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Cultural diversity has become a defining characteristic of an increasing number of societies. But just what does it mean? We immediately run into trouble, as much because of the inherent vagueness of the term ‘culture,’ as because of the fact that the expression refers to at least two distinct, though often interacting realities.
On one hand, ‘cultural diversity’ refers to diversity within a given cultural system. This system is composed of a shared and more or less well-defined core set of referents and beliefs. However, the population that shares this core is not a homogeneous group, but a composite whole made up of subcultures and subpopulations of differing size.
Each of these subpopulations experiences and affects the broader socio-cultural reality in different ways, according to different needs, wants, and positions in relations of power and force. But each of these populations is also made up of individuals who simultaneously resemble and do not resemble one another. That is, individual identities are themselves composite wholes defined in terms of ‘membership’ in myriad groups. Women and men, for example, constitute two broad, but extremely heterogeneous subpopulations. Unlike Gertrude Stein’s rose, the existential and political fact of being a woman both defines and is defined by belonging to many other possible groups.
Secondly, ‘cultural diversity’ refers to the co-presence of different cultural systems, or at least of significant bodies of people shaped by these systems, within the same geopolitical boundaries, such as is the case in countries, like Canada, with sizable, growing immigrant populations.
What is true of the first version of cultural diversity is also the case here. However, the picture is made more complex by the presence of more than one set of core referents and beliefs, and by the wide variety of their interactions, the nature of which is not yet understood. The latter are influenced by cultural proximity, majority-minority relations, migratory trajectories, economic conditions in the receiving country, and by length of stay, age, sex and gender roles. While it is important to pursue the attempt to define cultural diversity, it is equally important that we concern ourselves with its consequences, particularly in the area of women’s health, a still-emergent focus of research and public attention.
Given their diverse locations in socio-cultural space, not all individuals, groups or populations experience health determinants in the same way. What is true in terms of health determinants, or appropriate with respect to health practices, interventions, planning, programs, policies and research for one group is not necessarily true for another. Not everyone shares the same concept of health. This has a profound impact on how needs are articulated and identified, and on interactions with the health system at all levels, as well as on health outcomes themselves.
The challenge is to develop tools for research, intervention and planning that will lead to a better understanding of the dynamics of diversity as it operates and affects health—both across and within groups or subpopulations. If we think of this diversity as a diversity of statuses, then, to extend the discussion about sex and gender, the challenge is to develop models which can grasp and integrate the ways in which these statuses coexist and interact.
It is important to bear in mind that gender is not a homogeneous category. It varies both across and within culture. Health concerns of women defy easy description, partly because health risk factors for men are typically generalized to women, so risk factors of greater significance to women often do not receive the attention they deserve. We have only begun to understand how gender, as a non-unitary category, interacts with, and structures, other health determinants. Research has also begun to probe the relationship between gender and culture. The impact of migrant populations with culturally-valenced gendered norms are substantially different from those in Canada. For example, there is evidence linking cultural beliefs to the fact that certain immigrant women are less likely to participate in cancer screening programs, such as mammograms or Pap smears. There is also evidence that immigrant women from some countries with specific concerns arising from excision and infibulation practices tend not to consult health care providers as they fear misunderstanding and judgment.
Many questions remain about the precise nature of the relationship between socio-cultural factors and immigrant women’s physical and mental health. Although one is inclined to suspect that prevailing models of health do not adequately respond to the needs of women from culturally diverse backgrounds, the extent of this shortfall is not well known precisely because the extent and nature of a diversity of women’s health needs are themselves not well known.
Given the present state of knowledge, the consequences of cultural diversity for women’s health can, I think, be summed up by pointing to two significant gaps in health research, planning and interventions. Cultural diversity requires that we develop more sophisticated and more sensitive models of the interactions among health determinants.
Considering that Health Canada has brought forward 12 determinants of health including culture, sex and gender, it is essential that migration experiences be also accounted for. With regard to women, this means factoring in their diversity of statuses both within given cultural systems and at the various points of intersection between cultural systems.
This is no easy task, but it is necessary if we are to grasp and respond to the consequence of diversity on women’s health.
Bilkis Vissandjee is Associate Professor at the School of Nursing Sciences and Academic Codirector, Centre of Excellence for Women’s Health Consortium University of Montreal (CESAF).