Module 12: Cultural Humility
“The approach of cultural humility goes beyond the concept of cultural competence to encourage individuals to identify their own biases and to acknowledge that those biases must be recognized. Cultural competency implies that one can function with a thorough knowledge of the mores and beliefs of another culture; cultural humility acknowledges that it is impossible to be adequately knowledgeable about cultures other than one's own. Another term often used when discussing working with others outside of our own culture is cultural sensitivity. Cultural humility requires us to take responsibility for our interactions with others beyond acknowledging or being sensitive to our differences.”(1)
We are all shaped by the culture we were raised in. However, it is very important that researchers and care providers do their best to step outside of the cultural framework they are used to for the sake of those they serve.
What is cultural humility?
Humility has traditionally connoted a kind of meekness or humbleness, but it can also be used to “denote a willingness to accurately assess onself and one’s limitations, the ability to acknowledge gaps in one’s knowledge, and an openness to new ideas, contradictory information, and advice”.(2)(3) In the case of healthcare providers, humility takes on this second definition: rather than being very humble, meek, and self-effacing, these professionals must acknowledge the limitations of their cultural perspective and work toward overcoming this perspective in order to provide better care for those they serve. As Levi emphasizes in “The Ethics of Nursing Student International Clinical Experiences," cultural humility is an acknowledgement of one’s own barriers to true intercultural understanding.(4) It is the difference between intellectually knowing another culture and being able to truly relate to it. Knowing that one’s own perspective is necessarily limited makes it much easier to be reflective and proactive in relation to one’s prejudices and assumptions that might affect an interaction with members of a different culture.
Why is cultural humility important?
"Humility involves one's general attitude to one's place in the world and whether one feels subject to the same moral constraints as others. Unfortunately, the world is characterized by actions that reflect a value system where some lives are considered infinitely more valuable than others. In global health settings, humility is crucial and helps undermine neo-colonial trends that often permeate relationships between the North and South."(5)
First and foremost, cultural humility means not pigeon-holing people.(6) Knowledge of different cultures and their assumptions and practices is indeed important, but it can only go so far. Rather than assuming that all members of a certain culture conform to a certain stereotype, a good care provider will understand that while cultural differences will affect their interaction with individuals, each person remains an individual and should be treated as such.(7) Cultural humility is also an important step in helping to “redress the imbalance of power inherent in physician-patient relationships” or other relationships between care providers/researchers and those they serve.(8) Approaching each encounter with the knowledge that one’s own perspective is full of assumptions and prejudices can help one to keep an open mind and remain respectful of the person seeking care.
Merely acknowledging the differences between cultures is in itself an important first step toward cultural humility, but it is certainly not sufficient. It is possible to know everything that one could possibly know about a culture without demonstrating true cultural humility. As the California Health Advocates aptly point out in a recently published article on cultural humility, it is a kind of “reflexive attentiveness” that requires a great deal of “self-awareness” and goes far beyond “knowledge of the details of any given cultural orientation.”(9) Care providers must always be aware of the fact that even extensive knowledge about a given culture is not the same as having assimilated oneself into that culture, and therefore one must be aware of the differences that will still exist between their own perspective and the perspective of the members of that culture.
(1) Levi, Amy. “The Ethics of Nursing Student International Clinical Experiences” Journal of Obstetric, Gynecologic, and Neonatal Nursing. Vol. 38, No. 1, pp. 94-99 (2009). Accessed 3/24/09 <http://www3.interscience.wiley.com/cgi-bin/fulltext/121645515/HTMLSTART>
(2) Tangney J.P. “Humility: Theoretical perspectives, empirical findings and directions for future research” Journal of Social and Clinical Psychology. Vol 19, pp.70-82, 2000.
(3)Pinto, A.D., Upshur, R.E.G. "Global Health Ethics For Students." Developing World Bioethics. (Blackwell Publishing Ltd., 2007): 8. <http://www.jointcentreforbioethics.ca/people/publications/dwb2007.pdf>
(4) Wear, Delese. “On Outcomes and Humility” Academic Medicine, vol. 83, no. 7, pp. 625-626 (2008) Accessed 3/24/09 <http://journals.lww.com/academicmedicine/Fulltext/2008/07000/On_Outcomes_and_Humility.2.aspx>
(5) Levi, Amy. “The Ethics of Nursing Student International Clinical Experiences” Journal of Obstetric, Gynecologic, and Neonatal Nursing. Vol. 38, No. 1, pp. 94-99 (2009). Accessed 3/24/09 <http://www3.interscience.wiley.com/cgi-bin/fulltext/121645515/HTMLSTART>
(6) “UCSF Reinvents Medical Education” UCSF Today (November 13, 2001). Accessed 3/24/09 <http://pub.ucsf.edu/today/news.php?news_id=200111081&page=2>
(7) Miller, Suellen. “Cultural Humility is the First Step to Becoming Global Care Providers” Journal of Obstetric, Gynecologic, and Neonatal Nursing. Vol. 38, No. 1, pp 92-93 (2009). Accessed on 3/24/09 <http://www3.interscience.wiley.com/cgi-bin/fulltext/121645510/HTMLSTART>
(8) Borkan, J.M. et. al. “Towards Cultural Humility in Healthcare for Culturally Diverse Rhode Island” Medicine and Health: Rhode Island. Vol. 91, No. 12 (2008). Accessed on 3/24/09 <http://www.rimed.org/medhealthri/2008-12/2008-12-361.pdf>
(9) California Health Advocates. “Are You Practicing Cultural Humility? – The Key to Success in Cultural Competence” (April 2007) Accessed on 3/24/09 <http://www.cahealthadvocates.org/news/disparities/2007/are-you.html>