Local, regional and national journeys to cultural and linguistic competence

Government Initiatives to Improve Cultural Competency
Public Health Essential Services and Anchorage, Alaska’s Multicultural Action Plan

The Municipality of Anchorage Department of Health and Human Services (DHHS) serves a community of approximately 280,000 people, with over 30% of residents being culturally diverse.  More than 95 languages are spoken in the public schools where 49.9% of the students identify as non-Hispanic and chose a race/ethnicity category.  Anchorage is home to the Department of State’s sanctioned refugee resettlement program for Alaska.  Immigrants and refugees in our city originate from at least 70 countries.

Integrating the CDC’s 10 Essential Public Health Services throughout the DHHS Multicultural Action Plan (the Plan) activities creates unique strategies affecting health disparities and affirming community wellness.  In a proactive effort focusing on community engagement for a healthy Anchorage, Alaska, the Plan identifies particular disparity issues and uses public health services to positively influence both internal and external department practices.  The internal focus on demographics, interpreting or translation services, workforce cultural competency, and nurturing departmental involvement in policy creation and enhancement strengthens DHHS’ role in Anchorage’s diverse and mainstream community.  Externally, the Plan cultivates partnerships, brings about collaborative projects and maintains consistent, quality liaison with cultural community residents.  Emergency planning and preparedness for Anchorage, including vulnerable and cultural populations, build upon both internal and external application of the Plan.

The CDC’s 10 public health essential services are intricately woven through the Plan to establish inclusive and competent health programming for Anchorage multicultural and mainstream communities.  When looking at these 10 services individually, the following practical applications of the Plan emerge:

• Monitor health status to identify and solve community health problems inclusive of quantitative and qualitative data sources focused on demographic identification.
• Diagnose and investigate problems or hazards utilizing community health services of disease prevention and control, immunization, or reproductive health program.
• Inform, educate and empower people about health issues with language and dialect specific translated materials.
• Mobilize initiatives through partnerships with cultural community members working toward disparity reduction and developing intervention/prevention strategies focused on specific barriers to wellness and quality of life.
• Develop policies and plans that support individual and community health efforts while educating policy makers on the importance of accessible and inclusive community health and human services.
• Enforce laws and regulations that protect health and ensure safety by sharing prevention strategies and goals with public safety, child welfare enforcement and legislative entities.  
• Link people to needed social services and assure the provision of health care when otherwise unavailable through outreach and collaboration strategies within cultural enclaves while assisting municipal emergency operations (planning and preparedness) as liaison to cultural communities for information dissemination and outreach to vulnerable populations.
• Assure a competent public health and personal healthcare workforce by maintaining a language assistance database, providing staff education on OCR Title VI and CLAS standards, and monitoring customer inclusive information dissemination for department visibility throughout the Anchorage community.
• Evaluate effectiveness, accessibility, and quality of personal and population-based health services through identified culturally diverse enclaves and individuals throughout Anchorage for partnerships, collaboration, and activism focused on internal workforce strategies as well as external community engagement to strengthen policy and program development.
• Research for new insights and innovative solutions to health problems by seeking public and private funding streams for development of best practice initiatives and convening of the community for partnership relationships.

Innovations proven through Anchorage’s Multicultural Action Plan

DHHS publishesThe Alaska Native's Guide To Anchorage yearly for distribution during an annual statewide meeting of Alaska Natives.  This free 60 page booklet is a resource tool with safety tips and community services provided for Alaska Natives coming to Anchorage, either relocating or moving to our city.  More than 10,000 copies are distributed annually. This year's 9^th Revised Edition has almost 400 entries.

Opening Minds and Hearts – Introducing You to Cultures in Your Community is a DHHS partnership with the Anchorage YWCA.  Their “eliminating racism” mission is affirmed through discussion groups hosting Anchorage women sharing their unique cultural stories.  Jewish, Older, Lesbian, African, Middle Eastern, Asian, Hmong, Latino women are examples of featured programs over the past 2 years.

The Anchorage Health Literacy Collaborative founded in 2006 convenes members from health and literacy disciplines creating activism avenues for training, awareness, cancer screenings, education and demographic insights.  DHHS’ role, as a founding member, is focused on capacity building and developing a grant cache for future funding streams.

DHHS’ Cultural Navigation component of the Plan creates two-way benefits.  Cultural community members receive information on municipal health and human services while the department gains valuable insight on needs, network enclaves, mores or customs.  This give-and-take stance maximizes trust amid skepticism while nurturing future resource development.

Lessons learned/challenges overcome   

Most challenging for the Plan has been the securing of disparity data on a local level.  There are national and state of Alaska sources of data.  However, this data is (1) in the prevention content areas (tobacco, obesity) as opposed to specific disease or health condition parameters and (2) predominantly focused on Alaska Native populations.  Recommendations must be put in place developing mechanisms to capture local data for all Anchorage’s vulnerable and cultural populations.

Avoid looking for commonalities when providing health and human services to cultural communities.  Unique individuality compliments Anchorage’s cultural communities.  Solution oriented generalizations or looking for generic responses to everyday situations inhibit the provision of quality health care. 

Health information outreach to cultural community enclaves is best accomplished by going directly to the neighborhoods where traditional events or gatherings take place.  Efforts must include developing a trust relationship with community leaders in a one-on-one experience created through mutually beneficial goals and cooperation.  Bridging the gap would also include restoring confidence in government services when past experiences, especially those of immigrants and refugees, were not positive or perhaps non-existent.