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Keywords Health care, Workers, National cultures, Equal opportunities
Abstract Inequality and exclusion are characteristic of the experience of UK South Asian communities. In health care, community needs are often not addressed by health and social welfare services. An increase in cultural competency is now part of identified policy. The aim of this paper is to examine the extent to which there is evidence of cultural competency amongst professionals concerning South Asian parents caring for a person with cerebral palsy. Semistructured interviews were conducted with respondents from 19 service organisations. Results are presented on perceptions of service delivery and on the dynamics of service development: evidence is found that inadequate service delivery continues despite professional knowledge that it exists. Conditions necessary for the achievement of cultural competence are discussed. We suggest that service development to meet the needs of South Asian carers must form part of an overall strategy geared to change at different levels within and outside service organisations.
Introduction
There is considerable evidence that inequality and exclusion are characteristic of the experience of South Asian communities in the UK (Modood et al., 1997). Socio-economic disadvantage is apparent in higher levels of poverty, poorer housing and higher unemployment than is found in majority ethnic communities. In health and health care this inequality is replicated not least in the higher incidence of certain conditions such as cerebral palsy, learning disabilities and chronic illness within some South Asian communities (Azmi et al., 1996; Nazroo, 1996; Sinha et al., 1997). Moreover, it has been found that the needs of these communities are often not addressed by health and social welfare services, resulting in inappropriate provision and consequently low take-up of services (Chamba et al., 1999; Atkin and Ahmad, 2000).
Institutional racism has been a fundamental force in the difficulties faced by ethnic minority families with health care needs (Atkin et al., 1998). Stereotypes of South Asian families "looking after their own" are sometimes used by service providers to explain low take-up (Atkin et al., 1998). In addition, an "information vacuum" exists in terms of literature available to non-English speakers (Chamba et al., 1998). Carers and service users may lack awareness of services, there may be no minority ethnic staff that can speak their language or advise...