By Dr. Marc Babitz
Two big barriers to accessing healthcare are culture and language. I personally believe that this country is as great as it because of our diversity. We have managed to take some of the best things from almost every society and every culture in the world. As people have come to American they have brought these wonderful things to add to the wealth and greatness of our society. But as people come and do that, and come to work here and contribute, they also bring beliefs about health care, and of course the languages may often be different. Now Salt Lake County is a great example of that also and again I love to, with students ask questions so the question I'd love to pose to people is, "Do you know how many languages are spoken in Salt Lake County as the primary language of the family?--primary meaning that they really don't speak much English and they really speak this language at home?" There was a study done a few years ago in public schools. What they found was that there are 67 distinct foreign languages spoken in Salt Lake County as the primary language of the family, and there are over 35,000 children in our public schools who spoke a foreign language. These languages of course encompass all parts of the world. Now do those people deserve health care? They may have different feelings about health care and if they can't talk to the receptionist, or talk to the physician in their language, then how do they get health care? So that's another barrier that adds thousands and thousands more people into our system of access barriers.
Cultural beliefs about disease and health can also create barriers. The term we like to use in talking about culture is the word "health belief systems" where you look at medical models. Health belief systems are very different. We need to ask ourselves, “What is the culture of our system?” There was an anthropologist who studied this issue, and it is very useful because you can compare our beliefs to how other people believe. A great example I had about that was a wonderful woman who was of Chinese descent. She had been living in the United States probably 30 years. In fact her daughter was my patient who spoke beautiful English and was very much part of the mainstream culture, but her daughter brought her mother in to see me about a particular problem. In deciding to treat the problem, I wanted to give the mother what was one of the newest and strongest medicines we have. Now it's interesting, and this anthropologist points out, that newness and strongness are Western attributes of health care. We think if it's newer, it's better, which of course actually is not always true. And we think if it's stronger it's better, which actually is not always true. Stronger can mean more side effects and more money and things like that. So I wanted to give this woman this new strong medicine. She said, “No I don't want to take it. Do you have anything else?” And I was sort of puzzled and I asked, "What do you mean?" And she said, “ Do you have anything that has been around for awhile?” And then I remembered my cultural training which said that many people of Asian backgrounds and Asian culture, they value tradition, they revere their elderly, they value things that are old, their healthcare systems like acupuncture medicine are 4,000 years old, so I said, "Oh my gosh, what a mistake I'm making." So I suggested, "Oh I have another medicine, same class of medicine, and it's very good and it has been around for only 30 years, but it has been around for awhile, would you consider that?" And she was quite delighted to have a medicine that had been around for at least that long, as opposed to the "new" stronger medicine. So culture and health beliefs are very important, and we have many other examples of that--whether it's hot or cold, and yin and yang and balance, and balance and many examples in different cultures where we have to be sensitive to other people's beliefs about what will help them get well.