The Relationship Between Culture and Healthcare:

The Effect of Cultural Practices/Mindsets in India, China, and America on Health Outcomes
HPEB 470 Global Health Research Presentation
12/4/2018
Sabah Bhamani
Why I Chose This Topic
● We know culture influences health outcomes, but how?
○ Valuing medical findings?
○ Valuing cultural practices over medical beliefs?
○ Unhealthy practices tied into culture?
● Understand why people from certain cultures make certain
decisions whether those positively or negatively affect their health
● Familial history of high blood pressure and cholesterol
Research Question
What is the relationship between culture and healthcare
in India, China, and America and how do these cultural
mindsets/practices affect the healthcare of people
originating from these different backgrounds?

Subquestion: Which specific practices or cultural norms

are affecting the overall health of these populations.
Culture Affecting Health Outcomes
● Possible Factors (Singleton, K. & Krause, E., 2009):
○ related preferences
○ perception of control
○ roles of people in their lives
○ interaction with medical professionals

● Focusing on comparing/drawing parallels between 2 Asian cultures and the American

culture
India
● General Overview of Factors:
○ Arranged marriages
○ Extended family living situations
○ Karma
○ Celebrations with snacks/sweets
○ Religious associations
○ Etc.
India
● Diet:
○ Mithai: Celebrate weddings, birth of a child, graduation, new job, etc. (Mukherjea, A.,
Underwood, K.C., Stewart, A.L., Ivey S.L., & Kanaya, A.M., 2014).
○ Strong practice of snacking
○ =High rates of diabetes and high blood pressure (Green, R., Milner, J., Joy, E. J., Agrawal, S., &
Dangour, A. D., 2016).

○ Diverse diets (often vegetarian diets)= positive

● Family/Cultural Relationship Norms:

○ Collective family health decisions
■ Emotional, logistical, financial support
■ Elder authority: older mindsets
○ Expression to elders discouraged
■ May not question or voice concerns to healthcare professionals
Traditional Medicine
● India
○ AYUSH: traditional medical practice
■ Present in India before true medical system
■ Global presence being integrated into Western Medicine (Rudra, S., Kalra, A., Kumar, A.,
& Joe, W., 2017).
■ Possibility for those of lower SES
■ Less side effects
■ 70% modern Indian drugs from natural resources (Sen, S. & Chakraborty, R. 2016.)
● China
○ Government/Private Healthcare incorporates into medical treatment (insurance)
■ Positive impacts on overall health combining 2 forms of medicine
○ Chinese Medicine Journal: Acupuncture- verifying old traditions through medical findings
(Yeung, H.W., 2006).
China
● General Factors:
○ Collectivism preferred over individualism
○ Family centered approach
■ Emotional support
○ Diet
China
● Diet
○ Back then, lower SES= staple foods like potato and corn (also used for animal feed)
■ Higher SES could afford less nutritional varieties (Chang, X., DeFries, R.S., Liu, L., & Davis, K.,
2018)
■ Gave staple foods negative connotation
○ Chinese Medical Doctors Association= tries to promote outcome research and assess
healthcare interventions
■ Needs participation/people wanting to learn

● Family/Cultural Relationship Norms

○ Families make decisions (usually elders)
○ Open expression of problems discouraged- reluctant to reach out for medical assistance
○ Medical staff= dominant hierarchy
○ Family= incharge of emotional support so nurses focus on operative not emotional support
(Pun, J.K.H., Chan, E.A., Wang, S., & Slade, D., 2018)
■ less value of mental health in medicine
Comparing to the American Culture
● Gaps between American healthcare professionals and immigrant populations
● Comparing Ideals
○ African American populations
■ prayer= source of healing
○ White populations
■ do not relate higher being or family with healthcare (Vaughn, L.M., Jacquez,
F., & Baker, R.C. 2009)
● Western Medicine- focuses on individual and curing a pathogen rather than
understanding holistic context with cultural influences
○ Cultural competency training
America
● Appalachian population:
○ Used to also have male dominated societies
○ Concentration on family and faith for medical issues (Coyne, C. A.,
Demian-Popescu, C., & Friend, D., 2006)

● Diet:
○ High concentration of salt, sugar, fats (Myles, I.A., 2014)
■ Immune diseases
○ Obesity, cancers (breast cancer, colon cancer, etc.)
■ Immigrant assimilation
Further Inquiry
● Impact of Asian practices on American culture
○ Want to learn more about traditional medicine integration
○ Asian food (Indian and Chinese) integration into American diet
● Specific traditions resulting in better health outcomes
○ Many documents focused on harms, what are some more benefits?
■ Ex. Chinese warm water
○ Benefits of vegetarian diet
■ not eating beef in many Indian populations
 References
Chang, X., DeFries, R.S., Liu, L., & Davis, K. (2018). Understanding dietary and staple food transitions in China from multiple scales. PLOS One, 13(4). doi: https://doi.org/10.1371/ journal.pone.0195775

Coyne, C. A., Demian-Popescu, C., & Friend, D. (2006). Social and cultural factors influencing health in southern West Virginia: A qualitative study. Preventing Chronic Disease, 3(4). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1779288/

Green, R., Milner, J., Joy, E. J., Agrawal, S., & Dangour, A. D. (2016). Dietary patterns in India: A systematic review. The British Journal of Nutrition, 116(1), 142-8. doi: 10.1017/S000 7114516001598]

Kang, Y.M., Komakech, R., Karigar, C.S., & Saqib, A. (2017). Traditional Indian medicine (TIM) and traditional Korean medicine (TKM): A constitutional-based concept and comparison. Integrative Medicine Research, 6(2), 105-113. doi:

10.1016/j.imr.20 16.12.003]

Mukherjea, A., Underwood, K.C., Stewart, A.L., Ivey S.L., & Kanaya, A.M. (2014). Asian Indian views on diet and health in the United States. Family and Community Health, 36(4), 311-323. doi: 10.1097/FCH.0b013e31829d2549

Myles, I.A. (2014). Fast food fever: Reviewing the impacts of the Western diet on immunity. Nutrition Journal, 13(61). doi:10.1186/1475-2891-13-61

Ou, C.H.K., Wong, S.R., Levesque, J., & Saewyc, E. (2017). Healthcare needs and access in a sample of Chinese young adults in Vancouver, British Columbia: A qualitative analysis. International Journal of Nursing Sciences. 4(2), 173-178. doi:

https://doi.org/10.1016/j.ij nss.2017.03.003

Pun, J.K.H., Chan, E.A., Wang, S., & Slade, D. (2018). Health professional-patient communication practices in East Asia: An integrative review of an emerging field of research and practice in Hong Kong, South Korea, Japan, Taiwan, and

Mainland China. Patient Education and Counseling, 101(7), 1193-1206. doi: https://doi.org/10.1016/j.pec. 2018.01.018

Rudra, S., Kalra, A., Kumar, A., & Joe, W. (2017). Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014. PLoS ONE, 12(5). doi: https://doi.org/10.1371/journal.pone.0176916

Sen, S., & Chakraborty, R. (2016). Revival, modernization and integration of Indian traditional herbal medicine in clinical practice: Importance, challenges and future. Journal of Traditional and Complementary Medicine, 7(2), 234-244.

doi:10.1016/j.jtcme.2016. 05.006

Singleton, K., & Krause, E. (2009). Understanding cultural and linguistic barriers to health literacy. The Online Journal of Issues in Nursing, 14(3). doi: 10.3912/OJIN.Vol14No03 Man04

Sun, X., Tan, J., Tang, L., Guo, J.J., & Li, X. (2018). Real world evidence: Experience and lessons from China. Chinese Medicine 1(1). doi: 10.1136/bmj.j5262

Vaughn, L.M., Jacquez, F., & Baker, R.C. (2009). Cultural health attributions, beliefs, and practices: Effects on healthcare and medical education. The Open Medical Education Journal, 2(2), 64-74.

https://pdfs.semanticscholar.org/33fa/8f655bbb2b64b6891668 6ab20b5a21c66a9c.pdf

Worthington, R.P., & Gogne, A. (2011). Cultural aspects of primary healthcare in India: A case- based analysis. Asia Pacific Family Medicine, 10(1), 8. doi: 10.1186/1447-056X-10-8

Yeung, H.W. (2006). Chinese medicine: A peer-reviewed open access journal for evidence-led Chinese medicine. Chinese Medicine 1(1). doi: 10.1186/1749-8546-1-1
Questions?