want to achieve cultural competence?
If so, there
are some basic concepts you need to understand. Continue scrolling
learn some of the most important ones. Or, click on the topic links below
to go directly to a concept. The material is taken directly from my
"Caring for Patients From Different Cultures,
I will be making many
throughout this website. They should not be mistaken for stereotypes.
A stereotype and a generalization may appear similar, but they function
very differently. An example is the assumption that Mexicans have large
families. If I meet Rosa, a Mexican woman, and I say to myself, "Rosa
is Mexican; she must have a large family," I am stereotyping her. But
if I think Mexicans often have large families and wonder whether Rosa
does, I am making a generalization. A stereotype
is an ending point. No attempt is made to learn whether the individual
in question fits the statement. Stereotyping patients can have negative
results. A generalization,
on the other hand, is a beginning point. It indicates common trends, but
further information is needed to ascertain whether the statement is appropriate
to a particular individual. Generalizations may be inaccurate when applied
to specific individuals, but anthropologists do apply generalizations
broadly, looking for common patterns, for beliefs and behaviors that are
shared by the group. It is important to remember, however, that there
are always differences between individuals.
Values are the things
we hold as important. Just as each individual holds certain values, each
culture promotes different ones. American culture (and I use this term
loosely because there are literally hundreds of subcultures within the
United States) currently values such things as money, freedom, independence,
privacy, health and fitness, and physical appearance.
to assess a culture's values is to observe how it punishes people. In
the United States wrongdoers are punished by being fined (taking away
or incarcerated (taking away their freedom).
The Mbuti pygmies of Africa value social support, and they punish people
by ignoring them. The kind of health care provided by the American medical
system is often influenced by financial considerations, whereas concern
for family, low on the list of "American" values, influences much patient
behavior. Hence conflict may develop between health care providers and
United States, independence
is manifested by the desire to move away from home as soon as one is financially
able. In many cultures that value family more than independence, adult
children rarely move out before marriage and often not thereafter. The
health care culture also supports the values of independence and autonomy
in its efforts to teach self-care and in often giving information only
to the patient, excluding other family members.
is also very important to most Americans, who build fences to separate
their houses from each other. The U.S. health care culture tries to provide
privacy for patients by limiting visiting hours and offering no sleeping
accommodations for visitors. Many non-Anglo patients, however, prefer
just the opposite.
fitness are popular movements, particularly on the West Coast.
There are hundreds of food products labeled "low fat" and "low cholesterol."
People can be seen jogging on most city streets, and attendance at gyms
is high. This obsession with health leads the medical profession to expect
patients to comply with suggestions regarding changes in diet and exercise,
assuming that health and fitness is a value shared by all. It is not.
Furthermore, what is considered "healthy" varies cross-culturally.
for physical appearance
is manifested at every magazine stand. There are few women's magazines
that do not have articles on the latest diet, makeup, hairdo, and clothing.
The incidence of cosmetic surgery for both men and women is at a record
high. Surgical techniques are developed to minimize scarring and maintain
beauty. What is considered "beautiful," however, is not the same for every
people's values is the key to understanding their behavior, for our behavior
generally reflects our values. A dramatic example occurred in the early
1980s, when a Japanese ship captain was bringing a boatload of cars to
the United States. There was a disaster at sea, and the cargo was ruined.
The captain had done nothing to cause the disaster, and he could not have
prevented it. If an American ship captain had had a similar experience,
the first thing he probably would have done when he reached land was call
his insurance agent to see who would pay for the damages. The Japanese
captain killed himself. There is obviously a big difference between calling
one's insurance agent and killing oneself. The different reactions are
dictated by different values. The hypothetical American captain would
probably value money;
his concern would be for the financial loss. The Japanese captain was
concerned with his honor.
As the captain of the ship, he considered himself responsible for the
accident. The loss of the cargo meant the loss of his honor. Without honor,
he felt he could not live. Committing ritual suicide was the only way
for him to regain his honor.
influence our everyday behavior as well. Why are you reading this? Is
it because you value knowledge and hope to learn something? Is it because
you are required to read it for a course and you value good grades? If
so, are you motivated because good grades will get you a better job, and
with a better job you will earn more money, and you value money? Nearly
everything we do reflects our values on some level.
and the American Health Care Culture
One reason for so many conflicts and misunderstandings in hospitals is
the great disjunction between the values of the health care culture and
that of the patient population. As mentioned earlier, the health care
culture values autonomy
Patients, on the other hand, often value the family
over the individual, and prefer to make decisions as a group and to assist
the patient in "self-care" functions the staff thinks the patient should
do on his or her own. Furthermore, many prefer to have family members
with them at all times, leading to chaos and loss of control from the
perspective of the nurses. The health care culture's value of efficiency
often conflicts with patients' value of modesty.
Many doctors and nurses find concern about keeping patients covered difficult
when their primary focus is performing an appropriate procedure. The health
care culture also values self-control.
Many patients, however, come from cultures in which emotional
expressiveness is the norm. This can lead to resentment toward
such patients on the part of the staff. Problems also result from a disparity
between the world view of the health care culture and that of the patient
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The second most important concept
for understanding people's behavior is to understand their worldview.
Problems can result from a disparity
between the worldview of the health care culture and that of the patient
population. People's worldviews consist of their basic assumptions about
the nature of reality. These become the foundation for all actions and
interpretations. For example, people whose worldview includes the notion
that everything happens for a reason will tend to find meaning in all
events. A childless thirty-five-year-old woman who goes through the emotional
agony of finding a breast lump, only to have the biopsy turn out to be
negative, may interpret the experience as a message from the universe
reminding her that now is the time to decide whether or not she wants
to have children (breasts metaphorically representing nurturing). As
another example, someone who believes that the world is a hostile place
and “out to get them” may perceive a health care provider
who is late for an appointment due to a sudden emergency as deliberately
An individual’s worldview can have an important influence on his
or her health care behavior. For example, someone with a scientific worldview
might perceive birth defects as a mistake in the transcription of DNA
during the process of meiosis, while someone whose worldview encompasses
the notion of reincarnation might see it as resulting from improper behavior
in a past life, and someone who believes that God rewards good behavior
and punishes bad behavior might interpret it as punishment for one’s
sins. Thus, one’s worldview might affect one’s interest in
genetic counseling during pregnancy. Again, if part of an individual’s
worldview is that the physical body is all there is, that person might
want everything possible done to extend their life. A person who believes
that this life is but a precursor to the next, however, might be more
willing to “let go.” If one’s worldview holds that
life begins at conception, abortion will be viewed as murder; if, however,
life is thought to begin at the point that the fetus becomes viable,
a first trimester abortion is simply a medical procedure.
While we all have our own individual worldview, our culture can influence
the way we perceive things. Religion often defines the worldview of people
who are devoutly religious. Belief in the existence of God, for example,
might be part of their worldview. If people believe God confers both
health and illness, it may be very difficult to get them to take certain
medications or change their health behavior. They might not share the
health care culture’s belief that germs cause disease and that
diet and exercise contribute to one’s health. They may see no point
in worrying about high blood pressure or bacteria when moral behavior
is the key to good health.
Since people's worldviews consist of their assumptions about the nature
of reality, they rarely question the veracity of their beliefs. For example,
a devout Christian
might not be likely to conclude that God does not exist on the basis of the accidental
slaughter of innocent children. Rather, the Christian might simply remark that "God
works in mysterious ways." No matter how much "evidence" is presented
to the contrary, people rarely change or even question their worldview. Instead,
they reinterpret events in a manner consistent with their beliefs.
People’s Relationship to Nature
Another aspect of worldview involves people's relationship to nature. The culture
of the United States, for example, believes people can control nature. If the
land is dry, they irrigate. If bacteria cause disease, they destroy them. If
the heart does not work, they replace it. This also relates to the health care
culture’s view of the body as a machine; if it becomes broken, one should
simply turn it over to the mechanics (doctors and nurses) to be fixed. To the
consternation of many health care professionals, not all cultures share that
Other cultures, such as Asian and Native American, see people as a part of nature.
They strive to maintain harmony with the earth and look to the land to provide
treatment for disease. Herbal remedies are important in their cultures. Still
other cultures, such as Hispanic, believe people have little or no control over
natural forces. Que será, será. What will be, will be. Preventive
health care measures are likely to be ignored; they would do no good anyway.
Thus worldview can have important implications for health-related behavior.
Two key anthropological
concepts are ethnocentrism
and cultural relativism.
They refer to attitudes. Ethnocentrism is the view that one's culture's
way of doing things is the right and natural way. All other ways are inferior,
unnatural, perhaps even barbaric. Cultural relativism is the attitude
that other ways of doing things are different but equally valid. It tries
to understand the behavior in its cultural context. Most humans are ethnocentric.
It is natural to think one's own culture's way is best. Anthropologists,
however, strive to be culturally relativistic.
were to tell most Americans about a group of people in Africa who sometimes
kill healthy newborn infants, they would probably take the ethnocentric
attitude that these people were barbarians. If I were to explain that
they were hunters and gatherers living on the edge of starvation and that
if a second child is born too close to the first, chances are about 100
percent that both will die because the mother does not have enough milk
to support both, their attitude might change. They still might not condone
infanticide, but they might understand it as the only viable choice in
a desperate situation. Rather than seeing the Africans as barbarians,
they might realize that the people were forced to extreme measures by
hopeless circumstances. Their attitude would thus change from being ethnocentric
to culturally relativistic.
health care system tends to be ethnocentric because practitioners believe
that their approaches to healing are superior to all others. There is
a lot we can learn, however, from other cultures. Many modern drugs, including
quinine, were derived from plants used by native peoples. Westerners are
beginning to acknowledge the effectiveness of acupuncture for certain
conditions. The goal of all systems of healing is the same - to help people
get well. If all cultures could study each other's techniques with a culturally
relativistic perspective, the cause of modern medicine would be greatly
Time orientation, one's
focus regarding time, varies in different cultures. No individual or culture
will look exclusively to the past, present, or future, but most will tend
to emphasize one over the others. Chinese, British, and Austrian cultures
have a past time
orientation. They are traditional and believe in doing things
the way they have always been done. Interestingly, in many cases, countries
that emphasize the past are ones that were once more powerful than they
are now. This may be their way of recognizing and valuing that time in
their history. These cultures usually prefer traditional approaches to
healing rather than accepting each new procedure or medication that comes
with a predominantly present
time orientation may be less likely to utilize preventive health
measures. They reason that there is no point taking a pill for hypertension
when they feel fine, especially if the pill is expensive and inconveniently
causes unpleasant side effects. They do not look ahead in hope of preventing
a stroke or heart attack, or they may feel they will deal with it when
it happens. Poverty often forces people into a present time orientation.
They are not likely to make plans for the future when they are concerned
with surviving today.
white American culture tends to be future
oriented. That is reflected in the medical system's stress
on preventive medicine and enthusiasm for each new medical technique or
drug. In contrast to past-oriented cultures, progress and change are highly
valued. China is also shifting to a future orientation, as evidenced by
the long-term plan to reduce the country's population by limiting family
and African Americans tend to have a present
time orientation. This does not mean that they do not recognize
the past or the future, but living in the present is more important to
them. Their concept of the future may also be different from the Anglo
concept. For example, African Americans are more likely to say "I'll see
you" than "I'll see you tomorrow." The former implies the future but is
not specific. The future arrives in its own time. From this point of view,
one cannot be late. Conflict may occur, however, in interactions with
white middle-class people, for whom time is very specific.
last statement implies, time orientation can also refer to degree of adherence
to clock time.
From the perspective of one oriented to the clock, someone who arrives
at 3:15 for a 2:30 appointment is late. For someone who does not focus
on clock time, both represent mid-afternoon. This type of time orientation
appears to be related to subsistence economy. In countries with economies
based on agriculture, people tend to be more relaxed about time; as I
like to say, "The crops don't care what time they get picked." Many people
in traditional agricultural villages do not own clocks; the pace is slower
and more attuned to nature's rhythms. In contrast, industrialized nations
must pay attention to clock time. There are large numbers of people to
organize, and each must complete his or her task according to schedule
in order for the next person to begin. Without clocks, chaos would reign.
Just as cultures differ
in time orientation, they also vary in social
structure. American culture is organized according to an egalitarian
model. Theoretically, everyone is equal. Status and power are dependent
on an individual's personal qualities rather than age, sex, family, occupation,
or any other characteristic. In reality, things may operate differently,
but we hold equality as our ideal. Some cultures such as Asian are based
on a hierarchical model. Everyone is not equal. Status is based on such
characteristics as age, sex, and occupation. Status differences are seen
as important, and people of higher status command respect. Social structure,
then, can have an important influence on the way people interact.
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