Cultural Competency in New Jersey: Evolution from Planning to Law

Cultural Competency in New Jersey: Evolution from Planning to Law Debbie Salas-Lopez, MD, MPH Linda Holmes, MPA Dawne M. Mouzon, MPH Maria Soto-Greene, MD Keywords Cultural competency, cultural diversity, minority groups, delivery of health care, health promotion, access to care, quality of care, Hispanics/Latinos. Background In 1985, the U.S. Department of Health and Human Services released its Report of the Secretary's Task Force on Black and Minority Health, which was among the first reports to document major racial/ethnic disparities in health.1 The report found that, compared with Whites, Blacks had higher rates of infant mortality and mortality due to heart disease and cancer, while both Blacks and Hispanics had higher prevalence of diabetes than Whites. Concerned by these national trends, in 1990, the New Jersey Commissioner of Health established the Office of Minority Health (OMH) within the New Jersey Department of Health and Senior Services (NJDHSS), whose mission was to foster accessible and high-quality health services that help all racial/ethnic minorities in New Jersey achieve optimal health, dignity, and independence. This mission provided the framework for developing what would later be known as cultural competence. Cultural competence has been defined as "the ability of systems to provide care to patients with diverse values, beliefs, and behaviors, including tailoring delivery of care to meet patients' social, cultural, and linguistic needs" (p. 5).2 Cultural competence has recently gained attention as a potential strategy for improving quality of care and eliminating racial/ethnic disparities in health care.3,4,5 Here, we outline New Jersey's experience in developing community-sanctioned programs that seek to address effectively the health disparities encountered by historically [End Page 35] underserved populations. Box 1 presents a timeline of key accomplishments relating to minority health policy in New Jersey (Box 1). In this report, we focus on the cultural and linguistic competency health initiatives set forth following New Jersey's three Minority Health Summits (1999–2001) and how these initiatives became law. Click for larger view Box 1 Dates of Key Accomplishments Developing New Jersey's Health Agenda: A Collaborative Approach In 1993, New Jersey published its first major report on racial/ethnic health disparities in New Jersey, entitled, Closing the Gap: Improving the Health of New Jersey's Minority [End Page 36] Populations. This report found that, while African Americans and Latinos accounted for 17% of the population in New Jersey, they accounted for 67% of the new HIV cases in 1990. In addition, the infant mortality rate in 1990 was 2.5 times higher among African Americans and 1.5 times higher among Latinos than among Whites. This landmark report also urged the NJDHSS to develop policies and guidelines to ensure quality health care services for minorities in the state.6 In light of this call to action, NJDHSS began searching for a more effective response to the documented health care concerns of the state's minority populations. Despite the many programs developed for underserved communities, no forum existed through which leaders of the largest minority communities could exchange information on cross-cultural health issues. Thus, the New Jersey OMH organized three Minority Health Summits, the first for African Americans (1999), the second for Latinos (2000), and the third for Asian Americans/Pacific Islanders (2001), the largest minority populations in the state. Collaborators included local health department officials, health care professionals from various community and academic institutions in the state, local community members from all 21 counties of New Jersey, and leaders of various community-based organizations (CBOs). The Summit Series resulted in the development of three key recommendations for minority communities in New Jersey: 1) increase access to health care, 2) improve data collection, and 3) develop a cultural competency curriculum and standards to address health care disparities in communities of color. The Minority Health...