Peace and Conflict Studies - Spring 2014

Peace and Conflict Studies Volume 21, Number 1 58 “patients of culture x believe...and behave…”) (IOMNA, 2002, p. 206). The third approach is to focus on developing tools and skills that improve the providers’ communication skills and to apply an inductive framework that “focuses on the patient, rather than theory, as the starting point for discovery” (IOMNA, 2002, p. 206-207). The increased interest in trying to improve physicians’ cultural competency has certainly raised awareness of the need to be culturally sensitive. However, there is still much room for improvement. For example, although I do not deny the potential heuristic value of taking an etic approach to CCT, one that privileges the outsider’s point of view and focuses on isolating specific component of cultural groups, it tends to oversimplify the human cultural matrix and encourage stereotypes (Morris, Leung, Ames, & Lickel, 1999). The focus on attempting to configure universal categories of cultural behavior has unintentionally ignored the synergistic interaction that takes place among different cultures and the fact that cultures are dynamic. A recent literature review reflects that most studies measure cultural influence through racial or ethnic group membership that is “at best, a proxy for culture” (Kwack & Haley, 2005, p. 640). Furthermore, there is an inherent challenge in trying to reduce healthcare disparities by minimizing discrimination on the basis of race and ethnicity. That is, “in order to minimize discrimination on the basis of difference between people, differences must be systematically and authoritatively monitored, recorded and hence re-emphasized” (Banks, 1999, pp. 74-75). By subsuming race under culture, racism is redefined as a “cultural difference” which makes it easier to ignore racism, privilege, and power relations such as dominance/subordination (Beagan, 2003; Gregg & Saha, 2006). Framing CCT as learning how the “other” non-dominant group behaves and what their beliefs are has tendencies that may lead the learner to see them as inferior, exotic, or aberrant (Wear, 2003). This erroneously assumes that “normal” is an objective and color blind standard that does not reflect the cultural values of the dominant medical culture. Taking an etic approach to culture allows for the hard questions to remain unanswered: What are the structural and systemic changes that need to take place so that dying patients are no longer oppressed and ignored? How does occupying a space of white privilege impact end-of-life care for minorities? How do we address in CCTs the unequal power relationships and structural forces that have been sustaining health care inequality in the United States for centuries?