In working with diverse groups of people, public health practitioners should be aware that notions of health and disease differ across cultures, and that to do effective cross-cultural work they must understand those differences, says SPH Professor Gary Harper, who collaborates with communities in both downtown Chicago and rural Kenya. "We always have to be thinking about our viewpoints and perspectives on the communities we work with, how we understand them and connect to them—or not."
Toward that end, schools like U-M SPH have long included "cultural competence" training as a key part of their curricula. But Harper, like many others, finds the term limiting because "it tends to promote stereotyped notions—the idea, for example, that most Latinos are Catholic, or that family is important to African-American communities. You come away saying, 'I'm now competent to work with Latinos,' but how do you define 'Latino'? What type of Latino? What context?"
Harper prefers the more nuanced term "cultural humility," coined in 1998 by physicians Melanie Tervalon and Jann Murray-García. As they define it, "cultural humility" entails both a lifelong commitment to self-evaluation and self-critique and "the ability to recognize our own beliefs and assumptions and to break through commonly held assumptions and stereotypes that can get in the way of being 'competent' or 'sensitive' in another's culture."
"It gets us to think about our preconceived notions of other people," says Harper, who includes some discussion of cultural humility in all of his SPH classes. "I get really frustrated with how people approach cultural competence—it's a box you check off. But with cultural humility you have to think about it 24/7. You're constantly engaging in this self-reflexive process of challenging your notions. It's more work, but it's how we do better work." He adds that "cultural humility" also incorporates the notion of "intersectionality, the idea that we all have multiple identities, and they come together in a variety of different ways and contexts."
For SPH Professor Barbara Israel, cultural humility is a reminder "to show humility and mutual respect within the context of someone else's culture. It's the idea of listening—and not always having the answers. We as researchers have a lot of training, skills, and competencies, but we have to also recognize what we don't know. That's the part of cultural humility that I think is so important."
The Community Perspective
Three years ago, SPH Professor Gary Harper began working with a group of young black gay and bisexual men in Chicago to develop an HIV-prevention intervention. The young men were primarily from the city's South and West sides—home to Chicago's largest African-American communities—and came from a range of backgrounds. One was a professional classical and contemporary ballet dancer. Another was homeless.
Most had experienced discrimination. One had been attacked because of his sexual orientation and nearly died.
Together, the young men were committed to becoming social change agents by promoting healthy behaviors among young gay and bisexual black men. As part of that work, they would confront the social stigmas and media stereotypes that can lead young black gay men to engage in substance abuse, eating disorders, suicidal ideation, and risky sexual behaviors.
And they would change hundreds of lives—including their own. Today, as co-facilitators of Harper's ongoing intervention, Guys Like Us—Educated, Empowered, Everywhere (GLU-E3), these young men are working to prevent the spread of HIV among teenaged black gay and bisexual men—the population most at risk for HIV in the U.S. Additionally, several members of the group have enrolled in college and one is in graduate school. Together they spoke to Findings about the importance of cultural humility to their efforts:
"Young people can really tell when somebody is not culturally competent. They can tell when somebody is not relatable, and if they feel it's fake, they're not going to go for it. So my advice is to do your research on whatever you're trying to accomplish. If it's a certain race or type of people that you're not a part of, it doesn't mean that you can't do the work, but do your research and make sure you know your facts. Reach out to the appropriate people. Give credit where credit is due. If your heart's really in it, and you really mean to help, then you definitely can make a difference."
—Anthony Singleton, Program Coordinator, LGBT Center, Halsted; Co-facilitator, GLU-E3
"When we think about working with communities, we have to take the pulse of the communities. We can't just say, 'I know all this, I have this many years of experience.' That's great, but they also have experience, and they live that. I don't live on the south side of Chicago. I don't know what it's like to experience chronic long-term oppression like they have, because I have economic privilege. I have resources to remove myself from some of that. So my experience is different. The key is to appreciate those differences."
—Omar Jamil, Project Director, GLU-E3
"I find it helpful to check my educational experience and my public health background and really just be in the space—learn from members of the community and have them learn from me, and realize that everyone may not come to the same decision or agreement. It's really important to allow space for everyone to state their position—especially in these young age groups. They're learning a lot about life, and things go so much further when they can determine for themselves what it is they want to do, versus me being some old person telling them how they should think."
—Alan D. Johnson, Linkage to Care Coordinator, AIDS Foundation of Chicago; Co-facilitator, GLU-E3
"For me, cultural humility is about meeting people where they are. What is their background? What neighborhood, what region do they come from? Getting a sense for their current understanding of the issues that we're going to talk about and remembering that I am separate from this specific community, that these folks really are the experts of their own lives."
—Kylon Hooks, Drop-In Manager, Broadway Youth Center, Chicago; Co-facilitator, GLU-E3
"Dr. Harper is very intentional about seeking out people in the community and not just saying, 'This is what I've found,' but saying, 'This is what I'm interested in doing. How can I learn from and serve this community?' My colleagues and I actually see our ideas and words in the finished product of this collaborative process. It shows us that he cares about our opinions, is serious about the work, and wants to make a difference. He 'steps up by stepping back,' as I've heard other members of the community say, because in order to serve a community you need to give its members a voice and due recognition."
—Dion Rice, Senior Behavioral Research Associate, Ann & Robert H. Lurie Children's Hospital of Chicago; Co-facilitator, GLU-E3