Abstract
We propose broadening the concept of cultural competence to include environmental competence. Environmental competence refers to the ability of both public and private health providers and policymakers to be responsive to the constellation of physical, social, and economic environments in which patients and populations live. This concept is illustrated by examining health and economic disparities unique to coal mining areas of Appalachia, and discussing methods by which environmental competence may be developed and practiced. An understanding of environmental competence will allow providers and policymakers to form collaborative networks to address health disparities in Appalachia and other areas.
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