ABSTRACT
This chapter outlines the evidence for health disparities or inequities in the United States and describes the evolution of the cultural competence movement. The cultural competence movement is critiqued to help readers get a more sophisticated and more productive grasp of key issues involved, especially regarding the nature of culture. The chapter makes the reader to anticipate how those in health services research (HSR) may at present conceive of anthropology's role. Gender is not the only organizing principle implicated in health services maldistribution. Race and ethnicity figure highly. Local organizational systems and individual biases certainly play a role in supporting health inequity. But higher order social structures are implicated, too and these are perhaps even more important because they both sustain and construct individual and local system actions. When they do so in a way that robs individuals of agency or the right to self-determination and damages their well-being, something called structural violence is implicated.
