Moving beyond cultural competence in public health education to address health inequities

Public health workers interact with increasingly diverse populations. Education is essential to increase the capacity of public health workers who work to improve population health. Despite an emphasis of cultural knowledge in public health education programs, attention to other social health dimensions is less apparent. This issue has been identified in education curriculum for nurses, key public health professionals. Nursing education tends to disregard and minimize issues of race, gender and class (Abrums & Leppa, 2001) and has depoliticized discussions of race and other social differences (Hassouneh, 2006). The emphasis of cultural competence at the exclusion of social forces risks further marginalization of diverse health care clients (Wear, 2003). The purpose of this research was to link education and practice to improve health care outcomes of diverse communities. This research examined the trajectory of cultural competence and racism among nursing students upon entry into nursing school and their progression through nursing education. The research design was a cross-sectional survey in which levels of cultural competence and racism were ascertained among five cohorts of students at the same time. The sample size was 100 nursing students. The Symbolic Racism 2000 Scale was used to measure levels of racism in nursing students. The Cultural Awareness Scale and the Cultural Competence Behavior Scale were used to measure cultural competence. Descriptive statistics and regression analysis were used to analyze the data. The results reveal a gap in knowledge and praxis related to culture and race. Nursing students and other public health students must be given the opportunity to integrate their knowledge of causal factors associated with health disparities in a way that changes their behavior and care practices in the health care setting. These results facilitate recommendations for changes in nursing and public health curriculum to enhance quality and equitable care for all.