The Changing Demographics
There is no doubt that the United States is becoming more diverse. According to the U.S. Census Bureau by 2040 Latino's will have grown to 30% of the working age population up from 15% in 2008, African-Americans will represent 15% up from 13% and Asian-Americans will represent 9.6 % up from 5.3%. From 1980 to 2000 the minority population grew 11 times faster than the white, non-Hispanic population. Studies have shown that the growth in workforce diversity has been accompanied by additional challenges. As stated in the National Business Group on Health, 2009 report, "Employers need to be aware of these demographic shifts and to understand that in this new environment, a "one-size-fits-all" approach to employee health benefits will not be effective". These new employees may have differing health needs and may experience different treatments. "Employers assume that their health benefit investments will produce equal outcomes for all employees in terms of overall health status. Research is proving otherwise. Disparities in health and health care exist, even among employers with equal benefits."

Cultural Competency
Diversity in the workplace also requires understanding and being respectful of employees who may not look, talk, or behave the way main-stream white Americans do. Broadly speaking, cultures carry with them cultural communication styles and belief systems that are different than what may have been typical for businesses in the past. For employers to best serve the multicultural workplace and marketplace, cultural awareness is a necessity.

The dominant culture in the United States has grown from a western European model as described in Health Matters, A Pocket Guide for Working with Diverse Cultures and Underserved Populations**. They described the Western European culture as a Linear-Active Culture.

Linear-Active Cultures:

• Value facts and figures.
• Respect highly-organized planners.
• Think linearly.
• Use a straightforward, direct communication style.
• Take task-oriented approaches.
• Prefer rationalism and science over religion.

Compare that broad cultural model with one that is based on a Reactive Cultures model, which describes Asian, Native American and Pacific Islander cultures

Reactive Cultures:

• Value subtle communications, listen first, and then respond.
• Honor harmony, humility, and agreement.
• Use indirect communication style.
• Tolerate silence and find it meaningful.

In comparing these two broad cultural outlines, it seems that to be successful in reaching both cultures a one size fits all approach would not be effective. The critical element is to adopt a culturally sensitive perspective.

This approach and conscious accommodation of cultural difference has become know as Cultural Competence. The Federal Office of Minority Health defines Cultural Competence as "A set of congruent behaviors, attitudes and policies that come together in a system of care that enables effective work in cross-cultural situations".

Health Disparities

One business segment that demonstrated negative results from a lack of cultural competence is in healthcare delivery.  The Agency for Healthcare Research and Quality (AHRQ) has researched the disparity in healthcare performance for different cultures. These studies have shown that disparities exist even when access to healthcare and household income levels were in parity with the majority white population. The AHRQ studies have found that race and ethnicity influence a patient's chance of receiving many specific procedures and treatments. 

For example;

Heart disease
African-Americans are 13 percent less likely to undergo coronary angioplasty and one-third less likely to undergo bypass surgery than are Caucasians.

Asthma
Among preschool children hospitalized for asthma, only 7 percent of African-American and 2 percent of Hispanic-American children, compared with 21 percent of white children, are prescribed routine medications to prevent future asthma-related hospitalizations.

Breast cancer
The length of time between an abnormal screening mammogram and the follow-up diagnostic test to determine whether a woman has breast cancer is more than twice as long in Asian American, African-American, and Hispanic-American women as in white women.

Poor health outcomes for employees would have a negative effect on any business. Employers wishing to address cultural competence as it relates to healthcare can review standards developed by Department of Health and Human Services, Office of Minority Health. These are known as the CLAS standards* or Culturally and Linguistically Appropriate Service Standards. These standards can be found at www.ahrq.gov/fund/fr/fr122200.htm

The purpose of developing standards for cultural competency as it relates to healthcare is to promote improved outcomes. As AHRQ states:

• CLAS lead to better communication (measured by comprehension, satisfaction, etc.).
• Better communication leads to better adherence to medications and lifestyle changes.
• Better adherence to medications and lifestyle changes leads to improved health status.
• Improved health status leads to lower undesirable health care use (such as Emergency Department visits and hospitalization).

**Yehieli, Michael, Dr. P.H.; Greg, Mark A., Phd. "Health Matters, A Pocket Guide for Working with Diverse Cultures and Underserved Populations." Intercultural Press, 2005