How Does Culture Affect Healthcare?

It is no surprise that culture affects healthcare. However, the meaning of “culture” can be fluid and difficult to define. Given that culture can mean different things in different contexts, it helps to establish just how it affects healthcare perceptions, approaches and practices. Cultural competence starts with an effort to understand the beliefs and traditions of diverse populations.

Race and Healthcare

Certain races of people are more likely to get certain diseases than other races, which often affects the treatments given. Various aspects of race also affect outcomes and life expectancy. For example, African Americans are more likely to get heart disease than their white counterparts. They also react differently to certain medications. Asians, for example, are more likely to get diabetes with lower BMI than African Americans or whites. There are also disparities in health screenings. According to John Ayanian’s article in the Harvard Business Review, gaps in death rates from colorectal cancer have widened as “screening rates for blacks nationally have not kept pace with those of whites.” Working from this evidence, New York City was able to address these disparities through “coordinated public and private efforts to promote colorectal cancer screening.” Cultural competence in this case involves awareness and adjusting practices to save more lives. Education in cultural competence is imperative.

Unfortunately, racial disparity also has economic consequences. Ayanian notes, “Racial health disparities are associated with substantial annual economic losses nationally, including an estimated $35 billion in excess health care expenditures, $10 billion in illness-related lost productivity, and nearly $200 billion in premature deaths.” Narrowing the gaps in racial disparities would have an immeasurable effect on society.

Racial disparity is not only an issue concerning patients; there is also a racial disparity in the nursing field. Although more than 30 percent of Americans identify themselves as “non-white,” less than 20 percent of nurses claim to be minorities — according to the American Association of Colleges of Nursing (AACN). This disparity in representation results in a disparity of cultural competence, as many nurses are unaware of the ways different people approach health issues.


Although race can be an important factor in how a patient approaches healthcare, it is not the only one. One factor that many do not consider is the disparity in the genders of nurses. As the American Association of Colleges of Nursing reports, only around 9.6 percent of nurses are male, with nurse anesthetists representing the largest population of male nurses. In the U.S., nursing has more traditionally been associated with women more than men—a tradition that is changing quickly. Numerous studies have documented the difference in healthcare approaches among genders, and a nursing program that focuses on cultural competence can address these differences and ways to approach them.

Gender inequality in nursing cuts both ways. Men in nursing face cultural pressures resulting from the profession being traditionally seen as “women’s work,” but women in nursing still experience hiring and pay gaps. Although male nurses are the minority, “men tend to be disproportionally represented in senior posts” and are often paid more than their female counterparts, according to Beth Greenwood’s article in The Nest.

This gender inequality carries over into the healthcare provided. As reported by Mikalea Conley of ABC News, “Only 33 percent of women who had a heart attack in 2009 received some sort of surgery, compared with 45 percent of men.” Further, women are 44 percent more likely to die in valve replacement surgery than men. While there is no simple answer to these and similar problems, nursing programs that focus on cultural competence better prepare their students to tackle these issues.


Another demographic associated with different healthcare approaches and outcomes is region. In the U.S., this can mean the general area of the nation (Southeast, Southwest, Northeast, etc.) or it can mean differences within a region (urban, suburban or rural). For example, the National Organization of State Offices of Rural Health (NOSORH) reports that “a more holistic, patient-centered approach to health care in rural communities” results from rural healthcare providers having more opportunity to provide more comprehensive care to their patients. Cultural competency, in this case, is an understanding of regional differences in healthcare and what rural patients expect from their providers.

In addition to patient expectations, there are other differences in rural and urban healthcare. For example, despite having fewer healthcare resources than their urban counterparts, rural patients spend more of their income on healthcare. According to NOSORH, “Rural residents pay 40 percent of their healthcare costs out of their own pocket compared with the urban share of one-third.” Although 60 percent of trauma-related deaths occur in rural areas, only 24 percent of rural populations can reach a Level I or Level II trauma center within one hour. To provide quality healthcare for rural residents means big changes on the horizon for healthcare.

The Right Program

While some nursing programs avoid issues of cultural competence, others see these issues at the forefront of quality healthcare. Understanding how different people approach healthcare ensures not only better healthcare, but better working conditions for a new generation of nurses. Many online RN to BSN programs cover cultural competence, so it is imperative to research your nursing school options to make sure your education is current and relevant.

Learn more about the LSUA online RN to BSN program.


American Association of Colleges of Nursing: Fact Sheet: Enhancing Diversity in the Nursing Workforce

Harvard Business Review: The Costs of Racial Disparities in Health Care

The Nest: Gender Equality Issues in Nursing Careers

ABC News: Heart Health Care Gender Inequality Can Be Fatal for Women: Report

UT Southwestern Medical Center: Why do African-Americans face higher risk of heart disease?

UT Southwestern Medical Center: South Asian Type 2 Diabetes Study

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