Meeting the Challenge of Teaching Cultural Competence to Millennials

Millennials, those reaching adulthood in the early 2000s, are particularly difficult to reach when discussing health-related topics. Every healthcare-related course that I teach to my millennial students comes with its own set of challenges.

Millennials currently make up the largest and most diverse generation in the U.S. They are not only ethnically diverse; they are also diverse in worldly perspective. They are a generation more likely to forgo societal gender norms and be more accepting of various lifestyles.

Many millennials opt to live in urban settings, which are typically more diverse; they are more educated than previous generations; and they are historically more accepting of other ethnic groups and races, most likely because they were raised in more diverse environments themselves. Unfortunately, this makes it difficult for them to recognize that disparities do exist.

How do I convince my class of future healthcare workers that everyone doesn’t receive the same treatment or have access to the same services? How do I teach them that inequities exist and disparate care has a negative impact on health? As their teacher, I know that health status is influenced by social and cultural practices. Many of my students, however, have yet to make the connection.

At the same time, these students in my Cultural Diversity in Healthcare class listen to the same music, worship the same idols, and are fed the same steady diet of social media that often and inaccurately defines racial and ethnic cultures in terms of stereotypes and exaggerations.

I hate to sound like my mother, but millennials are two generations from social strife and struggle. Notions like compassion and empathy are not familiar to many of them. They have neither the history nor the lens of a broader perspective to recognize how different things were only a short time ago.

Consider the topic of health disparities — the lack of equity in health provisions for certain groups. It is hard enough having conversations about health inequity with adults, but how do we have conversations with college students whose experiences are likely limited to annual sports physicals and childhood immunizations?

In my lessons I emphasize that the “color” of America is going to be very different in the not-so-distant future. Demographic changes predict the browning of America to reach its peak by 2050. I also emphasize that these “brown” people will live longer and use more healthcare services as a result.  I stress the care needs of these groups and the demands on the healthcare system.

In the workforce, we will need more people who are prepared to assist and treat those from many racial and ethnic backgrounds and cultural perspectives. To be able to do so, to be culturally competent, is a goal that I have for my students. It is important that they understand the cultural context in which one defines his or her health and wellness and provide services accordingly.

Anyone who knows anything about the U.S. healthcare system knows that it has a troubled history. While many believe our troubles only began when Obama took office, those of us in the field know otherwise.  We’ve witnessed a system in the 1980s in which high reimbursements and consumer demands for new technologies were commonplace; a system in the 1990s that focused on partnerships, mergers, and managed care; and in the 2000s, a system that focused on prevention and pushed for consumer health literacy and self-advocacy. Again, millennials have only read about these things. The landscape of healthcare is vastly different in their eyes. They don’t see many of the problems they have yet to face.

When I discussed my course with the CEO of our local hospital, she made it clear she wanted her facility to better meet the needs of the diverse populations they served. She said she felt her organization was missing the mark for some of these groups. After much conversation and self-reflection, I decided no voice would be stronger in bringing the message home than that of someone experiencing cultural challenges in accessing care.

The CEO put me in touch with a local imam who spent the better part of two hours describing his culture and the needs of those in his community.  He then talked about the many reasons it was difficult for members of his community to access care. I’d never seen the students more focused as the imam was speaking. The Q&A session that followed included open and honest discussion about culture, fear, stereotypes, and healthcare.

My challenge as an educator is to understand the unique perspective of my millennial students. My goal is to become culturally competent in hopes of preparing them to be culturally competent as they encounter those from diverse backgrounds.●

Laurie Shanderson, PhD, MPA, is assistant dean for the School of Health Sciences at the Richard Stockton College of New Jersey.