An Introduction to Community and Primary Health Care

Introduction

Many countries, such as Australia and New Zealand, have a complex mix of Indigenous and immigrant groups, and therefore encounters with clients from different cultural backgrounds and beliefs in health care practice are inevitable. Health outcomes tend to be poorer for minority Indigenous populations and individuals who have a different cultural background to that of the main population group (Ehrlich et al., 2016). Cultural differences may relate to ethnicity, sexual orientation, religious and political ideology, and other less overt differences. As responsible health care professionals who practice with a social justice approach, we need to consider the effects of policies, practices and service delivery on all health care consumers. We have an ethical and professional obligation to ensure health care is provided in a culturally safe environment of mutual respect. Fundamentally culturally competent care means person-centred care. Health care providers must develop a willingness to listen, share understandings and acknowledge the unique identity of each individual (Skellett, 2012).

The key problems when caring for clients from diverse cultural backgrounds stems from a lack of understanding and tolerance. All too often, neither the health care provider nor the client understands the other's perspective. Despite this, Johnstone and Kanitsaki (2007) have reported resistance from health care professionals to undertake cultural diversity education. Such resistance reflects their failure to recognise and therefore respond to cultural imperatives in health care, or to practise in a person-centred manner. This chapter discusses cultural diversity, the need for culturally competent health care professionals and explores strategies for culturally competent practice.

Culture

Culture can be considered from multiple perspectives and pervades almost every aspect of life. Culture influences the division of labour, exchange and trading systems, economic systems, and the necessities of life and how these are accessed. Family life, kinship systems and how people interact with each other may be overtly and subconsciously influenced by culture. Giger and colleagues (2007) describe culture as a learned, patterned behavioural response acquired over time that includes implicit and explicit beliefs, attitudes, values, customs, norms, taboos, arts and life ways accepted by a community of individuals. They observed that culture is primarily learned and transmitted within the family and other social organisations, guides decision making and facilitates self-worth and self-esteem (Giger et al., 2007).