, have different cultural norms, come from a different socioeconomic background, and have a different style of dress. Recognizing and respecting cultural differences and understanding your own biases and beliefs are critical to effectively serving or assisting culturally diverse populations during or after an emergency.
- Understanding and Managing the “Dynamics of Difference”: This refers to the various ways cultures express and interpret information. Taking an individual’s medical history is a systematic way to collect both medical and cultural information. This information promotes cultural understanding and improves the quality of services provided to the individual.
Example: The RESPOND tool4 succinctly defines the key components of taking the medical history of culturally and linguistically diverse populations.
R – Build rapport
E – Explain your purpose
S – Identify services & elaborate
P – Encourage individuals to be proactive
O – Offer assistance for individuals to identify their needs
N – Negotiate what is normal to help identify needs
D – Determine next steps
- Development of Cultural Knowledge: Cultivating a working knowledge of different health and illness related beliefs, customs, and treatments of cultural groups in your local area can better equip public health officials and emergency managers with the information necessary to provide timely and appropriate services.
Example: Research illustrates that racial and ethnic minorities are disproportionately vulnerable to, and impacted by, disasters.5,6,7 Minority communities also recover more slowly after disasters because they are more likely to experience cultural barriers and receive inaccurate or incomplete information as a result of cultural differences or language barriers.
- Ability to Adapt Activities to Fit Different Cultural Contexts: This concept refers to the ability to adapt and as appropriate, to modify, the services offered to fit the cultural context of the patients and communities you are serving.
Example: Increasingly, the role of disaster personnel includes involvement with interpreters during the triadic interview.8 A triadic interview is a process in which people with limited English proficiency can communicate their needs in the language of their choice and the interpreter relays this information to the disaster personnel. This process fosters mutual understanding and builds trust between the survivor and the responder.
Need more information?
OMH’s Think Cultural Health initiative provides resources pertinent to emergency management and the provision of culturally and linguistically appropriate services. The Health Care Language Services Implementation Guide and the Cultural Competency Curriculum for Disaster Preparedness and Crisis Response provide valuable tools for the implementation of language access services as well as skill-building for public health and emergency managers when working with interpreters and translation organizations.
1 National Technical Assistance and Evaluation Center. Cultural Competency. Child Welfare Information Gateway, Administration for Children and Families, U.S. Department of Health and Human Services; 2009. Accessed 12 March 2015.
2 Good MJD, Brodwin PE, Good BJ, Kleinman A, editors. Pain as a Human Experience: An Anthropological Perspective. Berkley: University of California Press; 1992.
3 Rasmussen, Tina. The American Society for Training and Development (ASTD) Trainer’s Sourcebook on Diversity. New York, NY: McGraw-Hill, 1995.
4 For more information about the RESPOND tool, review the Cultural Competency Curriculum for Disaster Preparedness and Crisis Response.
5 Davidson, TM, Price M, McCauley JL, Ruggiero KJ, Disaster Impact Across Cultural Groups: Comparison of Whites, African Americans, and Latinos. American Journal of Community Psychology. 2013;52(1-2):97-105.
6 Bethel, JW, Burke, SC, Britt, AF. Disparity in disaster preparedness between racial/ethnic groups. Disaster Health. 2013;1(2):110-16.
7 Collins, TW, Jimenez AM, Grineski SE. Hispanic Health Disparities After a Flood Disaster: Results of a Population-Based Survey of Individuals Experiencing Home Site Damage in El Paso (Texas, USA). Journal of Immigrant and Minority Health. 2013;15(2):415-26.
8 For more information about the triadic interview, review the Cultural Competency Curriculum for Disaster Preparedness and Crisis Response.