________________________________________________________________ Cultural Humility in Healthcare
Individuals who are not privileged experience the opposite – such as being an automatic suspect or having to prove belong- ing (Minarik, 2017). Privilege is not a guarantee of success for those groups who receive it; however, it is an advantage that other groups do not receive and allows for opportunities that others are denied (Minarik, 2017). A final key aspect regarding privilege is that it is not necessarily visible to those who receive it. The invisibility of privilege is the key component that allows it to continue. More simply, when those who receive privilege do not recognize it, they are unable to take actions to change it. Once people become aware of privilege, they choose to use the benefits of privilege to advocate for marginalized populations Marginalization is an important concept in the delivery of patient care. Marginalization is the “act of placing a person or group in positions of lesser importance, influence, or power” (Dictionary.com., 2025). Examples of groups that have been, and are being, marginalized include ethnic and racial minori- ties, immigrants, the LGBTQ population, persons who are disabled, and the economically disadvantaged. Some experts have identified the following three themes of marginalization (Chim, 2022): 1. Creation of Margins: Margins act as barriers and connections between a person and the environment. Margins construct physical, emotional, and psychological boundaries that people experience during interactions with society. Enforcement and maintenance of boundaries divide the political and socioeconomic resources in an uneven fashion. This also facilitates the unbalanced distribution of critical resources such as healthcare (Chim, 2022). This illustrates the concept of social determinants of health (SDH), which is defined as “the circumstances in which people are born, live, work and age and the systems put in place to deal with illness” (World Health Organization [WHO], 2025). 2. Living between Cultures: Living between cultures is another factor that links marginalization to SDH. Although the boundary or margin separates the dominant and peripheralized group, incomplete integration leads to a person or group that lives between cultures. Incomplete integration creates a situation where a person or group relinquishes characteristics of the marginalized group in order to bond with the dominant society but is unable to do so. Examples of living between cultures are the ways of life of most immigrants, migrant farm workers, and other vulnerable groups. People living between cultures tend to live in areas characterized by limited employment and educational opportunities (Chim, 2022). 3. Creation of Vulnerabilities: Creation of vulnerabilities are created by the cumulative impact of the creation margins and living between cultures. Vulnerability is defined as a state of being exposed to and unprotected from health-damaging environments (Chim, 2022).
Marginalized groups often do not receive the same access to societal resources such as high-quality education, healthcare, housing, or equal access to voting as those groups that are not marginalized. The marginalization of oppressed groups prevents them from having a voice and helps to sustain the status quo in the United States in which White, economically well-off, and able-bodied individuals control access to social, economic, and political power. Healthcare Professional Consideration Healthcare professionals should recognize the power imbal- ances that result from oppression, privilege, and marginaliza- tion and work to correct the imbalances within the delivery of healthcare services and within the broader institutional and societal context.
PROVIDING PATIENT CARE WITH CULTURAL HUMILITY
The concept of cultural humility was first discussed in the medical world to better understand and address health ineq- uities and disparities (Tervalon & Murray-García, 1998). The concept has evolved to include ideas related to the creation of a broader and more inclusive society. Unlike the concepts of cul- tural competency and multicultural competency, which focus on gaining knowledge about cultural groups differing from the individual’s own with the hopes of better understanding those cultures and thus better meeting the needs of different groups who enter counseling, cultural humility focuses on the cultural context within America that marginalizes and oppresses some groups of people, while privileging and empowering other groups of people (Salahshurian and Moore, 2024).
ATTENDING TO DIVERSITY Critical Thinking Exercise
Trinh, a 17-year-old first-generation American of Hmong decent, is graduating first in her high school class. Her school counselor has encouraged her to apply to top-level colleges, several of which are hours from home. When Trinh asks about some nearby colleges, the counselor simply tells her that they are “well below her abilities,” even though one is highly regarded. She is accepted by the top-level colleges to which she applied, including two Ivy League schools. Despite generous financial aid packages, Trinh does not accept offers from any of these schools. Past the deadline to apply to the local 4-year colleges, Trinh decides to go to the local commu- nity college and live at home. Her counselor tries to persuade Trinh to reconsider one of the Ivy League schools. Trinh tells the counselor that she needs to stay home to help care for younger siblings and translate for her parents during doctors’ visits. The counselor engages Trinh in a role play to help her tell her parents that she needs to make her own decisions and go away to college.
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