CULTURE

CULTURE

Culture is an active, dynamic, and complex process of the way people interact and behave in the world. Culture encompasses the concepts, beliefs, values (including nurturing of children), and standards of behavior, language, and dress attributable to people that give order to their experiences in the world, give sense and purpose to their interactions with others, and provide meaning for their lives. Culture requires an attempt to understand, from the patient and family perspective, questions such as: What is the nature of health? How does one keep healthy? What is the nature of illness? How does the illness work? Where does it come from (illness attribution, etiology)? What is the approach to treatment? and What is the expected outcome? An appropriate inquiry that addresses this realm includes open-ended questions such as: "What worries (concerns) you the most about your child's illness?" or "What do you think has caused your child's illness?" These questions facilitate the patient's or family's discussion of their thoughts and feelings about the illness and its causes. Cultural understanding also includes concepts and beliefs about how one interacts with health professionals and what one expects from health professionals. The spiritual and religious aspect of health and health care also can be viewed from this perspective. These differences in perspectives, values, or beliefs may affect the health of the child in an adverse way and may result in differences between the pediatrician and the patient and family. Significant conflicts may arise because religious or cultural practices may lead to the possibility of child abuse and neglect. In this circumstance, the pediatrician is required by law to report the suspected child abuse and neglect to the appropriate social service authorities (see Chapter 22).

Complementary and alternative medicine (CAM) practices constitute a part of the broad cultural perspective. It is estimated that 20% to 30% of all children use some CAM; 50% to 75% of adolescents use CAM. Of children with chronic illness, 30% to 70% use CAM therapies, especially for asthma and cystic fibrosis, whereas only 30% to 60% of children and families tell their physicians about their use of CAM. Therapeutic modalities for CAM include biochemical, lifestyle, biomechanical, bioenergetic, and homeopathy. Some modalities may be effective, whereas others may be ineffective or even dangerous.

By 2020, almost half of U.S. children will be of Latino, African American, Asian, or Native American ethnicity. In many states, this shift already has occurred. Currently, there are immigrants and refugees from Southeast Asia, eastern Europe, the Middle East, Asia, Africa, Central America, South America, and other parts of the world, with a variety of languages and health beliefs. Rapidly changing demographic shifts in populations make it likely that the pediatrician will encounter many different cultural identities. Understanding patient and family health beliefs and practices enables pediatricians to practice better health care.