Culture and Its Impact on Health and Healthcare
Culture is the shared system of meanings, values, beliefs, language, practices and social relationships through which people understand life, illness, healing and death. Culture does not determine every decision, but it strongly influences how people explain symptoms, seek help, communicate distress, use food and medicines, and relate to health professionals.
Define culture and health; explain cultural influences on illness beliefs and health behaviour; describe explanatory models, ethnomedicine, language and stigma; identify risks of cultural stereotyping; and provide culturally safe, respectful and clinically effective care.
1. Culture, society and health
Culture is learned, shared, transmitted and adapted. It includes visible practices such as food, dress and ceremonies, and less visible assumptions about the body, family, gender, time, authority, pain and responsibility. A patient may belong to several cultural groups at once, including family, ethnic, religious, professional, generational and online communities.
2. Cultural concepts of health and illness
Different communities may understand health as balance, strength, social harmony, spiritual protection, fertility, ability to work or freedom from symptoms. Illness may be explained through infection, heredity, environment, stress, social conflict, ancestors, spiritual causes or a combination. A doctor's task is not to ridicule the explanation but to understand it, identify danger and build a safe treatment plan.
3. Explanatory models
An explanatory model is the patient's or family's answer to: What is the problem called? What caused it? Why did it start now? What does it do? How serious is it? What treatment should be used? What is expected to happen? Asking these questions reveals beliefs that may affect consent and adherence.
| Area to explore | Useful question | Clinical value |
|---|---|---|
| Cause | “What do you think caused this problem?” | Identifies beliefs, guilt, stigma and possible exposures. |
| Expected treatment | “What treatment were you hoping for?” | Reveals expectations and opportunities for negotiation. |
| Previous help | “What have you already tried?” | Prevents unsafe duplication and improves trust. |
| Family meaning | “Who else is concerned or involved?” | Shows support, pressure and decision-making roles. |
| Preferred explanation | “How much detail would you like today?” | Respects autonomy and information preferences. |
4. Language and communication
Language affects symptom description, consent, risk communication and safety-netting. Translation is not only word substitution; idioms, metaphors and culturally specific meanings matter. Use a trained interpreter when necessary, speak to the patient rather than the interpreter, use short sentences and confirm understanding with teach-back. Do not use children as interpreters for sensitive or complex information.
5. Pain, distress and emotional expression
Culture may influence whether pain is openly expressed, minimised, attributed to a social or spiritual problem, or communicated through bodily symptoms. Avoid assuming that quietness means little pain or that dramatic expression means exaggeration. Combine the patient's report with examination, function and risk assessment.
6. Food, diet and healing
Food practices may be linked to identity, religion, pregnancy, illness, age and household roles. Some restrictions may cause malnutrition; others may support health. Ask what the patient eats, avoids, can afford and believes is therapeutic. Dietary counselling should be culturally acceptable, locally available and compatible with medical goals.
7. Family, gender and decision-making
Some patients expect collective decisions; others expect individual privacy. Gender and age may determine who controls money, speaks for the family or gives permission. Respect the patient's autonomy while safely involving relatives with consent. A family member's presence must not prevent disclosure of violence, sexual health concerns, mental illness or other sensitive information.
8. Religion and spirituality
Spiritual beliefs may provide hope, coping, community support and meaning. They may also influence refusal, fasting, blood-product decisions, end-of-life preferences or the use of prayer alongside treatment. Ask respectfully about spiritual needs and involve chaplaincy or a trusted leader when the patient requests it, without allowing spiritual support to replace urgent medical care.
9. Traditional and complementary healing
Patients may use herbs, spiritual care, massage, traditional birth attendants or other healing systems. Ask openly and non-judgementally about products and practices, because some may interact with medicines, delay referral, cause toxicity or be beneficial for wellbeing. Document relevant use, provide risk information and seek collaboration where safe.
10. Stigma and culturally patterned illness
Stigma may affect HIV, tuberculosis, epilepsy, infertility, mental illness, disability, cancer, sexual health and substance use. It can lead to secrecy, delayed care, violence and treatment interruption. Use person-first language, protect confidentiality and challenge discriminatory statements. Cultural humility requires ongoing self-reflection rather than claiming to “master” another culture.
11. Cultural competence and cultural humility
- Self-awareness: recognise personal assumptions, bias and power.
- Cultural knowledge: learn relevant histories and practices without treating groups as identical.
- Communication skill: ask, listen, clarify and negotiate.
- Respect: preserve dignity even when beliefs differ.
- Adaptation: modify explanations, timing, diet and follow-up when clinically safe.
- Humility: remain curious and let the patient be the authority on their experience.
12. Cultural safety in clinical care
Cultural safety asks whether the patient experiences the service as respectful and free from racism, humiliation and coercion. It includes privacy, language access, appropriate consent, disability access, fair triage, respectful touch and protection from discrimination. A service may consider itself culturally competent while patients still experience it as unsafe; feedback matters.
13. Risks of stereotyping
Stereotypes turn a population pattern into an assumption about an individual. Do not assume that every patient from a particular group refuses treatment, uses traditional medicine, wants family involvement or holds the same beliefs. Ask the individual and use clinical evidence. Culture should explain questions, not replace assessment.
14. Applying culture to common clinical situations
Ask about food restrictions, birth preferences, family decision-making, traditional birth support and danger-sign knowledge.
Explore local explanations of distress, spiritual support, stigma, safety and preferred forms of help.
Adapt diet, medicines and follow-up to work, family roles, food availability and beliefs about long-term treatment.
Discuss disclosure, family involvement, spiritual needs, preferred place of care and advance decisions respectfully.
15. A practical cultural assessment
- What language and form of explanation does the patient prefer?
- What does the patient think is happening and what caused it?
- What help has already been sought?
- What foods, medicines, herbs or practices are important?
- Who should be involved in decisions, and what does the patient want kept private?
- Are there religious, gender, disability or access needs?
- What plan is both medically safe and acceptable to the patient?
16. Doctor's responsibilities
- Ask rather than assume.
- Use interpreters and plain language.
- Respect beliefs while explaining evidence and danger signs.
- Check for harmful interactions or delays in care.
- Protect autonomy, confidentiality and freedom from discrimination.
- Reflect on bias and seek help when cultural conflict is complex.
17. Summary
- Culture shapes meanings, communication, health behaviour and trust.
- Explanatory models help doctors understand the patient's view of illness.
- Culturally safe care combines respect with clinical safety.
- Ask about traditional and complementary care without judgement.
- Avoid stereotypes; assess each patient as an individual.
18. References
- World Health Organization. Health and rights of Indigenous Peoples.
- World Health Organization. Traditional, complementary and integrative medicine.
- General Medical Council. Cultural competence.
- National Academies of Sciences. The patient–doctor relationship.
Educational note: Respectful cultural care must always be combined with clinical assessment, patient safety and applicable professional standards.
