Culture is defined as a set of guidelines (both explicit and implicit) that inform behaviour in a particular society or group. This dynamic and adaptive system of values, norms, beliefs and practices is socially acquired and transmitted intergenerationally, rather than by genetic means. Ethnic identity, for example, is a socially defined category grounded on common ancestry, language, and social experience. Other cultural groups can be based on social class, religion, age, occupation, location, and leisure-time activity, to name a few. In light of this, it is not uncommon for individuals to identify with several cultural groups simultaneously.
Cultural diversity in health and illness
Though the pursuit of health and wellbeing is culturally universal, public perception of disease is often socially constructed according to the cultural context in which people live. As such, the interpretation of medical knowledge and the treatment of illness can differ significantly from one culture to the next. This includes how patients express their symptoms, their style of coping, their support system, as well as their willingness to seek treatment. In certain cultures, for example, it is believed that illness is the result of supernatural phenomena requiring treatment in the form of ceremonies and rituals to drive away spirits, witchcraft, voodoo, and the use of Shamans and traditional healers (Kirmayer, 2004).
Because cultures reflect prevailing standards of behaviour within identifiable groups in society, cultural norms establish what is acceptable behaviour and define abnormality in reference to these norms. In short, abnormality is culturally relative.
For this reason, illness prevalence rates can be influenced by cultural context. Contrary to Western societies, which patholologize abnormal behaviour, many cultures do not consider hallucinations and suspiciousness to be signs of mental illness (Pote & Orrell 2002).
Mounting evidence suggests that cultural differences in morbidity and mortality are also tied to socioeconomic resources. Minority cultural groups tend to be overrepresented in lower-socioeconomic strata of society and health disparities among these groups can, in large part, be attributed to inequalities in the underlying differences in socioeconomic status (Nazroo & Williams, 2006). Marginalization, stigmatization, loss or devaluation of language and culture, and lack of access to culturally appropriate health care and services can all have detrimental effects on the health of individuals outside of mainstream society (PHAC, 2013).
In Canada, Aboriginal peoples are more likely to report fair or poor health status compared to non-Aboriginal Canadians as a result of social exclusion (Reading & Wien, 2009). They are increasingly segregated and lack the power to influence decisions made by governments and other institutions.
Closing the gap
Cross-cultural variation can play a major role on the provision of healthcare. Cultural differences between patients and healthcare providers may lead providers to dismiss symptoms that are important to patients and patients to not comply with prescribed treatments. Our understanding of health must therefore place culture as a central determinant to ensure that the needs of patients are acknowledged and met.
Cross-cultural understanding and cultural competence are essential skills that must be learned and incorporated during every healthcare encounter, to overcome barriers between patients and providers. Cultural competency requires empathy, curiosity, and respect for other people’s opinions and beliefs. Even though healthcare providers might not agree with the beliefs of their patients, they must recognize that other opinions and explanations exist besides the Western biomedical model.
It is also important to note that there is tremendous variability within groups. While cultures may be shared, people are not homogeneous and may not adhere to all the norms and values of custom or react similarly to new ideas.
The take-home message is this: develop an understanding of the person as an individual and remain nonjudgmental toward unfamiliar beliefs in order to achieve patient satisfaction, patient safety, and improved health outcomes.
Kirmayer, L.J. (2004). The cultural diversity of healing: meaning, metaphor and mechanism. British Medical Journal, 69(1), 33-48. Doi: 10.1093/bmb/ldh006
MirreNL. (2011). Medicijnman Dancing Thunder in traditionele kleding [Photograph]. Retrieved from https://commons.wikimedia.org/wiki/File%3AMedicijnman_Dancing_Thunder_in_traditionele_kleding.jpg
Nazroo, J.Y. & Williams, D.R. (2006). The Social Determination of Ethnic/Racial Inequalities in Health. In M.Marmot & R. G. Wilkinson (Eds.), Social Determinants of Health 2nd ed., (pp. 238-266). Oxford: Oxford University Press.
Pote, H.L. & Orrell, M.W. (2002). Perceptions of schizophrenia in multi-cultural Britain. Ethnicity and Health, 7(1), 7-20. Doi: 10.1080/13557850220146966
Public Health Agency of Canada. (2013). What makes Canadians healthy of unhealthy? Retrieved from http://www.phac-aspc.gc.ca/ph-sp/determinants/determinants-eng.php
Reading, C.L., & Wien, F. (2009). Health inequalities and the social determinants of Aboriginal peoples’ health. Prince George, BC: National Collaborating Centre for Aboriginal Health.
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