Healthcare is an increasingly global industry, with international providers and suppliers covering multiple markets. But though the human body may be the same across different markets, patient approach to healthcare can be very different.
A patient’s cultural background hugely informs their approach to their health and influences how they consume healthcare services.
It’s important to understand their patients in this particularly intimate area of their lives if healthcare brands are to succeed outside their home market.
Take attitudes to vaccination – the preventative treatment that’s massively contributed to the eradication of killer diseases such as smallpox and polio. There’s a troubling anti-vaccination movement in some western countries, particularly the US.
Here vaccination is often mistakenly linked to autism, after the publication of a now massively-discredited study. But other markets have their own anti-vaccination movements, motivated not by claims of a connection with autism but by other local concerns.
In markets such as India, it’s often suspicion of the West that fuels distrust in vaccination programmes. In parts of West Africa at risk of Ebola, mistrust of authorities has fuelled the belief that either the disease is not real, or that it’s deliberately spread by health workers.
South Africa’s attempts to fight HIV have been hampered by denialists even at a governmental level. The UN’s special envoy for AIDS in Africa described the country as the “lunatic fringe” in the fight against HIV/AIDS and described the government as “obtuse, dilatory, and negligent about rolling out treatment”.
The World Health Organisation has found that the most effective vaccine programmes are those tailored to specific countries. It’s important to understand local reasons for hesitancy to engage with health services, in order to design messages that address and overcome them. It’s a message that also applies to healthcare brands trying to engage with new markets.
Language and healthcare access
Language is another factor affecting patient access to health provision. A 2011 study in the US found that elderly Hispanic patients were much less likely to get their flu vaccination if they had weaker English language skills.
Another study found that Californian parents that favoured Spanish over English were less likely to get their daughters vaccinated against HPV. The language used by healthcare providers to engage with their patients may be significant in helping overcome their reservations and access care.
Engaging with patients in their own language can also help promote better health outcomes when they do engage with services. South African patients often engage with healthcare practitioners in their second or even third language. This impacts on the ability of practitioners to communicate health advice and education.
But language isn’t the only barrier to effective healthcare interactions. A patient’s cultural approach to social interactions with health authorities can also be a major issue.
That’s particularly the case when patients perceive there to be a large power distance between themselves and the healthcare provider.
A study in South Africa found that Xhosa speakers, who rarely accessed healthcare services in their own language, often didn’t admit they hadn’t understood what was explained by their doctor, as they felt it disrespectful to challenge them. China seems to have the opposite problem – attacks by patients on doctors are increasingly common.
Pain and culture
One of the most significant areas of cultural differentiation when it comes to healthcare is pain. Some cultures are intolerant of pain and have high expectations that pain will be managed and defeated.
Other cultures are more stoic, seeing pain as a fact of life and one to be borne rather than necessarily fixed. This can lead to cultural clashes between healthcare workers and patients from different cultures.
An Asian patient may be far less expressive about pain than one from a Mediterranean culture, even though their suffering is equal. Healthcare practitioners may find it hard to properly assess a patient’s condition under these circumstances.
A person’s cultural background can also affect whether they admit symptoms to their healthcare providers at all. If medics are seen as high-status people, patients from deferential cultures may not see them as approachable.
People from cultures that defer to higher status individuals may feel less inclined to report pain to their medic because they don’t feel their suffering is the problem of a higher-status individual. Other cultures understand suffering in religious terms, as a test of faith or a penance. This may lead them to avoid seeking help, even when pain is an important symptom of undiagnosed illness.
Human language has limited capability to convey personal experience. After all, how can a person really convey a feeling to someone who has no experience of their own to compare it against?
Sometimes patients are encouraged to report their pain on a scale of 1 to 10, but really this just asks patients how much worse they can imagine suffering to be. People from cultures that encourage the suppression of emotions are much more likely to underreport pain using any kind of scaling system.
How culture affects the market for healthcare
These cultural differences may be frustrating for front-line practitioners dealing with patients from other cultures, but culture also affects market provision of healthcare.
China’s a massive expanding healthcare market at present, and expenditure doubled between 2006 and 2011. It may seem a tempting market for health brands but it’s important to understand how Chinese consumers think about health in order to make a success of this market.
Just as the healthcare market for conventional ‘Western’ medicine such as vaccines has doubled in less than a decade, so too has demand for traditional Chinese medicine. Healthcare providers not only need to market their own products and services, they also need to compete against an entirely different system of medicine – one they may not understand.
A shortage of medical facilities and doctors means that in rural areas, traditional style medicine may be the only kind on offer. There’s also a widespread perception that physicians put their economic welfare ahead of patients’ interests.
Traditional medicine may seem more aligned to local values, and so viewed with less suspicion. Western companies seeking to corner the Chinese market may find it challenging to overcome the unique local attitude to healthcare provision. However, understanding the local approach to health is vital to make a success in any market.