Vitals in Practice: The Role of Critical Librarianship in Supporting Cultural Competence and Humility Building at Academic Health Sciences Institutions

By Tabitha Y. Samuel, MLIS (Associate Professor/Digital Archivist, Waring Historical Library, Medical University of South Carolina) <samuel@musc.edu>

Introduction

In the wake of the exposure of systemic racism and the social unrest of 2020 that resulted from the brutal murders of George Floyd, Ahmaud Arbery, and Breonna Taylor, many libraries and archives, like countless other public and private sector institutions, self-reflected and developed pledges and plans to critically evaluate and work to eliminate the presence of white supremacy in their practices, collections, and culture. For libraries and archives, this process of evaluation, formally known as critical librarianship, has now become more of an urgent need for those based at academic health sciences institutions because of the health disparities revealed by the COVID-19 pandemic.1 Although there are numerous factors that have and continue to contribute to the health disparities that exist in the current landscape of American medicine, whiteness and white supremacy manifest as structural racism in the mere design of the system and permeate at the heart of these issues.2 And, more granularly, the patient-provider relationship struggles to thrive should the provider lack adequate cultural competency and humility skills and training, which are the fundamentals required for effectively communicating with and providing care to diverse patient populations,3 and for addressing other social determinants of health, such as language, health care insurance coverage, quality of care, and health literacy, that heavily influence patient outcomes.4 Without such training, providers are ill-equipped to successfully confront their implicit biases and, thus, help to sustain the cycle of factors contributing to health disparities. It is, therefore, vital for libraries and archives, as the information centers at academic health sciences institutions, to practice intentional critical librarianship to build, sustain, and grow institutional understanding of the histories and cultures of the communities in which an institution serves and, thereby, its development of clinicians, students, and health sciences professionals equipped with cultural competence and humility.

Significance of Critical Librarianship

Conceptually, critical librarianship entails continuous evaluation of library and information science in theory and in practice through the lens of critical theory, which “acknowledges that racism, patriarchy, capitalism, and similar systems of power and oppression have become nearly inextricable from many aspects of Western culture, largely due to centuries of dominance by white, heterosexual, Christian males. This centralization of power led to the marginalization of ‘others…’”5 In theory, critical librarianship, on its own, is inherent in the nature of the core values and code of ethics defined by the American Library Association and the Society of American Archivists and in the various functions of the library and archives in practice, such as stewarding collections, providing equitable access, and preserving the historical record. However, biases as well as library and archival theory and practice designed through the lens of whiteness and white supremacy have and continue to impair the ideals of librarianship and archival practice, and result in issues such as silences in collections and offensive descriptors and language used to characterize historically marginalized communities and their lived experiences in catalog records and metadata. According to Claire Sharifi and Jill BarrWalker in “Critical Librarianship in Health Sciences Libraries: An Introduction:”

“It is important to recognize the structural racism built into our profession and our spaces. Just fifty years ago, libraries were segregated spaces. The myth of library neutrality that claims libraries and library workers are objective and that we should bring no biases or emotions to our work is challenged by critical librarianship…”6

Actively and intentionally practicing critical librarianship offers the needed distinction, and guides committed librarians and archivists endeavoring to dismantle structural racism embedded in their collections, practices, and in the culture of their institutions.

In practice, critical librarianship aims to dismantle systems of oppression in the policies, environment, and various practices carried out by a library or archives. Typically, this can include but is not limited to eliminating offensive language and descriptors in catalog records, metadata, and in finding aids to properly describe historically marginalized communities. Additionally, information professionals can evaluate collections for archival silences, update collection development policies and practices to diminish gaps, contextualize harmful content in collections, and build relationships with community partners to develop programs that engage historically marginalized communities as users and collection donors.

Building Cultural Competency and Humility in Clinicians and Health Professionals

Cultural competency is characterized as respecting “diversity in the patient population and cultural factors that can affect health and health care, such as language, communication styles, beliefs, attitudes, and behaviors,”7 and it is the “foundation to reducing disparities by being culturally sensitive and providing unbiased, high-quality care.”8 Cultural humility, on the other hand, is defined as “having a humble and respectful attitude toward people of other cultures. It involves ongoing self exploration combined with a willingness to learn from others.”9

It is believed that these skills can assist health care practitioners in better understanding the cultures and histories of the patient populations that they serve in order to more adequately address factors that contribute to health disparities that they may not otherwise recognize or discover in interactions with patients due to communication barriers, such as provider bias, language, and challenges providers may experience in relating to and in building trust with patients of cultures and identities different from their own. Providing care without cultural competency and humility perpetuates the disconnect in the patient-provider relationship, too often yielding disparities in morbidity and mortality rates, such as the disproportionate mortality rate of Black maternal patients compared to their White, Asian and Hispanic counterparts.10 These disparities are defined by race, gender, sexuality, and other identities in their patient populations.

If equipped with cultural competency and humility, health care practitioners can provide care more effectively with compassion and with a better understanding of their patients. They will be equipped with the skills needed to build a healthier patient-provider relationship. This would entail serving with compassion, actively listening and engaging without assumptions, learning the histories and cultures of the populations they serve, and confronting personal bias. Additionally, practitioners will be better situated to engage patients and patient families in the development of plans of care that offer instruction and meet their needs. With cultural competency and humility skills, practitioners can also help to ensure a more balanced continuity of care for all patients, and institutions will be more effective in offering robust patient family liaison services. All these aspects, in addition to a myriad of others, can help to address social determinants of health that contribute to disparities in health care.

Cultural Humility and Competence through Critical Librarianship

Librarians and archivists at these institutions should support cultural competence and humility training through critical librarianship practices and by being attuned to the needs of their institutions and the communities they serve. At the institutional level, this could look like creating modules and exhibits dedicated to educating health sciences professionals and students about the history of the institution and the histories of the communities it serves, highlighting collections documenting the local history and historically marginalized communities, hosting lectures to address the histories of issues in health disparities and social justice facing the local communities, and exposing health sciences professionals and students to a diversity of thought in open access scholarly communications, reference interviews, and evidence-based practice resources.

From a community and outreach perspective, libraries and archives should be poised to engage the communities they serve, including those that are historically marginalized, with the intention of building trust. This requires that cultural competency and humility guide relations with community members. This work could entail building relationships with collection donors and informing them about key processes, such as the development of finding aids and digital collections, involving the collection(s) that they donate. These efforts could also include partnering with community members on projects that document the community, developing events that engage the community and that teach community members ways to document and preserve their family histories. However, the end goal of this work cannot be accomplished without providing cultural competence and humility training to all library and archival staff.

Conclusion: The Role of Critical Librarianship in Building Cultural Competency and Humility

As the information centers of their institutions, archives and libraries at academic health sciences institutions can play a pivotal role in equipping clinicians, students, and health sciences professionals with cultural competency and humility. Taking critical librarianship practices a step further, librarians and archivists at these institutions can be an active presence for dismantling systems of oppression by educating their institutions about the histories of the cultures and communities in which they serve through exhibit and library guide curation, exposing students and clinicians to a diversity of thought in open access scholarly communications, reference interviews, and evidence-based practice, and by hosting lectures to address issues in health disparities and social justice facing their patient populations. Overall, the end goal should be — whether health or information sciences professional — individuals should seek to serve with cultural competency and humility by committing to recognizing and addressing their biases, learning about the histories and cultures of the communities they serve, and building relationships with those they serve with empathy, compassion, and respect. The success of librarians and archivists practicing intentional critical librarianship at academic health sciences institutions in reaching this goal can only be sustained, however, through their own active commitment to cultural competency and humility, their ability to establish trust in the communities in which they serve, and the buy-in and support of their institution.

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Tabitha Y. Samuel is the Digital Archivist of the Waring Historical Library, the rare books and special collections library of the Medical University of South Carolina. A Columbia, South Carolina native and Furman University graduate, Ms. Samuel received her Master of Library and Information Science from the University of South Carolina.

Endnotes

1. Ruqaiijah Yearby, Brietta Clark, and José F. Figueroa, “Structural Racism in Historical and Modern US Health Care Policy,” Health Equity 42, no. 2 (2022): 187-194, doi: 10.1377/hlthaff.2021.01466

2. “Let’s Talk: Whiteness and Health Equity,” National Collaborating Centre for Determinants of Health, 2020. https://nccdh.ca/ images/uploads/comments/Lets-talk-whiteness-and-health-equity_2020_EN.pdf

3. James Knibb-Lamouche, “Culture as a Social Determinant of Health,” In Leveraging Culture to Address Health Inequalities, ed. Karen M. Anderson and Steve Olson (Washington, DC: The National Academies Press, 2013), 5-12.

4. Samantha Artiga and Elizabeth Hinton, “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity,” KFF, May 10, 2020. https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-ofsocial-determinants-in-promoting-health-and-health-equity/.

5. David H. Ketchum, “Introduction: Critical Librarianship” in Critical Librarianship: Advances in Library Administration and Organization, ed. Samantha Schmehl Hines (United Kingdom: Emerald Publishing, 2020), 1.

6. Claire Sharifi and Jill Barr-Walker, “Critical Librarianship in Health Sciences Libraries: An Introduction,” Journal of the Medical Library Association 107, no. 2 (2019): 258-264, doi: 10.5195/jmla.2019.620

7. Ada Stewart, “Cultural Humility Is Critical to Health Equity,” American Academy of Family Physicians (blog), April 19, 2019, https://www.aafp.org/news/blogs/leadervoices/entry/20190418lv-humility.html.

8. Stewart, “Cultural Humility.”

9. Stewart, “Cultural Humility.”

10. Selena Simmons-Duffin and Carmel Wroth, “Maternal Deaths in the U.S. Spiked in 2021, CDC Reports,” NPR, March 16, 2023, https://www.npr.org/sections/health-shots/2023/03/16/1163786037/maternal-deaths-in-the-u-s-spiked-in-2021-cdcreports#:~:text=The%20maternal%20death%20rate%20among,the%20rate%20for%20White%20women.