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Population Health for Nurses

21.5 Culture Matters in Addressing Health Inequalities

Population Health for Nurses21.5 Culture Matters in Addressing Health Inequalities

Learning Outcomes

By the end of this section, you should be able to:

  • 21.5.1 Recognize how culture influences health outcomes.
  • 21.5.2 Identify questions nurses can ask to promote cultural understanding.
  • 21.5.3 Describe culture’s role in shaping health beliefs and practices and the implications for health outcomes.

Minority populations in the United States face persistent racial disparities resulting from systematic inequality. Factors such as poverty; lack of access to healthy food, safe housing, and quality health care; discrimination; and environmental toxins can contribute to the development of chronic diseases such as diabetes, heart disease, and asthma, as well as mental health disorders. See Structural Racism and Systemic Inequities for more information.

Disparities in health outcomes have significant implications for individuals, families, and communities. They can lead to reduced quality of life, increased health care costs, and decreased productivity and economic opportunities. In addition, they can perpetuate cycles of poverty and disadvantage as individuals and communities struggle to overcome the burden of poor health.

Social Determinants of Health and Culture

As discussed in Social Determinants Affecting Health Outcomes, social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age. This definition includes socioeconomic status, education, immigration status, language, neighborhood and physical environment, employment, social support networks, and access to health care. These determinants are shaped by social, economic, and political forces and can profoundly impact health outcomes.

Culture is also an SDOH because it can shape health beliefs, behaviors, and practices. As discussed previously, cultural beliefs and values can influence a person’s decision to seek health care, adherence to treatment plans, and perceptions of health and illness. For example, cultural beliefs about mental health may influence a person’s willingness to seek treatment for depression or anxiety. Ultimately, cultural and social determinants impact an individual’s health and well-being.

Furthermore, cultural factors can intersect with other social determinants of health. For instance, individuals from racial and ethnic minority populations may experience disparities in health care access and outcomes due to social and economic factors such as poverty, limited education, and discrimination. These disparities can be exacerbated by cultural factors such as language barriers, mistrust of the health care system, and traditional health practices.

Legal scholar Kimberlé Crenshaw coined the term intersectionality in 1989 to describe the interconnectedness of social identities, such as race, gender, sexual orientation, and socioeconomic status, and how they overlap and intersect to create unique experiences of privilege or oppression. These experiences cannot be understood by looking at each identity in isolation. This framework is particularly relevant when considering health disparities, as people of color, women, LGBTQ+ individuals, and those with lower socioeconomic status may experience compounding disadvantages that impact their health outcomes. The box in the previous section examined the role culture plays in diabetes management for South Asian communities. The box below considers how SDOH have influenced diabetes management among this population.

Influence of Social Determinants of Health in Diabetes Management of South Asian Immigrants

Various social determinants of health can significantly influence the management of diabetes in South Asian immigrants. These determinants include language barriers, access to resources, health literacy, education, discrimination, and stress.

  • Language and cultural barriers: Language differences can create communication obstacles between health care providers and South Asian immigrants, hindering their ability to comprehend diabetes management instructions, treatment plans, and access to suitable resources. Additionally, cultural beliefs, norms, and practices can impact diabetes management decisions and adherence to treatment recommendations. South Asian immigrants tend to place great importance on family (Bhandari & Titzmann, 2017); therefore, involving family members in self-management is crucial (Baig et al., 2015).
  • Health literacy and education: Limited health literacy and lack of diabetes education materials in native languages can hinder South Asian immigrants’ ability to self-manage diabetes. Addressing health literacy gaps and providing culturally appropriate educational resources are crucial for diabetes management (Estacio et al., 2015; Min et al., 2022).
  • Discrimination and acculturation stress: South Asian immigrants may face discrimination, racism, and acculturation stress, which can contribute to chronic stress levels and impact diabetes management. Discrimination in health care settings can lead to mistrust and reluctance to seek necessary care. Acculturative stress can have a negative impact on mental health when individuals attempt to integrate host country customs into their own culture. This stress can manifest in various forms, including intergenerational conflict, discrimination, and depression (Karasz et al., 2019).

To effectively manage diabetes—or any other health issue—in South Asian immigrants, nurses must consider these factors; provide culturally sensitive health care services, language access, and health education; and address the effects of cultural and intersectional discrimination. Collaborating with South Asian immigrants to address their specific needs and overcome barriers is key to effective diabetes management.

Understanding and addressing the cultural and social determinants of health is essential to promoting health equity and reducing health disparities. By recognizing the influence of culture on health outcomes and working to reduce barriers to care, health care providers can improve health outcomes for all individuals and communities.

Client-Centered Care

Cultural misunderstandings can affect the nurse’s ability to assist clients in achieving optimal health outcomes. Nurses and other health care providers caring for a client whose native culture is different from their own may make assumptions about the client’s intelligence and perceive them as irresponsible or disinterested in their health due to a lack of understanding of cultural beliefs and values (Dowling, 2002). As discussed at the beginning of this chapter, nurses and other health care providers must avoid stereotyping based on religious or cultural background as a measure of client safety. Nurses must recognize that each person has a cultural identity (Agency for Healthcare Research and Quality, 2020). Cultural misunderstandings can be avoided by asking clients to share their health beliefs and customs.

According to the Agency for Healthcare Research and Quality (2020), nurses and other health care providers should be prepared to respectfully ask clients about their culture and beliefs in the context of providing care. Centering the client’s view and experience builds trust and can help ensure the nurse provides respectful, appropriate care. For example, a nurse might ask a client the following:

  • Do you have any dietary restrictions we should consider as we develop a food plan to address your health concerns?
  • Some people like to know all the details about their illness, while others prefer to know only what is most important. How much do you want to know, and is there anyone else you would like me to talk to about your condition?
  • What do you call your illness, and what do you think caused it?
  • Do any traditional healers advise you about your health?

Health care professionals, particularly nurses, have an ethical responsibility to fully understand how culture shapes health beliefs and practices and influences health outcomes. Nurses must recognize that a person’s culture is a crucial aspect of their identity. Nurses must be capable of managing cultural differences in beliefs and practices to promote a client-centered relationship. These topics will be examined further in Transcultural Nursing and Culturally and Linguistically Responsive Nursing Care.


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