Effective Medicine Must Weigh Religion, Culture


The recent launching in California of Viva Health - a health maintenance organization targeting the Hispanic population, shows that diversity is an issue that affects far more than education and employment. It reinforces the need to understand the health issues of various cultural groups and how to leverage them for the business opportunities they represent.

Historically, commercial medicine has been controlled by the insurance industry with its mass-market focus. That was the case until recently when fierce competition forced medicine to adopt a segmented marketing approach. Now there is growing awareness that the use of healthcare services relates to cultural values and roots.

Research into the link between culture and medicine has been advanced because of work done by the Center for the Health and development of Children and Youth at Saint Francis Hospital and Medical Center. It provides insight into a folk illness known in the Latino and Puerto Rican communities as empacho.

Dr. Lee Pachter, one of the researchers, found that less than 10 percent of parents whose children were afflicted with the illness sought assistance of a pediatrician. One conclusion Pachter drew was that visits to doctors were not effective because of the lack of confidence by parents that the pediatrician could intervene successfully.

Where then did the parents turn for help? To a traditional therapist healer called a santiguadora. When the pediatrician and the santiguadora joined forces, the latter performing his healing ritual and the physician accepting and respecting the folk remedies in an open manner, children afflicted with this illness got better faster. Culture, religion and biomedicine also come together in a hospital setting when the patient is a Hasidic Jew. Hasidic Jews consider the rabbi to be as important as the physician in matters of health and this can change a health practitioner's perception of a patient's noncompliance with a doctor's recommendations to simply a situation in which the patient needs more information before making a decision.

Medicine Needs to Consider Culture

The phenomenal growth of the immigrant population in North America has critical relevance to many areas of healthcare, not the least of which is homecare, care of the elderly and rehabilitative care. Homecare health practitioners must be sensitive to the cultural and religious dynamics of their clients because upwards of 90 percent of all healthcare occurs in the home, rather than in a physician’s office or an operating room.

The organizers of the Viva Health HMO recognized an overlooked service niche among the providers of healthcare that revolved around issues of awareness and sensitivity to the language and culture of Hispanics. And the same is also true for the immigrants from Asia, the Pacific, the Caribbean and for other large ethno-cultural populations. The implications for achieving appropriate medical outcomes because of cultural values and belief systems are enormous because 12 percent of the population were born outside the United States. Similar issues affect workers’ compensation claims. Both industry and managed care organizations want employees to return to work as soon as possible. These attempts, however, are stymied by care givers lack of respect, sensitivity and understanding involving the health perspectives linked to the cultural values of many of the injured workers. Correcting this situation could help lower workers’ compensation costs.

The allied health field of rehabilitative medicine– nurses, counselors, claim examiners, case managers, physical and occupational therapists, dietitians and others—is devoid of meaningful representation from immigrant groups. The picture is the same for insurance and managed care companies. The virtual absence of Hispanic decision makers among national insurance and health organizations in Greater Hartford that operate nationally is testament to this. This diversity gap is an indicator of a lack of health care sensitivity and competence. It has given rise to companies such as Viva Health. What about wellness programs now proliferating among numerous private sector companies? These companies have data regarding the ethnic-cultural makeup of their workforce. They have also not addressed culture-related health and wellness issues., traditions, language, communication variables and belief systems of their diverse workforce. It is still the discredited one size fits all approach.

In Healthcare, how we define ourselves is a reflection of what we believe about how illnesses affect us.

Why is it virtually impossible to achieve appropriate medical outcomes when culture is ignored? It is related to what is understood regarding the notion of care and how we define ourselves. Notions of care are influenced by the alliance developed between the care provider and the patient as well as the expectations of each regarding the outcomes from recommended therapies. In healthcare, how we define ourselves is a reflection of what we believe about how illnesses affect us. It is also a reflection of family dynamics and interactions , socio-economic status, religious beliefs and values, which include views held regarding the use and efficacy of folk, or non-Western medicine. An HMO for every cultural group is not the answer. It is the responsibility of and willingness by those organizations to develop or strengthen capabilities around cultural diversity, healthcare competence and expanded notions of service to diverse populations.

— James Z. DanielsPublished in The Hartford Courant Op-Ed pageSunday, January 15, 1995