Why Culture Matters in Healthcare

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When it comes to the healthcare system, quality care is usually pictured as experienced staff, efficient treatment, and state-of-the-art equipment. It might even seem counterintuitive to assert that factors outside the realm of medicine often determine life-or-death outcomes for patients. However, as research continuously demonstrates the overrepresentation of health concerns in racial and ethnic minorities, it is clear that only considering the biological aspects of healthcare leaves behind communities where cultural factors and barriers contribute to systematic disparities in health. There is a pressing need for integrating culture-specific considerations in the medical system, as it is undoubtedly a determining factor of patient health and overall experience, especially in contexts of cultural difference.

The cultural factors that influence the provision of healthcare only started to be considered from the 1990s, with the rise of discussions surrounding cultural competence along with patient-centered care. Since then, academics have put forward a number of terms describing specific abilities and attitudes that take cultural differences into consideration. These include cultural sensitivity, cultural safety, cultural humility, and others, with cultural competence being the most commonly used term. Cultural competence is the ability to provide care to patients with diverse values, beliefs, and behaviours, taking into account their social, cultural, and linguistic needs. Cultural competence tends to focus on the implementation of services, though this is not to say that attitudes do not play a crucial role as well.

From local clinics to global humanitarian missions, adopting culturally competent reforms is possible and necessary in all fields of healthcare provision. These reforms often intersect with wider efforts to serve historically marginalized groups. Indigenous-focused healthcare is a particularly salient example, where current reconciliation efforts of governments address past instances of cultural repression and medical injustices, including but not limited to the criminalization of traditional healing ceremonies and practices.

In the case of Canada, the federal government has only fairly recently made formal declarations and plans towards minimizing these inequalities under a mandate called Truth and Reconciliation. This is intended to address the country’s long history of injustices against Indigenous peoples, the effects of which have manifested in healthcare as lower life expectancies, higher rates of diabetes, and increased mental illness hospitalization rates.

A 2015 report published by the Truth and Reconciliation Commission calls for “[recognizing] the value of Aboriginal healing practices and [using] them in the treatment of Aboriginal patients” as well as “providing cultural competency training for all health-care professionals”. Put into practice, this can look like Indigenous-led traditional healing programs designed to strengthen community bonds and cultural connection integrated within existing efforts to tackle issues of mental health and opioid addiction. The goal is not to replace Western medicine with Indigenous healing practices, but to offer a holistic approach that gives more options for patients and considers the greater historical, social, and cultural factors that shape health outcomes.

The Western model of health and illness is widely taken as the default perspective, but it is not always the best fit for the patients in concern, especially in regards to mental health treatment. Western talk therapy, based on the theories of Freud and others, is what many of us consider as the given treatment for trauma, depression, and other psychological conditions. This form of therapy involves a one-on-one discussion with a licensed psychiatrist, often voicing dysfunctional thoughts and developing ways to overcome them. Studies have shown these approaches are effective in helping patients with depression and anxiety.

However, these benefits cannot be generalized to societies of vastly different cultures and thus outlooks on sickness, trauma, and healing. During the aftermath of the 1994 Rwandan genocide, Western efforts to support the mental health of locals failed because of the incompatibility of the Western model with Rwandan attitudes on trauma. Rwandans felt aid workers were intrusive and re-traumatised people by having them reflect on their experience, rather than using their traditional model of being outside in the sun, drumming to be active, and rallying the community for support. Western research has just recently been demonstrating the positive effects of interacting with nature and exercising on mental health. For patients still dealing with the mental health repercussions of the Rwandan genocide, an approach rooted in community healing and local ways of thinking can be more effective, as shown in a pilot program rooted in Ubuntu philosophy, which emphasizes reconciliation, harmony, and mutual caring in the service of community and justice.

In multicultural countries like the US, culturally competent healthcare is even more essential especially in metropolitan areas with a large cultural diversity. It can be something as easily overlooked as adjusting dietary recommendations based on culture and ethnicity. A New York nurse found that her efforts to reduce the blood sugar levels in her Latino patients were not effective because she only told them to avoid white bread, not realizing tortillas were the main cause. These minor considerations that go beyond having interpreters and translations have enormous potential to improve preventive care but also provide a less stressful experience for patients and build their trust in the system.

Cultural and social frameworks shape all aspects of our lives, and healthcare is no exception. Differences in backgrounds need to be acknowledged to improve healthcare for everyone, whether it be through incorporating non-Western approaches in targeted programs, avoiding universally imposing Western models of healing on international missions, or considering all levels of interaction—from having a casual chat with your doctor to receiving life-saving surgery. It’s about time we envision healthcare as more than just medicine and truly put the patient first.