Also, as noted earlier, there is a tendency for the onus for health problems to be put on the individual, to “blame the victim.”

Some ethnic groups or cultural groups are more likely to be impoverished, which affects their health status. The committee concluded that none of the current terms, including “race,” ethnicity, and culture (interpreted as cultural group), successfully captures the complexity of people’s experiences and contexts, which may explain the disparate health risks and outcomes found in American society. Thus, in order to understand and, ultimately, to contribute to the elimination of health disparities, we should think in terms of cultural processes and examine how the life experiences of people may be impacted by social forces, such as discrimination, that are based on perceptions of difference. For this reason, breaking out of ethnic and cultural boundaries to embrace the concept of experiential identity is important.

It is not within the scope of this volume to operationalize the concepts of cultural group identity proposed here. It is important for future committees or task forces to work toward ways of operationalizing “cultural group identity” that would serve as markers of increased likelihood of shared experiences among those identifying with a cultural group.

CULTURAL COMPETENCE AND HEALTH COMMUNICATION

Cultural competence has been investigated largely in the context of the delivery of health services in clinical contexts. The field of cultural competency is based on an underlying belief that disparities in health outcomes are the result of a range of social factors, including race/ethnicity, education, socioeconomic position, gender, age, and sexual orientation. A wide range of models has been offered; many of the models use cases to illustrate key points. Systematic research rarely has been applied to develop or test existing models.

Models of cultural competency and tools to assess the capacity of organizations to serve cross-cultural populations, and those de-



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