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The Toolkit for Cross-Cultural Collaboration was created as a result of a study of collaboration styles of African American, Asian American, Native American, Hispanic American, and Anglo American communities. While some similarities were found across communities in styles and markers of success, a great chasm separated each minority community from the Anglo American Communities. The chasm was created by differences in expectations, styles, assumptions, values, body language, and privilege. Each minority community understands that great differences separate them from the Anglo American mainstream cultures. In contrast, Anglo American communities do not have much awareness of the magnitude of differences. Occasional events open a small portal to this awareness, but Anglo Americans do not experience cultural differences as a central concern in their lives. For minority communities, the differences are not only central, but vast and inescapable.

The consequences of gaps in collaboration and communication styles are devastating to each minority community and to the nation as a whole. For minority communities, some consequences are: health services are underutilized, and many children do not complete their education. The resulting economic disadvantages are passed from generation to generation.

Following are examples of differential at-risk behaviors and outcomes for ethnic minorities, from the Centers for Disease Control and Prevention Web site (1998, 1999) and the Department of Health and Human Services Public Health Services Web site (1998, 1999):

Asian American and Pacific Islanders: The number of Hepatitis B cases among Asian American and Pacific Islander (API) children is two to three times greater than the rates for all children in the United States; tuberculosis rates for APIs is five times higher than the rates for the total population; 36 percent under the age of 65 have no health insurance; and for Southeast Asian men, smoking prevalence is 34% to 43% compared to 27.6% for Anglo American men (Department of Health & Human Services, Public Health Service (1998).

Hispanic Americans: Tuberculosis prevalence is twice the rate for the total population; Hispanic Americans are almost twice as likely to have diabetes as Anglo Americans; and among Hispanic American youth ages 15-24, homicide was the leading cause of death (Department of Health & Human Services, Public Health Service, 1999).

African Americans: Through 1997, over one third (36%) of AIDS cases were among African Americans, who represent only 13% of the U.S. population; 60% of all women reported with AIDS in 1997 were African American; 62 percent of all reported pediatric cases for 1997 were African American; 63 percent of HIV diagnoses for young people ages 13 to 24 were among African Americans; African Americans are 1.7 times as likely to have diabetes as Anglo Americans; over 20 percent of poor African American children have high blood lead levels compared to 8 percent of poor Anglo Americans; African American children have twice the infant mortality rate of Anglo American children and four times the rate for causes related to low birthweight; and among African American youth ages 15-24, homicide was the leading cause of death (Centers for Disease Control and Prevention, National Center for Disease Control and Prevention. (1999).

Native Americans: Diabetes prevalence is 70 per 1,000 compared to 30 per 1,000 for the total population and cirrhosis deaths are 21.6 per 1,000 compared to 8 per 1,000 for the total population; the rate for Sudden Infant Death Syndrome is 2.5 times higher than for Anglo American infants (Centers for Disease Control and Prevention, 1999).

What is the cost of failing to prevent at-risk behaviors or reduce poor health outcomes through collaboration with ethnic minority communities? Diabetes alone was estimated to cost $98 billion in direct and indirect health care costs for 1997 for the total population (Centers for Disease Control and Prevention, 1998). If the rate of diabetes for ethnic minorities matched Anglo American rates, billions would be saved each year in health care costs.

In terms of human suffering:

• Risk of stroke is 2 to 4 times higher in people with diabetes
• Sixty to sixty-five percent of people with diabetes have high blood pressure
• Diabetes is the leading cause of blindness in adults 20 to 74 years old
• Heart disease death rates are 2 to 4 times higher for persons with diabetes
• Diabetes is the leading cause of end-stage renal disease (dialysis, kidney transplants)
• Sixty to seventy percent of people with diabetes have mild to severe forms of nervous system damage
• More than half of lower limb amputations occur among persons with diabetes

Starting the Collaboration Process

This toolkit brings a new set of perspectives to the study and practice of collaboration between and across ethnic groups. A similar perspective has not yet been found in the collaboration literature, especially in cross-cultural collaboration. Studies in the past have been built primarily upon the disciplines of speech communication, sociology, anthropology, and psychology. What the authors bring to this study is the perspective of intercultural communication, and methods to evaluate the effectiveness of programs. This process can lead to improved communication and collaboration between agencies and ethnic minority groups.

While persons in minority communities know that differences separate them from the Anglo American communities, they do not understand the exact nature of the differences in communication styles and values. Instead of understanding these differences, persons from minority communities perceive that they are treated disrespectfully. (Sometimes they are, by individuals displaying prejudice). Because of behaviors they experience as disrespectful from the Anglo American communities, minorities often withdraw from participation in services designed on an Anglo American model. Cross-cultural collaboration to improve services for members of other cultures then becomes very difficult.

Some members of minority communities move away from their own traditions and adopt the values and styles of the mainstream or Anglo American community; such individuals may have frequent communication gaps when dealing with both traditional and mainstream communities. They may find they are not trusted within their own minority communities and they are not fully accepted within the mainstream community. Since they usually work and associate with Anglo Americans, such individuals are more accessible to mainstream organizations and are most often asked by mainstream agencies to represent minority communities. This further expands the gap in communication.

Minority communities perceive it as an act of disrespect when a mainstream agency appoints someone to "represent their interests." Instead, communities believe that they should choose their own representatives.

In these circumstances Anglo Americans are frustrated because they have chosen persons of high visibility-to them-from minority communities in an attempt to bridge gaps and increase involvement of the community. They then find that participation or service utilization from those minority communities is still lacking, even after the agency's good-faith (but uninformed) effort to correct the situation.

If persons from a minority background have high visibility within the Anglo American community, such as administrators within mainstream organizations, it does not mean that they also have high credibility or visibility within a minority community. Their adoption of values and styles of the Anglo American community may have simultaneously discredited them within their communities of origin. Persons who have high visibility within the Anglo American communities are usually not the best people to choose as representatives for minority communities.

The best choices for representatives for minority communities are found by asking those who actively serve within those communities. For example, leaders within the African American communities may found by contacting leaders of some of the larger churches serving primarily African Americans. Leaders of Native American communities may be found through contacting members of the tribal governments, who can consult with traditional leaders. For Asian Americans, contact the faith communities serving primarily Asian Americans; also, contact neighborhood associations where Asian Americans predominate. For Hispanic Americans, contact the faith communities and the Hispanic advocacy groups.

Each of the above organizations may help identify the most respected leaders within the communities they serve. Such respected persons, however, may not be particularly effective, or interested in communicating with, the Anglo American communities. The community leaders may have had a history of frustration and perceived or actual disrespect.

Finding respected minority community leaders to represent a community is a necessary, but not sufficient, condition for effective cross-cultural collaboration. A person with training in bicultural competence may also be necessary to bridge communication gaps before and during the collaboration process. Having a respected representative and a culturally competent facilitator are two necessary elements for effective cross-cultural collaboration. For long term success, however, much more is needed.

The Cross-Cultural Collaboration Toolkit identifies areas of miscommunication that defeat attempts at cross-cultural collaboration. The Toolkit is designed to help administrators and community leaders become more culturally aware and therefore more effective at collaborating successfully.

Issues underlying the gaps in cross-cultural collaboration, however, are deep, systemic, and even global. A toolkit cannot, of course, solve the problems alone. Training to increase cultural competence must be incorporated into our national and local infrastructures. We need to work with schools and media, as well as politicians and administrators. Our current and future leaders need specific training to increase their cultural competence.

The problem of insufficient cultural competence for cross-cultural collaboration goes back to the earliest beginnings of humanity. Every human culture teaches its members to value their beliefs, mores, and views of reality as the best, as the ideal; in some cases, cultures teach that their beliefs are the ONLY acceptable way to be or think. The resulting lack of cultural interchange and adaptation is pervasive and severe. However, given the wide diversity present in modern societies, cultural competence is a necessary skill, allowing us to provide appropriate services to all citizens. Given our modern technologies, it is also a skill we need for global survival.

Bias in Terminology

It is difficult to discuss issues of diversity or multiculturalism. Many of the words related to this issue have unintended connotations, leading to inaccurate communication and the furthering of unintended biases. Finding an appropriate term for the non-minority population is especially challenging.

"Whites" is the official term used by the federal government. However, referring to a group based on skin color rather than ethnic affiliation is not supportable on the basis of biology, anthropology, or any science. As Jared Diamond points out in Race Without Color:

…it's easy then to distinguish almost any native European from any native sub-Saharan African; we recognize Europeans and sub-Saharan Africans as distinct races, which we name for their skin colors: whites and blacks, respectively. What could be more objective? As it turns out, this seemingly unassailable reasoning is not objective.

For example, "…races defined by body chemistry don't match races defined by skin color." Based on biological systems of classification, "…many anthropologists today conclude that one cannot recognize any human races at all." If "race" is based on DNA rather than body chemistry, another conclusion is reached. "If so, the primary races of humanity may consist of several African races, plus one race to encompass all peoples of all other continents."

If we were just arguing about races of nonhuman animals, essentially the same uncertainties of classification would arise. But the debates would remain polite and would never attract attention outside the halls of academia.

Classification of humans is different 'only' in that it shapes our views of other peoples, fosters our subconscious differentiation between 'us' and 'them,' and is invoked to justify political and socioeconomic discrimination. On this basis, many anthropologists therefore argue that even if one could validly classify humans into "races", one should not.

Diamond concludes with "The last thing we need now is to continue codifying all those different appearances into an arbitrary system of racial classification." (Diamond, J. 1994, p. 1).

"White" also seems to mean "normative" or "non-minority." Why? If one examines recent federal reports from many of the most authoritative sources, such as the Centers for Disease Control, one finds that each "minority" group is identified in terms of ethnicity; the majority group, in contrast, is identified by skin color.

If one views "whites" as one more ethnic group, instead of the "normative" group, then the proper term would be "Anglo American" or "European American." One therefore has to ask, "Do key policy makers not recognize that Anglo Americans are also an ethnic group, not just the normative group for the culture?

Why would one group be identified by skin color and every other group in terms of ethnicity or geographic origin? If the ethnicity and geographic origins of Anglo Americans are unnoticed, taken for granted, and invisible, then we can understand why an older term, referring solely to skin color, has been maintained. Unfortunately, this practice only serves to maintain a lack of cultural awareness.

A noted national expert on multicultural communication, Carlos Cortes, asked a number of experienced trainers in multicultural communication to divide themselves into groups by ethnicity. The "white" participants (other than those who were Jewish) said they did not know where to go because they 'weren't really a part of any ethnic group.' Dr. Cortes says this is what happens every time he requests a group to divide itself this way (Cortes, C., 1997).

Anglo Americans rarely understand that they also are an ethnic/cultural group.

Cortes also pointed out that this phenomenon is one of the central barriers to intercultural communication in the U.S. If a group does not understand that it is an ethnic group, what is their alternative concept of themselves? Do they unconsciously consider themselves the "human norm" group, in contrast to others, who are "culturally different?"

Skin color is not a useful classification. It does not predict behaviors or values. In contrast, knowing a person's ethnicity can help improve communication, the foundation for effective collaboration.

A compelling argument against the use of "white" to describe the majority in the United States is from the pioneering study of A. G. Greenwald and M. R. Banaji (1995) in which an assessment was made of the terms "white" and "black" in reference to people. They found strong bias associating the term "white" with what is desirable and good in people (by persons who consider themselves "white") compared to bias against the word "black."

For more information on why skin color or race should not be used as a way of defining groups, see Geometer of Race (Gould, 1994), which provides a history of the development of our current classification system for human races.

Given all the reasons mentioned above, the authors therefore prefer the ethnic term "Anglo Americans" or "European Americans" to refer to the majority population. The term "Anglo Americans" is commonly used and understood as referring to persons who are not ethnic minorities. However, it literally refers to people of English origin or descent, so it is not inclusive. The term "European American" is preferred by many specialists in multicultural communication, but is not yet common in everyday language. It is not even included in Merriam-Webster's Collegiate Dictionary (1993). In addition, "European American" can also refer to citizens who are immigrants, such as those who have recently arrived from Eastern Europe and the former Soviet Union.

The term "Anglo American" was also chosen to help clarify the invisible privilege associated with this ethnic group in comparison to others. We found that this invisible privilege, and an associated lack of cultural awareness, is a central barrier to effective multicultural collaboration.

McIntosh (1988) outlines the invisible nature of "white" privilege. Included in her article are forty-six questions Anglo Americans can ask themselves. Answers to those questions serve to raise the reader's consciousness of unearned privilege.

We had difficulty with the term "Collaboration" also. The Multnomah County Strategic Plan (1998) defines collaboration as "a mutually beneficial and well-defined relationship between two or more entities for the purpose of increased outcomes, enhancing the probability of greater achievements together than separately." Although the Plan was designed by people with cross-cultural experience, the definition subtly supports Anglo American values more than the values of some ethnic minorities. For example, "greater achievement" may not be a central reason for many ethnic minorities to agree to collaborate; rather, ethnic minorities may meet primarily to form a foundation for trust, at least initially.

In addition, we found that ethnic minorities tend not to use the term "collaboration." In fact, we were advised by community leaders not to use the term because its use would indicate we had an Anglo American perspective. This document will use the expression "multicultural collaboration" to mean "effective communication across ethnic communities, created by adapting to the expectations, communication styles, and values of the participants. The purpose of that communication is to work together and build trust."

While the word "respect" never arose among the Anglo American mainstream agency representatives we interviewed as an issue that affected collaboration, it was perhaps the central term each of the ethnic minority communities focused on as the problem. Being treated disrespectfully by agency staff was seen as a central barrier to collaboration by the ethnic minorities.

"Respectful" interaction includes treating others in a way that supports their feeling of being valued as individuals and as members of their cultures.

The words "ethnic," "culture," "cultural sensitivity," and "cultural competence" are used throughout this document. Please see the Glossary at the end of this document for definitions of these terms.

We have used the expression "ethnic minority communities" to refer to minority individuals or cultures. We are defining "ethnic minority community" as those persons who share membership within a group because of history, values, expectations, social experience, religion, nationality, language, traditions, culture, communication styles, self-identification, and/or physical appearance. Individuals are often identified as members of an ethnic group solely because of their appearance and/or dialect, but this is not a sufficient basis for establishing ethnicity.

A person's ethnicity is a combination of self definition shared values shared norms for behavior group acceptance If any of these four elements are missing, the individual should not be considered an adequate or appropriate representative for that ethnic group.

For example, individuals could be chosen to represent "persons of color" because of their appearance, but they may not identify with, associate with persons from, or operate according to the values of, the ethnic minority they appear to represent. They may have assimilated Anglo American cultural values, despite the fact they may sometimes experience discrimination from that culture.

Although persons may be discriminated against because they appear to be an ethnic minority, experiencing discrimination does not translate into an ability to represent the values of the minority group.

The following chapters provide a framework for understanding and adapting to diversity in communication. They can assist in avoiding barriers to trust that are invisible and ethnically based. The comparison may also permit better diagnosis of where trust has been violated in the past, so an appropriate mending of the relationships can begin.