Weekly Topic: Editorial: Cultural humility and our implicit biases: a reflection
Lauren Bernstein

Veterinary public health is public health

Someone recently asked me where my interest in veterinary public health began and wondered what veterinarians do within public health, a question that I, like many in this field, have received from veterinarians and non-veterinarians alike. I typically respond with genuine enthusiasm as I detail important roles like promoting antimicrobial stewardship, ensuring food safety and security, surveilling the country’s food supply for potentially devastating diseases, researching emerging zoonoses, advocating for farmworker health and safety, among many many others.

Although I may have spent my academic and professional careers exploring the breadth of these roles in government buildings, on farms, in abattoirs, and in veterinary clinics, my initial interest in this field arose from a social justice perspective when I observed, for the first time, what health disparities looked like and how animals fit into that picture.

As I wrap up my Master of Public Health this semester, I have recognized that my coursework incorporates intentionally redundant themes, highlighting the importance of understanding social determinants of health and how they influence health risks and outcomes. We frequently discuss these determinants in our classes in the context of structural racism, upstream policy changes, and health equity promotion. Understanding this is the cornerstone of ethical public health practice and servant leadership. Despite the emphasis on these themes, they’re often left out of veterinary public health and veterinary practice conversations. Veterinary public health is public health, and the factors that influence the public’s health also influence animal health and welfare, client and farmworker health and well-being, and our ability to practice, drive policy, or research with cultural humility.

CDC Research on Social Determinants of Health

A commitment to lifelong learning and critical self-reflection

Cultural humility and cultural competence are often used synonymously. The latter implies an objective that can be mastered in enabling effective cross-cultural communication or partnerships. The term has been widely criticized for this implication that learning ends when an individual presumes to have achieved it.

Cultural humility more accurately describes the continual learning process throughout an individual’s life, creating space for an individual to simultaneously understand another’s culture or belief system, understand one’s own cultural identities, and recognize how these influence personal biases and assumptions. This philosophy cannot be mastered; instead, it is used as an approach to navigating veterinarian-client dynamics or institution-community partnerships with greater self awareness and understanding.

To develop cultural humility requires critical self-reflection- recognizing your own implicit biases and the unequally distributed privileges that may benefit you. In practice, I understood that recognizing these biases were essential for promoting an equitable work environment and providing fair, ethical, and equally accessible veterinary care. I was also acutely aware of my privilege. I was raised to value education and academic and personal achievement and, despite my debilitating veterinary school debt, I still had the resources to make reasonable financial decisions and find employment in a society that benefits me.

And yet, despite my awareness of my own privilege, my awareness of systemic discrimination, my concentrated efforts to practice cultural humility, and my duty to provide equitable veterinary care, I still had embedded assumptions that would often prove to be inaccurate.

Video: Cultural humility

Journal of Health Care for the Poor and Underserved

Teaching cultural humility

“If you can’t afford the vet, you can’t afford the pet.” Many of us have heard, or perhaps even uttered, this worn out phrase which immediately diminishes the value of the human-animal bond and assumes that a client’s financial health is static. It also assumes that all clients have had equal access to education about or hold the same sociocultural beliefs about preventive care and animal husbandry.

Shifting this presumptive mindset requires individual growth and our collective engagement. The AVMA Council on Education requires veterinary schools to foster inclusion and diversity within the institutions themselves and throughout the curriculum, combining traditional veterinary knowledge (i.e. anatomy, physiology, pharmacology) with opportunities to integrate service learning or transcultural immersion. Such cultural humility training allows students to recognize that culture may influence a client’s decision making.

Positive outcomes of this training are well documented in human medicine and include improved patient compliance, health outcomes, and leadership skills among health providers. It also increases patient willingness to seek care and enables better engagement with more diverse populations. Navigating sociocultural barriers may improve our ability to convey important medical information, which strengthens veterinary-client-patient relationships, enhances clinical decision making, and ultimately improves care.

Journal of Veterinary Medical Education

Journal of the American Veterinary Medical Association

Additional resources

Questions, comments, feedback about today's Weekly Update? Please email Dr. Lauren Bernstein.

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Lauren Bernstein

Lauren Bernstein

Lauren received her BS in Animal Science from the University of Tennessee. Following a Rotary International site visit to South Africa as an undergraduate student, she decided to focus her prospective veterinary career on public health, specifically on issues involving diseases at the human-animal-environment interface. She completed her veterinary education at the University College Dublin, School of Veterinary Medicine. When she's not in the office, she enjoys yoga, embracing the outdoor activities in Minneapolis, and finding excuses to talk about her rescue cat.