Introduction

Disease does not occur in a vacuum. It occurs in a specific cultural context which determines how the illness will be identified, interpreted, and managed. Culture is a social matrix that includes the ethnocultural background of both patient and clinician, as well as the knowledge and practices that each brings to understanding and treating illness (Kirmayer et al., 2003). Cultures are not fixed, stable entities. They are fluid and dynamic, especially in the face of globalization which increases tension between local worlds and global trends (Bibeau, 1997).

In pluralistic societies, cultural diversity is both a source of richness and a clinical challenge. Culture-related barriers to healthcare range from language to poor adherence (which has been documented frequently but is still not well understood) (Beiser, 1988). Unfortunately, healthcare providers tend to focus on cultural differences and de-emphasize the role that specific cultural value systems, coping strategies, and solidarity networks can play in the healing process or in framing chronic illnesses.

Different countries have developed a variety of models for culturally appropriate care, which tend to reflect the historical, social, and political orientations of mainstream societies. For example, the UK model focuses on avoiding racism, the US model attempts to match patients with clinicians from the same ethnic background, while the Australian and Canadian models focus on developing culturally competent healthcare providers who are able to provide culturally responsive services (Kirmayer and Minas, 2000).

To address cultural dimensions in clinical care, clinicians will identify:

• their own personal, professional, and institutional subcultures

• how these may shape the clinician–patient interaction.