The Toolkit
CULTURAL DIFFERENCES
What do we mean by cultural differences?
Cultural differences can arise when organizations – and their staff members – have different cultural norms, expectations, and behaviors than the people they serve. As societies move toward greater diversity and globalization, awareness of these differences becomes more important to ensure that services are effective. Service providers and their clients may come from different national, race, ethnicity, ability, religious, or sexual identities. These identities may contribute to different experiences and attitudes about health, well being, and health care. Such differences may also affect how people understand, accept, or manage problems and interventions.
Cultural differences can show up when interacting in unexpected ways: body language that seems either aggressive or stand-offish; reluctance to provide important, personal information; extreme deference to authority (service providers, teachers, etc.); code switching (changing behavior to “fit in”); or appearing to accept recommendations, but not following through.
Surprising Fact!
More than 90% of experimental psychology studies, which help shape perceptions of what’s “normal,” are conducted in WEIRD (Western, educated, industrialized, rich and democratic) cultures. Yet WEIRD cultures account for only 12% of the world’s population.
How can cultural differences affect health equity?
Experiencing cultural clashes can increase long-term physiological conditions caused by stress, such as immune system suppression and hypertension. Mental health impacts can include depression and anxiety, sleep problems, substance use, low self-esteem and confidence, and feeling like an outsider. This can reduce people’s capacity to cope with stress, to interact socially, and to thrive and succeed. Cultural differences can negatively impact academic or work performance and heighten stress. A lack of trust or access to healthcare information or services can make people less likely to seek help for their problems. People who are immigrants or from minority communities are particularly vulnerable.
Providing medical information that is accurately translated and won’t be misinterpreted is essential; so is learning about different beliefs and practices among the populations you serve. In some cultures, for example, physical and mental illness are explained by mystical beliefs or destiny. Diagnoses of mental illness or other conditions may be rejected because of stigma, or because people have different ways of understanding mental distress. Indigenous communities may use traditional or spiritual healing approaches, and religious or spiritual people may feel strongly about the role of prayer or meditation in their health.
Actionable Examples
WHAT OTHERS HAVE DONE
Center your clients’ cultural values and practices in your services
A council of First Nations, Inuit and Metis people worked with an Ontario hospital system to reconsider their position on being a “100% tobacco free” campus in recognition of the important healing role that tobacco plays among some of their people. The council and the hospital created specific, informed exceptions to this policy. They also built a sweat lodge, where traditional healing and prayer ceremonies could be held, on hospital grounds. When combined with cultural training for staff, and increased hiring of First Nations, Inuit, and Metis professionals, these practices have helped the hospital system better serve all of its communities.
Hire from/partner with different communities
A community organization in Maine hired a Rwandan refugee to be a cultural broker. She helps other immigrant families understand that Americans have different norms about many things, from body language and gender roles to trust in authority. These can lead to misunderstandings at work and school and can get in the way of navigating social services and medical care. For example, the cultural broker may translate or intervene with schools. Problems may arise from the children’s past trauma or when the school’s academic and behavioral expectations are worlds away from the parents’ experiences. She also teaches life skills to children of all ages. Spending the time to openly discuss confusing situations and needs, offering simple advice and working through and modeling problem solving can make a big difference.
Bibliography
Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs
An evidence-based guide to developing and sustaining cultural broker programs in health care settings. From Georgetown University’s National Center for Cultural Competence (for HHS).
Clash: How To Thrive in a Multicultural World
Extensive research and examples of cultural divides in our workplaces and communities and how to understand and address them by leading Stanford social psychologists. From Plume.
A meta-analysis of cultural mismatch, cultural competency and their interrelation with health disparities in urban schools. From the peer-reviewed academic journal Journal of Praxis in Multicultural Education.
Developing the Cultural Awareness Skills of Behavior Analysts
Strategies for improving cultural awareness, assessment and choice of culturally appropriate interventions. From the peer-reviewed, academic journal Behavior Analysis in Practice.
Health Literacy: A Prescription to End Confusion
A summary of research, illustrated by cross-cultural stories. From the Institute of Medicine (US) Committee on Health Literacy.
How Culture Influences Health Beliefs
Article examines different beliefs and practices across a range of cultures. From EuroMed.
Research showing that people from Western, educated, industrialized, rich and democratic (WEIRD) societies are the psychological and behavioral exception, not the norm. From the peer-reviewed, academic journal Nature.
A review of research on the origins and consequences of social-class differences in university and professional settings. From the Association of Psychological Science.
Acknowledgements
Dr. MarYam Hamedani
Executive Director, SPARQ, Stanford University
Dr. Renee Linklater
Director of Shkaabe Makwa, Centre for Addiction and Mental Health, Ontario, Canada
Dr. Gilberto Lopez
Assistant Professor, School of Transborder Studies, Arizona State University
Dr. Lourdes J. Rodríguez
Senior Program Officer for Women's Health, St. David's Foundation; Adjunct Faculty, University of Texas School of Public Health, Austin
Amelia Rubenstein
Director of Research and Programs and Jattna Gomez, Director of Equity and Community Engagement, SAFE Center, University of Maryland
Sreytom Tim
Research Assistant, Family Studies, University of Minnesota
Tessa Whitecloud
Former Executive Director, One Just City, Winnipeg, Canada
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