Racial and ethnic health disparities

Can cultural competence-based techniques help reduce existing racial and ethnic health
disparities?


This research has found the theoretical connections between cultural competence and
health disparities frequently presented by scholars and policy-makers to be potentially
unsound. An extensive literature review and policy analysis conducted indicates that the
relationship between cultural competence-based techniques and documented racial and
ethnic health disparities is predicated on select studies suggesting ‘patient satisfaction’
results from cultural competence-based programs and thus plays a crucial role in reducing
health disparities (Betancourt et al., 2003; Baquet, 2005; Anderson, 2011; James et al,.
2011; Lie et. Al., 2011). These studies provide no evidentiary support for the increase of
patient satisfaction alongside cultural competency-based efforts, or the reduction of
health disparities alongside experienced patient satisfaction.
My MA research has also elicited a number of critical issues pertaining to concepts of
‘cultural competence,’ such as implicit power dynamics, paradoxes of ‘knowing’,
problematic interpretations of ‘culture,’ and the reification of racial hierarchies. These
concerns suggest that ‘achieving’ or even ‘working towards’ cultural competency-based
frameworks may, in fact, be prejudicial.
Collectively, this MA research prompts the question(s): Given the tenuous relationship
between cultural competence and documented health disparities, and the potentially
problematic nature of cultural competency frameworks, should cultural competencybased framework be utilized in medical education. There may be other advantages to
utilizing cultural competence-based frameworks within medical education curricula, and
these will be explored.


Principal Research Question:


My doctoral research will seek to address the following principal research question:
“Are cultural competency-based frameworks, which presently inform medical education
curricula, ethically defensible?”
The innovation of this research lies in the fact that such critical investigations of cultural
competency and articulated implications for present medical education still remain in
their infancy.
Research Design:
The initial exploration of cultural competence conducted within my MA research will
largely substantiate two chapters concerning the present conception and purpose of
cultural competency-based efforts.

A number of specific questions will guide my research. In combination, the prior
literature and its voids, together with my MA dissertation observations suggest the
following issues will prove relevant in my investigation:
What is articulated as the reason/justification for New Zealand’s current cultural
competence-based medical education program(s)?
What is aim of cultural competence within the context of medical education?
What is the observed or implicit relationship between concepts of race, ethnicity and
culture?
– How are these concepts constructed/implicated?
Methodology:
My research design will involve the use of philosophical investigation, which includes
reviewing the scholarly literature on cultural competence and medical education, and
critically analyzing arguments in support, and in question, of cultural competency-based
efforts. I will be extensively reviewing the current cultural competence-based programmes
within both of New Zealand’s medical schools and speaking with key informants on the
topic.
To critically address the concept of cultural competence, this thesis will introduce some of
the methodological tools from the scholarship of Michel Foucault. This approach provides
novel way of interpreting and problematizing knowledge systems, providing relevant but
new questions, objects of enquiry and epistemological and ontological flexible dimensions of
research analysis.
While the above speaks to the nature of this PhD most broadly, the research will be
approached as an exploration that unveils and shapes itself as it progresses.
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