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Health promotion programs in global health systems need to incorporate culturally competent care and provide linguistic access. This article describes the challenges in one country, the United States, and reports on research studies, which articulate the current gaps in meeting the above goals. Health care providers are bound by both legal and ethical standards to provide such care. Legal standards are cited. Regardless of legal standards, health care providers are also bound ethically to provide such care. An analysis of basic ethical concepts of principalism is described for the importance of these aspects of care.

The premise of this article is that one cannot have a successful health system without inclusion of culturally competent health promotion programs. And, one cannot have such health promotion programs without an understanding of the role that cultural and linguistic competence plays in the provision of clinically competent and cost-effective services. Not only is there a need for culturally competent care that is legally mandated in some countries, such care is ethically necessary. The first part of this paper will address the need for culturally and linguistically appropriate care and applicable laws and standards. The latter part of the paper will provide an ethical analysis. However, before doing that, one global perspective of health care concerns for underserved populations will be presented as well as a discussion of the importance of the use of ethical frameworks.

WE ask our readers to accept the old wish for a Happy Christmas, although we know that in some minds there may be a thought that happiness in such times as these is problematical. Yet we are, so far, a fortunate people, in spite of our difficulties. As a nation we survive and increase in Strength as in confidence. As librarians we have given the best of our men and women to the active services, and most of those who remain are immersed in one way or another in the national effort. We have lost fine libraries in a night, but the will to survive, to win and to create Still survives and kicks. The days are full of difficulties, problems to be solved, high fences and dangerous to be climbed, but we have got through so far, and are convinced we shall continue. It is the most absorbing age in human memory, and we are happy to be alive to overcome its challenges.

THINGS have travelled full circle. There was a time when the Swedes were busy learning from our enterprise and experiences, especially in the fields of industry and commerce; now the position is somewhat reversed and we are eager to profit from them in such diverse fields as social welfare, labour relations, modern design generally, and what is more relevant here, librarianship. Sweden has also much to offer from its cultural life through its novelists, poets, artists and musicians, many of whom deserve wider audiences both here and in other countries.