ABSTRACT

For the last quarter century, Washington State has been ranked in the top third of the United States in health status while Arizona has been consistently around the bottom third. This gap can be partly explained by data related to traditional determinants of health like education, income, insurance rates and income. Moreover, Washington State invests three times more resources in the public health sector than Arizona. Surprisingly, however, Hispanic children in Washington State have poorer health status than Hispanic children in Arizona. This dissertation explores possible explanations for this unexpected situation, using as a conceptual framework the cultural competency continuum developed by Cross.

The study consisted of analysis of health-related data from Washington State and Arizona, and interviews with state health administrators, local health departments, community-based organizations and university administrators in both states. This research makes a modest contribution to the role that cultural competence plays in the development and implementation of health policy and programs, and the potential impact of this approach on health status. The dissertation ends with recommendations for health policy-makers and program planners, particularly in states with a significant proportion of minority groups.