standards are in place, demonstrations and evaluations of programs implementing these and other relevant standards should be conducted. It is important to begin to measure the effects of these standards.


William Vega, describing himself as “having been a gardener in the vineyard of cultural competence,” commented that cultural competence is a heterogeneous concept. This makes it difficult to standardize measures and then link them to a specific form of training. Vega explained that because supervisors and chief executive Officers set and sustain policies, they should be willing to experiment. And as they experiment, those in leadership roles should be aware of the complexity of measuring cultural competence and the tentative nature of the process that Anne Beal described and have the willingness to go the distance in order to achieve cultural competence. Andrulis responded that leadership should play a key role and that leadership is where the process should begin. At the same time, building cultural competence within an organization among an array of practitioners might assist with sustainability. The recognition that every organization has strengths and assets and the tying of those assets to the measurement of cultural competence can lead to a strategy to build on those assets.

Valerie Welsh, the performance improvement evaluation Officer at OMH (Office of Minority Health), described research looking at public awareness of health disparities over time. She reported that although the general public’s awareness of health disparities has increased, the increase has been relatively modest. Awareness of health insurance disparities is higher, and African Americans are more aware of health disparities than are other racial/ethnic groups. The public has a very low level of awareness of health disparities affecting Asian Americans, even among Asian Americans themselves. Welsh said that increasing awareness is the first step in trying to address the problem. Awareness of disparities is markedly higher among physicians than among the general public; nonetheless, physicians too underestimate the degree of the disparities in many areas.

OMH released a strategic framework addressing health disparities in 2008. Welsh said that as the framework was being created, the Office found much research about the nature of the problem of health disparities and on the contributing and causal factors. In particular, more Americans are aware that disparities in health insurance coverage exist. However, what was not found was research identifying the specific outcomes at the individual, societal, and systems levels. This raised questions of how those outcomes should be measured so that methodologically sound evaluations of interventions designed to ameliorate those factors can be conducted.

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