cultural humility Archives

In April, we reported on a thread that came up during the Black Birth Maternal & Infant Health Symposium: capitalism and how it influences health equity.

This month, the United States Breastfeeding Committee (USBC) hosted Philanthropy with an Equity Lens featuring Dr. Cara V. James of Grantmakers in Health.

For those who couldn’t attend, there will be a recording sent to registrants. And if you missed registration, we’ve distilled the conversation in hopes that you’ll use it as a jumping-off point in your discovery or continued understanding of operationalizing Diversity, Equity, and Inclusion (DEI) or what is sometimes referred to as J.E.D.I. (Justice, Equity, Diversity, Inclusion).

First off, USBC Senior Engagement & Training Manager Denae Schmidt and Dr. James made the distinction between operationalizing DEI and advancing health equity. Simply put, the former is the practice and the latter is the outcome. Dr. James suggested participants think of the distinction as the difference between who is doing the work and who is being served.

So, what practices are philanthropists adopting in order to serve the advancement of health equity?

Funders are reevaluating what is truly needed from grantseekers. Many are making the application process less tedious, acknowledging that many small organizations do not have the resources to “jump through hoops.”
Some funders are forgoing reporting requirements, adopting the concept of trust-based philanthropy. Trust-based philanthropy embraces the idea that the community has a lot of expertise, as Dr. James puts it. In this relationship, there is trust in the collaboration, a power share. Dr. James nods to MacKenzie Scott who tends to vet organizations on the front end in order to understand their focus, and then give funding with no strings attached.
Over the past five or so years, there has been a shift in the field to recognize that there needs to be more capacity-building for grant seekers. Catchafire is a “network of volunteers, nonprofits, and funders working together to solve urgent problems and lift up communities” offering pro bono services. Find out how that works here: https://vimeo.com/462743914
Dr. James reports that more people are starting to recognize that policy is an important piece in health equity. She said that we need to get “upstream” to address health disparities which means that we need to address the structures that lead to poor outcomes in conjunction with providing resources to organizations.

What are some tips for grant seekers?

Grantseekers can check funders’ websites for statements on commitments to DEI to make sure it’s a good fit for them. Grantseekers might also research what other projects funders have supported to get a sense of what kind of work they invest in.
Grantseekers might consider inviting potential funders to their events in order to engage with the community. Dr. James suggests not approaching the first meeting with funders with an “ask”.
Work alongside and across spaces to pool resources like talent and time. Collaboration expands reach, and this is desirable to funders.
Don’t be afraid to reach out to funders to get more information about how proposals can align more with their commitment.

Schmidt and Dr. James closed with some thoughts on why good intentions just aren’t good enough. Mainly, good intentions don’t always lead to action, Dr. James pointed out. And sometimes, she added, they can lead to harmful action. She reminded us that we didn’t start talking about health equity in 2020. These discussions had been happening long before, and what has been missing are the resources and the support in leadership.

What leadership talks about in public and in private signals what they care about, Dr. James continued. Individuals leading DEI initiatives need to have the authority and the respect to make decisions.

So, generally speaking, what can we all do to help operationalize DEI?

Take the courageous stand to commit to DEI.

Facilitate the collection and evaluation of DEI initiatives, so that we can gain an understanding of what is happening in these spaces.
Enter spaces with cultural humility. Recognize who is already in the space and what you can learn from them.

I’ve been following this conversation started by the Grammar Girl:

“I was a guest on a podcast where kids asked two people questions to decide who was the fake and who was the real expert.

The host said that early on, the kids thought the fake was the expert every time because the actors answered every question confidently, and the experts would hedge or even sometimes say, ‘I don’t know.’

They eventually told the fakes to be less confident so the kids would have a chance of picking the expert sometimes.”

The Grammar Girl’s post was making a point specifically about ChatGPT, but the sentiment can be applied more generally, and in our case to the field of lactation and other perinatal care providers.

Some of my favorite comments on the Grammar Girl’s post include:

Never trust an expert who isn’t willing to admit that they don’t know.

Experts know that there are sometimes variables or gray areas, thus they don’t answer in terms of absolutes.

That makes me think of how an intelligent person (possibly an expert in something) is still curious and open minded enough to not always be sure of everything.

Those who are experts, look before they leap, stop before they comment, ask for help and do their research. Saying ‘I do not know’ is a strength.

It reminds me of the quote: ‘The enemy of knowledge is not ignorance, it is the illusion of knowledge.’

Individuals on the perinatal care team can get stuck in a rut where humility is absent, and this can become dangerous for their patients.

Debra Bingham of PQI, in a recent newsletter, reminds us of physiologic humility.

Bingham writes:

“Perinatal health professionals work tirelessly to provide the best care they can. Unfortunately, sometimes we get stuck performing “strong but wrong” routines. For example, we have centuries of evidence to tell us that physiologic birth practices are key to having the best outcomes. Yet, too often we do not practice what I like to call physiologic humility. Humility that the physiology of a woman’s body before, during, and after giving birth is complex and typically works well on its own. Thus, we should proceed with physiologic humility because there are so many limitations in our knowledge of the complex physiologic processes related to birth …

As perinatal health professionals it is our responsibility to do everything possible to ensure that women in our care get to experience Mother’s Day. Especially this month, may we all continue to keep that in mind and as a top priority.”

In all fields of care, cultural humility must also be maintained. As defined by the National Association of County & City Health Officials (NACCHO), cultural humility (CH) is “a lifelong process of self-reflection, used to better understand the multi-dimensional identities of clients in order to establish and maintain respectful, healthy, and productive relationships.” NACCHO’s Shifting the Care Paradigm Fact Sheet describes how lactation care providers can partner with families and their community to understand individual patients’ cultural background, experience and personal challenges, and specific goals.

In the U.S., perinatal care is often siloed; however, this trend seems to be evolving as care becomes more collaborative. Collaboration requires all care providers to exercise a level of humility, offering their expertise while respecting and hearing out other members of the care team. Most importantly though, care team members must work together to respect their patient’s wishes and facilitate informed decision making.

“Absolute certainty leaves little room for shared decision-making,” the author of Humility and the practice of medicine: tasting humble pie points out.

The author later concludes that “the cultivation of humility is often painful and requires a high level of self-awareness and reflective practice.”

A challenge indeed, but worth the effort. Consider “taking a bite” of “humble pie.” [Chochinov, 2010]

Tag: cultural humility

Tips for infusing equity into philanthropy

The enemy of knowledge is not ignorance; it is the illusion of knowledge

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