Cultural Humility --- and why it matters!

Cultural Humility

My road to discovering cultural humility was long, complex, and iterative. I have struggled with how to use our technical expertise to address health inequities and reduce health disparities. In April 2014, the San Francisco Department Public Health launched the Black/African American Health Initiative (BAAHI) which required me to question my assumptions and redefine my role. This happened by improving how we listen to our African American staff and communities.

I initially focused on technical solutions, but quickly learned (again!) that technical solutions---no matter how great and well-intentioned---will not take root and spread if we do not address underlying mental models, and explicit and implicit biases. Through an iterative process BAAHI emerged into three components:
  • Cultural humility (focused on racial humility)
  • Workforce development
  • Collective impact for health disparities
Cultural humility brings together and synergizes two important concepts: culture and humility. Culture is a "set of patterns of human activity within a social group and the symbols that give such activity meaning. Customs, laws, dress, architectural style, social standards, religious beliefs, and traditions are all examples of cultural elements. At every level, societies to individuals, culture is multi-dimensional and each individual has their own unique, multi-dimensional expression of culture which is dynamic and changing. Much of culture is hidden: we only see the symbols (behaviors, words, customs, traditions) but not the underlying beliefs, values, assumptions, and thought processes.

Humility is "the noble choice to forgo your status, and to use your influence for the good of others before yourself" (John Dickson). Humility is a universal character virtue because it is positively valued in nearly every society, culture and religion, and throughout modern history. Cultivating humility enables one to seek honest, critical feedback, and to improve relationships, trust building, team performance, and intellectual growth.

In 1998, Melanie Tervalon and Jann Murray-García published a groundbreaking article that challenged the concept of "cultural competency" with the concept of "cultural humility." When you accept cultural humility, by definition, you acknowledge that you can never truly achieve cultural competency. Cultural humility is committing to lifelong learning, critical self-reflection, and continuous personal transformation.

Here is my synthesis of their classic paper on this concept:
  1. Commit to lifelong learning and critical self-reflection.
  2. Cultivate humility, opening our heart to transformation.
  3. Realize our own power, privilege, and prejudices.
  4. Redress power imbalances for respectful partnerships.
  5. Recognize and validate our common humanity.
  6. Promote institutional accountability.

“Humility is the noble choice to forgo your status and use your influence for the good of others. It is
to hold your power in service of others” (Source: John Dickson, Humilitas, I have come to believe that cultivating humility and practicing humble inquiry is central to leader, team, and organizational learning, performance improvement, and transformation. Organization culture is transformed through relationships (dyads and teams). Prejudices include explicit and implicit biases.

Humility and humble inquiry builds trust. Trust enables cooperation. Cooperation is necessary for shared visioning, shared decision making, and shared learning.

I believe that promoting cultural humility is one path to organizational transformation that will enable continuous improvement internally and externally with the diverse communities we serve.

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