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Talking about Culture and Health
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Overview: Culture is the way people live. Culture affects everything we think and do, from how we treat our elders, to who we allow to be a healer, to what we do when our children do not feel well.

Culture shapes our health as much as our genes do. The way we define ourselves culturally (by ethnicity, religious belief, politics, sexual orientation, disability, age and more) affects what we will do for their health.

A good health care provider recognizes this and tries to learn about the many cultures of his or her patients. While no summary of a culture can possibly describe the variation that exists among individual members of a cultural group, it is a good idea to learn more about the general health beliefs and experiences of a given group.

Culture: Questions & Answers
Tips on providing equitable treatment regardless of culture


Q. What exactly is meant by “culture?" Doesn’t everyone belong to a lot of cultures?

A. There are many, many definitions of “culture”, but one of them is “the beliefs and values shared by two or more individuals that shape their behavior”. And yes, everyone belongs to a variety of different (and sometimes even seemingly opposing) cultures. A patient may belong to the culture of motorcycle riders, the culture of cigar smokers and the culture of rose growers. Each of these cultural identities will shape that person’s health through his beliefs, values and behaviors.

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Q. What is cultural competence?

A. Cultural competence in health care is evident when people of all cultures are treated in a way that affirms their worth and preserves their dignity. Cultural competence is important in every aspect of our public lives, but it is a crucial skill for health care providers, who deal daily with diverse people in life and death situations. Cultural competency is not just awareness or sensitivity to different cultures. A culturally competent provider knows about different cultural perspectives and has the skills to use that knowledge effectively in cross-cultural situations.

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Q. How do I talk to a patient about his or her culture?

A. Because every patient is an individual with a unique personal history, belief system, and communication style, what you think you know about someone may not be true. Until you know that the cigar-smoking, motorcycling patient you are seeing for shortness of breath also regularly sprays his roses with pesticide, you may not know enough about his culturally-based behavior to treat him effectively.

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Got a question? Share it on the Exchange members' discussion forum.

Tools:
Key publications, websites and organizations on culture and health

National resources

Ethnomed contains information about cultural beliefs, medical issues and other related issues pertinent to the health care of recent immigrants to Seattle or the US, many of whom are refugees fleeing war-torn parts of the world.

Provider’s Guide to Quality & Culture: A federally managed site with comprehensive information about common health beliefs and practices of numerous groups, models for understanding cultural competence, videos and more. Sample the site with this 23-question cultural competence quiz.

Delivering Culturally Effective Health Care to Adolescents: A guide from the American Medical Association the impact of culture on the health status of teens.

CLAS-Talk: E-mail discussion group sponsored by Resources for Cross Cultural Health Care and the DiversityRx website. Topics include design, delivery and evaluation of culturally and linguistically appropriate services (CLAS) in health care.

Minnesota connections

Culture Care Connection: This Stratis Health site is an online learning and resource center aimed at supporting health care providers, staff, and administrators in their ongoing efforts to provide culturally-competent care in Minnesota.

CHW Services are Reimburseable: The Department of Human Services can facilitate reimbursement for Community Health Worker (CHW) services. CHWs are members of minority ethnic, racial or cultural groups, who serve as liaisons between their fellow community members and the health system. This publication from DHS explains the details.

Deaf and Hard of Hearing People Have Their Own Culture: A review of the culture of deafness, provided by the Minnesota Department of Human Services. Covers terminology, ASL, deaf-blind culture, and more.

Meet the Lothsampas A video about a relatively new cultural community in Minnesota, the ethnic Nepali-speaking Lothsampas from Bhutan. The Minn Post also has posted a video featuring a refugee couple from Togo, explaining “why we are here.”

2008 state directory: Health Resources Serving Diverse Cultural Communities. Published by the Refugee Health Program, Minnesota Department of Health. Hard copies of the directory can be requested from MDH. Contact Maggie Kenyon-Schultz at margaret.kenyon-schultz@state.mn.us or at (651) 201-5528.

Mshale offers news for MSP African community Mshale is a community newspaper based in Minneapolis for African immigrants. Contains original news stories, newslinks to other websites, blogs, entertainment features, and ads. A good way to keep up on news affecting African patients.

HealthConnect – A Practical Guide to Community Outreach. Available free of charge from the Medtronic Foundation, this book offers practical tactics and resources to improve the ability of health care advocates to reach and serve people of all backgrounds.

My Heart It Is Delicious: Setting the Course for Cross-Cultural Health Care. The inspiring story of St Paul's Center for International Health, founded by a "baker's dozen" of former refugee camp workers and volunteers. Describes the Center's evolution into a model institution for culturally sensitive care for refugees and immigrants. Newly available from Afton Press.

My Body: Human Reproductive Anatomy booklet: Booklet in both English and Somali, for health providers and educators and their Somali patients to help them better understand reproductive functions and how certain contraceptive methods work. Order free copy while supplies last from Minnesota International Health Volunteers.

Minnesota Ethnic Resources Directory: On-line directory of nearly 800 non-profit cultural, social and human service, educational, artistic, religious, community and government organizations engaged in ethnic/nationality services and activities.

Healing by Heart: Culhane-Pera, K. et al Clinical and ethical case stories of Hmong familes and western providers, edited by four Minnesota physicians and ethicists. Available on Amazon.com

Immigrant Health: A Call To Action: Recommendations from the Minnesota Immigrant Health Task Force, a two year advisory panel co-sponsored by the Minnesota Department of Health and the Minnesota Department of Human Services.

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How would you know my clan makes health decisions for me?

Culture shapes the health care choices we make. Guessing is no substitute for asking. Learn how and why to communicate clearly about cultural values.