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How often is it that we encounter views such as “cultural differences” or “culture-related health beliefs” as the reasons why immigrants encounter disparities when approaching healthcare institutions? Is culture really to blame for the inequalities that migrants face when accessing healthcare systems? Why is this even an important question to ask?
There is no doubt that migrants face a hearth of vulnerabilities when settling in a new country, such as lack of language knowledge, unfamiliarity with institutions and access to labor market opportunities. But how do migrants access healthcare systems when they first arrive? How do they communicate their illnesses and what are their expectations in how doctors may diagnose them or communicate their methods of treatment?
If you do your homework in the suffocating amount of immigrant health literature that looks at how immigrants access healthcare facilities (as well as the quality of those services provided in terms of accommodating migrants’ specific needs), you begin to notice the creeping re-appearance of culture as an explanatory ground on the inequalities that migrants face.
How different could the culture of the host country and the country of departure be when comparing people’s health attitudes? This question of course relies on which ethnic group of people you observe as well as the countries of settlement: Turks in Germany, Africans in Italy, Chinese in Australia, Albanians in Macedonia. The migratory pathways and patterns are enormous, complex and almost impossible to summarize.
The point is not to undermine culture as an aspect to analyze when looking at the ways in which migrants integrate into their host country, in particular approach healthcare services. In fact, analyzing different understandings of culture regarding health has lead to an array of interesting ethnographic accounts of how different ethnic groups of people communicate health differently.
The point is, on the contrary, to look beyond the cultural explanations when looking at how migrants perceive or interact with healthcare institutions. The culture of a particular group of “ethnic” immigrants is not homogeneous, static or stationary. Migrants are a diverse group of people, and differ in mountainous ways in terms of their age, gender, socio-economic status, class, recency of arrival, education, city of settlement and departure.
For example, imagine two Italians, a man from Naples and a woman from Milan moving to America. Would the pathways through which these two people incorporate into America be the same? Would the “culture” of these two people be the same? Here, gender would play an imperative role, as would ‘city of departure’, as the cultural traditions, behaviors and customs between Naples and Milan are vastly different. Migrants are therefore diverse; they come from different places, have different life trajectories and come from various cities. It is important to acknowledge this because scholars attend to migrants as if they share strong cultural bonds, identity and unity. What about the people that don’t identify with their cultural groups and do not rely on their ethnic background to access institutional services?
So why do scholars, scientists and academics continue to use the “cultural” model when exploring not only how migrants access health systems, but incorporate into the society in general? Perhaps looking at this through a political dimension could help answer the question. It is simply in the interest of nations and policymaking strategies to homogenize ethnic groups of migrants. If you endorse the pluralism and diversity of people, then you must also adopt and embrace multicultural policies. However, multicultural policies are not always in the interest of all countries.
Politics aside, the point is to give more attention to diversity and difference, rather than lumping people into a particular cultural or ethnic category. This clearly impacts the way we view each other, the stereotypes that are created and perpetuated. Stereotypes are useful for one thing only: funny films. But looking at the ways in which they impact institutions and policies is important, and affects a lot of people.
Step outside the cultural model, look at culture through a meticulous lens and try not to base assumptions on cultural unity.
Image credit: Doctors of the World UK via Flickr.com