Talking about Healthcare, Culturally Speaking

One illness is not the same for everyone

Why do some people seem to bounce back from illness better than others, whilst some people are more frequently sick and take a long time to recover? Genetics set aside, there are a host of external factors at play and interacting that influence how illness is experienced by people.

As far back as the mid-19th century, it has been shown that there are numerous contributing factors that influence an individual's health outcomes. These factors include sociocultural factors, behavioral, financial, environmental, and educational contributors.

In fact, death rates in the mid-19th century declined, this was linked predominantly to improvements in nutrition, sanitation and the availability of cleaner water. However, it was also determined that factors outside of these influenced medical care and health outcomes. Global bodies uniformly agree that social conditions such as where a person lives, their age, place of birth, their workplace, level of education, and community support structure will all influence healthcare outcomes. These social factors or determinants influence the health-related needs and results for people. Even though separately evaluated, they still form an intricately linked and complex picture of a person's overall health requirements, how they approach the healthcare system, and ultimately, how they might recover from an illness.

"Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue. - Michael Marmot

Data shows us that healthcare outcomes still diverge greatly across the globe. Recent data indicates that 17.9 million people died of cardiovascular-related diseases in 2019. Also, 17 million people died from what is considered pre-mature death, meaning death under 70 years of age. More recently, the Covid-19 pandemic has highlighted the disproportionate healthcare outcomes between various racial, cultural and linguistic groups.

On a different note, 415 million people are currently diagnosed and suffer with diabetes. That means that as many as 1 in 11 adults are diagnosed with diabetes. By 2040 this number is expected to rise to as many as 642 million adults diagnosed with type 2 diabetes. Could social determinants and social factors be contributing to variable health seeking behaviors, adherence to medications, and dietary guidelines, and in turn alter the future health outcomes of patients more than anticipated and prepared for?

Does not having a diverse views of healthcare come at a cost?

Type 2 diabetes is perhaps an appropriate health condition to pause at and consider how illnesses are viewed and can be experienced differently by various cultures and races. In the USA, type 2 diabetes is ranked as one of the highest public health expenditures, with nearly twice as many black adults developing type 2 diabetes compared to white adults. Researchers have established that both biological and social factors account for these increasing rates of diabetes.

Similarly, in Australia, as many as 1 in 20 people have diabetes, with 1.3 million people currently navigating the mental, physical and social requirements of their diseases. Unfortunately, children are also developing type 2 diabetes at increasing rates.

McMahon and colleagues conducted a study on the rates of type 2 diabetes in children in Australia, 53% of the children are Indigenous with 42% living in rural areas.

This poses some key questions on the influence of the genetic and social factors on the development and progression of this disease.

Important to administrators is the annual costs of type 2 diabetes in Australia which is upwards of AU$ 6 billion. The Australian Commission on Safety and Quality in Healthcare reports that diabetes complications account for 7% of costly and preventable hospitalisations in Australia. Subsequently, is there space for the healthcare system to improve accessing, diagnosing and maintaining healthcare outcomes?

Although a multifaceted problem to solve, the likely long-term solutions, particularly around chronic disease prophylaxis lies in navigating and understanding more about the social factors driving a patients diagnoses, accepting treatment protocols, and pursuing positive outcomes.

Social determinants of healthcare

So what does this really mean or practically look like for a patient?

Only when individual social determinants of health have been considered and possible gaps in current treatment protocols exposed, a more relevant and likely effective healthcare plan of action can be implemented. Healthcare-seeking behaviors greatly differs between ages, genders, and between different cultural groups. Many years ago, Google and smartphones were not around to influence the conversations between doctors and patients.

Where a person lives, their lifestyle choices and the cultural lens through which a person views doctors and the healthcare system will shape how they regard illnesses and seek healthcare support.

For example, there is a belief in some Chinese communities that states of physical health are determined by fate. Similarly, in some African communities healthcare-seeking behaviors, concerning traditional healers, are influenced by beliefs and cultural traditions. Numerous religions place healing from illness in that hands of faith. Perhaps anatomically human bodies are similar, however, the perspectives through which sickness, and disease are viewed, and healthcare services are sought is vastly dissimilar and should be valued.

This influences healthcare outcomes. In fact, once social determinants are included in the ‘whole patient diagnosis and treatment protocol’ healthcare outcomes can improve and disparities are reduced. Yet, are healthcare workers and doctors familiar with how to listen with 'cultural ears'? Under the immense pressures of the current healthcare workforce environment, are they equipped to treat patients with cultural sensitivity? Do they have the time for such lengthy consultations? This is a discussion for another post.

Making healthcare personal

How different would healthcare visits and discussions with healthcare professionals be if healthcare workers were privy to the dialogue in a patient's mind? If the doctor knew about the commute to work, long working hours, cultural and religious beliefs, family support structure or a language barrier? How different cultures views, experiences and understandings of health and disease influences treatment approaches and compliance. Also, factors like housing and income influence healthcare outcomes. The use of appropriate materials, culturally-sensitive conversations and goals should be discussed to facilitate different individual patient needs.

Building a culturally competent healthcare system

What can done done about a seemingly elaborate and probably ambiguous problem?

Firstly, leaders striving for healthcare equality know it has many dimensions to it, one can start with a conversation and up-skilling the healthcare workers that directly contribute to a culturally competent healthcare system.

Culture in itself is a set of norms, beliefs values and ideologies that guide thinking and behaviors, therefore, integrating cultural sensitivity into healthcare practices requires intentional inclusion and an expansion of the healthcare worker's knowledge concerning values and behaviors different to one’s own, but it also includes understanding their own.

When it comes to matters concerning health and disease-this is not a skill developed fleetingly or without deliberate intent. Ask any healthcare worker, nurse or doctor-it took years of training and examinations. Advancing culturally competent healthcare and services that aid in diminishing identified gaps in healthcare will take quite some time.

References

• -Gibbons, M. C. (2005). A historical overview of health disparities and the potential of eHealth solutions. Journal of medical Internet research, 7(5), e435.

• -Haire-Joshu, D., & Hill-Briggs, F. (2019). The next generation of diabetes translation: a path to health equity. Annual review of public health, 40, 391-410

  • www.diabetesaustralia.com.au

• https://www.nih.gov/news-events/nih-research-matters/factors-contributing-higher-incidence-diabetes-black-americans

• Increase in type 2 diabetes in children and adolescents in Western Australia,

• Sarah K McMahon, Aveni Haynes, Nirubasini Ratnam, Maree T Grant, Christine L Carne, Timothy W Jones and Elizabeth A Davis Med J Aust 2004; 180 (9): 459-461

• -https://www.safetyandquality.gov.au

• https://data.oecd.org/inequality/income-inequality.htm

• https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

• https://www.diabetesaustralia.com.au/about-diabetes/diabetes-globally/

• Chen, Y.C. (2001). Chinese value, health and nursing. Journal of Advanced Nursing, 36 (2), 270-273.

• Amzat, J., & Razum, O. (2014). Sociology and health. In Medical sociology in Africa (pp. 1-19). Springer, Cham.