'Cultural competence' and the medical management of difference.

摘要

The incorporation of "culture" into U.S. biomedicine has been increasing at a rapid pace over the last several decades. The Office of Minority Health has released a list of fourteen requirements and recommendations for the development of Culturally and Linguistically Appropriate Services, medical schools are requiring students to receive "cultural competence" training, and managed care organizations are creating new positions for cultural and linguistic specialists. The push for cultural competence has developed in response to changing demographics and increasing health disparities, with advocates arguing that in order to provide equal health care for all, cultural differences must be recognized.;This dissertation examines the development of "cultural competence" and its implementation into several key areas of health care: health disparities research, medical education, managed care organizations, and clinical settings. Based on ethnographic fieldwork conducted between 2001 and 2006 in California, I examine the multiple understandings of "culture" that emerge in the effort to develop a more culturally competent health system. I argue that the use of the culture concept can depoliticize our approach to inequality and health disparities, perpetuate a focus on the "exotic" aspects of cultural difference, and maintain an understanding of biomedicine as essentially culture-free. Ultimately, this research suggests that the use of "culture" in cultural competence work can have the unintended consequence of reinforcing, rather than challenging, dominant social hierarchies in the United States.