Academic journal article Australian Health Review

Re-Visioning Cultural Competence in Community Health Services in Victoria

Academic journal article Australian Health Review

Re-Visioning Cultural Competence in Community Health Services in Victoria

Article excerpt


There are few studies exploring the need to develop and manage culturally competent health services for refugees and migrants from diverse backgrounds. Using data from 50 interviews with service providers from 26 agencies, and focus group discussion with nine different ethnic groups, this paper examines how the Victorian state government funding and service agreements negatively impact on the quest to achieve cultural competence. The study found that service providers have adopted "one approach fits all" models of service delivery. The pressure and competition for resources to address culturally and linguistically diverse communities' needs allows little opportunity for partnership and collaboration between providers, leading to insufficient sharing of information and duplication of services, poor referrals, incomplete assessment of needs, poor compliance with medical treatment, underutilisation of available services and poor continuity of care. This paper outlines a model for cultural consultation and developing needs-led rather than service-led programs.

Aust Health Rev 2008: 32(2): 223-235

THE DEMOGRAPHIC PROFILE of the Australian population indicates that Australia is a rich and complex multicultural society with more than six million migrants resettling in Australia since 1945. Available data suggest that 30% of Australians are from a culturally and linguistically diverse (CALD) ancestry; almost a quarter (23%) of the Australian population were bom overseas, and 15% of the population speak a language other than English at home.1-5 About 36% of all Australian refugees and humanitarian entrants are relocated within Victoria.6 The State Department of Education, Employment and Training7 indicates that Victorian migrants originate from 208 countries, follow more than 100 religious faiths, and speak 151 languages. Half of the Victorian population (44.5%) have at least one parent born overseas while 20% come from countries where English is not the main or official language.

Meeting the health needs of the Victorian ethnic population requires considerations of cultural and linguistic diversity. The challenge for health and welfare agencies is to provide a system of services to respond to the needs of diverse communities and individuals regardless of their backgrounds. However, resources are scarce and not all needs can be met; needs must be prioritised. For small marginal ethnic groups, an ethnospecific response becomes arguably unjustifiable. Although the ethno-specific model of service delivery is long recognised as more viable for larger ethnic communities,8 small communities are left with fewer options where there are no alternative models of service delivery. This is particularly important as settlement experiences vary across individuals and communities.

Transition becomes more difficult than most migrants and refugees imagined. In this sense, settlement is well understood as a vexed process with the potential to impact upon health and wellbeing. For example, more than 250000 CALD first generation adult Australians experience mental disorders in a year.4 Further, CALD Australians have been found to have high rates of suicide9 and a lower hospitalisation rate for mental disorders and all diagnoses when compared with their English speaking counterparts.10,11 In addition, CALD Australians have significantly higher rates of diabetes and diabetes-related hospital separations and deaths.12 Other documented health needs have included dental problems, care for pregnancy and child health, and sexually transmitted diseases.

Cultural competence has emerged as a framework to help health care providers improve the health outcomes of CALD communities.13 The lack of awareness about cultural differences and CALD clients' lack of knowledge about the health system can result in two unwanted outcomes:14

* compromised patient-provider relationships, especially when miscommunication occurs, making it difficult for both providers and patients to achieve the most appropriate care; and

* effects on patients' health beliefs, practices, and behaviours. …

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