How culture affects healthcare delivery


Healthcare is complicated.  Healthcare across diverse cultures is even more so.

Healthcare technology vendors are obsessed by global economies of scale affecting healthcare delivery: How many codes and components of their products are compatible with the systems in the international markets they sell?  Needless to say, the greater the localization needed, the higher the development costs.

Despite some healthcare universals, customization of many product features is unavoidable given government regulations related to national or regional healthcare systems. While not easy, most global companies are prepared for adjusting these features as the price of entry into the market, especially to overcome locally based competition.

What becomes a bit trickier is the application of “softer” cultural issues that have more to do with patient behavior in healthcare settings than they do with the pure technology. What further complicates the issues is that countries have become much more diverse, making a one-size-fits-all product even in those markets almost impossible.

An interesting challenge is the variation between certain cultures of their description of pain in a clinical setting. How can one normalize clinical data on pain management when some describe what may be the same degree of pain very differently?

For example, a GlaxoSmithKline’s Global Pain Index study shows that China and Russia are on totally different ends of the spectrum when it comes to how likely they are to verbalize pain, with the Chinese statistically much more likely to verbalize their discomfort. The study also showed that the description of pain varied wildly, ranging from “aching,” “cramping,” “numb” and “dull” to “throbbing” and “stinging.”

This variance creates challenges even for the typical 1-10 pain scale given that the exact same amount of pain may be quantified in a totally different way across cultures.

Some of the more challenging aspects of cross-cultural healthcare occur during natural disasters and epidemics. There are many cases where Somali immigrants have refused measles vaccines due to a distrust of western medicine. In 2017 there were 79 cases of the measles in a Somali community in Minnesota — 9 more cases than the entire nation saw in 2016.

This sense of distrust also extends to first responders in cultures where there is a strong distrust for national police and emergency services. This was reported among southeast Asian emigres, where first responders in yellow vests were attempting to guide victims to safe shelter. Many of the victims ran in the opposite direction, given their frame of reference that they might be held in government camps for long periods.

Finally, many healthcare providers servicing large populations of immigrant communities report that the ability to get intake information becomes increasingly difficult due to a fear of deportation. Many patients only want to talk specifically about the ailment and little about their families and work histories. This again emphasizes the importance for healthcare organizations to establish trust within both legal and illegal immigrant communities. This takes on special significance in epidemics like the Zika virus, where travel from high risk geographies has a major impact on the spread of the disease.


  1. Shirley Ramos says:

    Interesting read – and this is a complicated topic. How to verbalize and standardize articulating pain – the distrust that accompanies ‘we are here to help you.’ Recently coming back from a near death cancer experience myself – and having experience working in Afghanistan ( Kabul & Barek-Aub) with healthcare needs/experiences. And then you integrate the ‘business’ of creating products/delivering services for multiple populations. I am just beginning to do some research and thought in this area – but wanted to let you know that this article didn’t go on ‘deaf ears’.


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