Culture is a building block of one’s identity, it shapes their beliefs, their behaviors, values, and interests ultimately leading to one's understanding of the world and how to live in it. This identity develops from birth and is continuously shaped by our experiences, people, and places, providing a unique perspective on life from person to person, as well as between different groups of people. In the context of healthcare, a culture will shape an individual’s understanding and behaviors around health, disease, and self-management. If these cultural differences are not taken into account, there is potential for miscommunication between health care providers and patients and may affect the quality of care a patient receives (1).
Why is diverse culture really important in healthcare?
Great Britain is multiethnic and very dynamic with populations of minority ethnic groups increasing drastically. Between 2001 and 2011 the population of minorities (e.g. Asian, Black, and other) almost doubled from 4.6 million to 7.9 million, making up almost 14% of the population (2). Despite making up less than one-quarter of the population, these groups have reported a higher prevalence of diseases such as diabetes, obesity, and cardiovascular disease (3), with some populations experiencing up to three times the rate of disease compared to the white population (4).
It’s been reported that fewer than 40% of primary care clinicians recognize the presence of racial health disparities (5). Recent studies have shown consistent inequalities in health and quality of care leading to lower rates of satisfaction within ethnic minorities (6), potentially due to the lack of awareness of cultural diversity within healthcare systems and providers. Also, the authors of the 2014 Lancet Commission on Culture and Health argued that “the systematic neglect of culture in health and health care is the single biggest barrier to the advancement of the highest standard of health worldwide” (7). This highlights an inadequate provision of healthcare for members of diverse minority groups. We can recognize that culture is unique in defining an individual’s attitude, approach, and behavior in society. Considering the progressive diversification of the UK population and increasing prevalence of diseases, it is very certain that healthcare professionals need to be aware of culture to be able to provide the highest quality of care.
How can healthcare systems make meaningful change?
The diversity of black and minority ethnic groups within the NHS staff has seen large improvements due to the Workforce Race Equality Team (8). This change results in a more inclusive culture within the NHS which may positively impact patient satisfaction, comfort, and care. Minorities face health disparities that can partly be attributed to culturally inadequate healthcare systems. By creating a more diverse environment, there will be more consideration for people of different colors, cultures, and backgrounds.
Cultural competency training has been a proposed strategy to ensure culturally appropriate care to bridge the gap of inequality (6). Cultural competency evolved in the 1980s from addressing the needs of populations different to ‘mainstream’ culture, building skills and knowledge to understand and respond to cultural differences (9). Recently, this form of cultural education has been critiqued for a few reasons. Primarily, the use of competence reduces something as complex and unique as culture down to a set of external boxes to tick which may inadvertently reinforce racial and ethnic stereotypes (9).
Two dimensions have defined culture: the first dimension refers to surface structures that relate to the superficial characteristics of a target population such as language, clothing, or food. The second dimension refers to deep structures involving cultural, social, historical, or environmental forces that affect the target population (10). There is no ‘one-size fits all’ for culture. It is complex and attempting to define and teach it solely on the surface level can potentially do more harm than good. Stereotyping reduces the patients' experiences to how society expects someone of their background to behave, disregarding the actual ‘deep’ complex sociocultural contexts in which patients live (1). It is because of this that cultural education must go beyond the realms of ‘competence’ and rather it must involve the development of ‘’critical consciousness of the self’’. This practice involves taking a step back and looking within ourselves to address one’s own biases and establish an active connection with social justice to foster cultural awareness (11).
This same practice is needed on the wider public health scale. Studies of culturally tailored interventions (interventions that have been modified to fit the needs of a particular cultural group) have shown that by incorporating both the surface and deep layers of culture, interventions for the management of disease in ethnic minorities have been more successful than those that didn’t include both (12). Only looking at one side of culture runs the risk of oversimplifying patients’ whole experience into a few characteristics.
The need for increased cultural awareness within healthcare is becoming increasingly more important. To provide high-quality care for all patients, regardless of race, ethnicity, age, gender – healthcare professionals must work internally to reflect on personal biases while also recognizing the societal problems that affect their patients. This enhancement of cultural awareness will allow healthcare professionals to be able to place medicine in a social context and deliver the highest quality medical care to all.
Take-Home Suggestions
1. Communication - establishing clear communication that fits the patients’ needs (such as assigning a translator or providing resources with appropriate literacy level).
2. Work to understand your own unconscious bias. The Implicit Association Test is a good first step to recognize one’s bias and how to control them.
3. Facilitate discussion – health is not solely medicine. Talk with patients to understand more about their unique traditions and customs. These may be relevant to the patient’s clinical situation.
This article was written by Noor Wadi, Registered Dietitian and edited by Mei Wan FdSc, BSc (Hons), RD, MBDA, an HCPC Registered Dietitian and Nutritionist.
Are you looking for a culturally aware healthcare professional that understands your dietary requirements? Or are you a healthcare provider that wishes to deepen your organisation's cultural competency? Book your free 15 minute discovery call with Mei to find out how she can help.
References
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