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Cultural Types   To Cultural Competency theme page

Several authors have proposed ways to classify cultures, highlighting the contrasts between them. A general awareness of these may help you in communicating with people from different cultures.

A well-known approach was proposed by Gerd Hofstede in 1991 when he arranged cultural values along five dimensions:
  Power distance:
How does the society deal with inequality; how far is unequal power accepted?
In cultures such as in Arabic countries, Mexico or India, “power distance” is high. In these cultures, subordinates tend to respect and accept their boss merely because of his position ("everyone has his place").
Relevance to Medicine: This tends to lead to unquestioning acceptance of a doctor’s orders. Patients from societies with lower power distance may not automatically respect a doctor's opinion and may tend to question your reason for saying what you do.
  Avoidance of uncertainty:
The norms and beliefs regarding how people react to ambiguous situations

Countries such as Japan, France or Greece tend to avoid uncertainty; they prefer predictability and so develop strict hierarchies, laws and procedures. Deviant ideas are discouraged and consensus is important, so there is typically a strong sense of nationalism.
In Nordic and Anglophone countries, people seem to tolerate uncertainty more; they dislike structure; there is less nationalism.
Relevance to Medicine: People from cultures that avoid uncertainty may wish their doctor to provide clear guidance on what they must do. People from cultures that tolerate uncertainty may accept that there are always alternative approaches; a therapy may be tried and if it works, great, but if it does not, another one may.

  Individualism vs. collectivism: Are people seen as unique and valued for their achievements?
Or, are they seen as members of a social group (family, class, organization or team) which takes precedence over the individual?

In individualistic countries (Australia, US), people are responsible for themselves and initiative is valued; people have relatively weak ties to their organization.
In collectivist countries such as China or Japan, a person’s identity is based on their group membership, so they value tight social frameworks and a feeling of belonging to an organization.
Relevance to Medicine: People from individualistic cultures may expect to make their own decisions regarding their health.
It is common for people from collectivist cultures to take therapeutic decisions as a member of a group; social pressures may strongly influence the individual, who may fear a sense of humiliation if he does not comply. Collectivist societies value harmony whereas individualistic societies value self-respect and autonomy. .

  Masculinity Countries such as Mexico, Germany or Japan espouse traditionally masculine values such as assertiveness, materialism and lack of concern for others. People work long hours and their job is of central importance. Gender roles are clearly distinguished; often the husband will make decisions for the wife. By contrast, low masculinity cultures (Sweden, Denmark) value quality of life, concern for others. However, universal trends such as dual-career families are eroding the gap between high and low masculinity cultures.
Relevance to Medicine: Masculine values tend to coincide with a clear distinction between gender roles; often the husband will make decisions for the wife.
  Orientation to time: Do people focus on long-term or short-term goals? Western societies typically have a short-term focus and view time as a valuable resource. There is an emphasis on focusing on one thing at a time. For other societies (African; Caribbean; some Indian groups) time urgency is much less important. They may be polychronic (lots of things can happen at once and things can be put off to later: mañana). Expect patients from such cultures to be late ("Eight o'clock Jamaica time" means any time after around nine or nine-thirty. Roughly). In some Arabic cultures, deadlines may even be viewed as an insult: important things take a long time and cannot be rushed.

(Source: Hofstede G. Cultures and organizations: software of the mind. London: McGraw Hill, 1991)

Trompenaar proposed a slightly different way to classify cultures, and referred to many of the same ideas. He contrasted cultures in terms of how people relate to each other, running from cultures with a personal basis to those with a social basis. He then applied this distinction to four dimensions of relationships, shown on the left of this matrix:

Personal cultures
Societal cultures
Obligation (as a personal versus a social duty) In personal cultures, obligation is defined universally; obligations are imposed consistently, without regard for individual circumstances In a societal culture, obligations are particular and based on relationships; personal trust is high and so is duty to family
Emotional orientation in relationships In personal societies, communication is subtle and restrained (Japan), so may be hard to read for someone brought up in a social culture Societal cultures are affective: physical contact is accepted and people express their feelings openly; body language is strong (Italy)
Involvement in relationships In personal cultures, relationships tend to be direct, open and, if needed, confrontational (USA, Britain). Work and personal life are separated In society-based cultures, relationships are diffuse and indirect; private and work life may be linked (the family business: China) and direct confrontation is avoided
Basis for Status and Power In personal societies, respect is based on the person’s competence and achievements. Women can gain access to senior positions, and newcomers are respected if they prove themselves. In a society-based culture, status is ascribed: based on age, gender, family origins, social position, etc.

Another dimension of culture that is relevant to health is the tendency to trust others: this is the notion of "social capital". Perhaps surprisingly, people from individualistic cultures tend to trust strangers more highly than do people from collectivistic cultures. In surveys that ask questions on agreement with statements such as “Most people can be trusted”, Nordic societies score highest, although China is also very high. Several Latin American countries and East Europe score low.

Finally, how do cultures react to change? This may reflect religious values. Western societies feel they can to some extent shape the future; others believe in destiny, “as God wills,” etc. This will influence how they react to illness – as something to be suffered, or as a challenge to overcome?

Nerd's Corner…(click here)
Differences in Culture

Nerd's Corner

Differences in Culture
Cultural differences can be wonderfully subtle.  Consider this distinction:
"Do not do unto others as you would not have them do to you" (Chinese Confucian).  This prohibits harmful acts.
"Do unto others as you would wish them to do to you" (Judeo-Christian).  This promotes helpfulness.



A nice comparison of Aboriginal and Western values was provided by the Aboriginal Human Resource Council

Updated August 18, 2011