Avoiding premature coronary deaths in Asians in BritainBMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7027.375 (Published 10 February 1996) Cite this as: BMJ 1996;312:375
Cultural factors are important
- Sangeeta Patel
- Clinical lecturer Division of General Practice and Primary Care, St George's Hospital Medical School, London SW17 ORE
EDITOR,—An improved health service for all minority groups is to be applauded (even if the motives are predominantly economic). It may, however, be simplistic to suggest that the way to prevent coronary heart disease among Asians is to inform them of factors that would increase their likelihood of coronary heart disease and then expect them to change their lifestyle accordingly.1
The assumption that each person appreciates health risks solely on the basis of information that he or she possesses ignores the large influence of cultural factors on the degree of importance that people ascribe to any risk.2 The idea that people then analyse the costs of these risks and change their behaviour accordingly assumes, firstly, that they use an economic cost-benefit conceptual model to determine their behaviour3 and, secondly, that they will be in a position to change it.
The medical profession often assumes that if people do not correct their behaviour then they are not behaving in a reasoned way or are unable to attach appropriate priority to their health, and they may then be held responsible for having brought on their illness.4 Categorising a racial group as being at risk of a disease for which they may be blamed will marginalise them. This is particularly unnecessary when we are aware of the limited efficacy of health education campaigns, even among the supposedly rational, “health maximising” white middle classes.
I agree that coronary heart disease among Asians is an important issue that warrants funds for public information and that we should not avoid our responsibilities as a profession to attend to the health requirements of minority ethnic groups merely because this is a sensitive issue. My point is that if we concentrate solely on the changes that should be made by individuals, from any minority group, to decrease their risk of illness, without regard to the complexity of factors that affect their conceptualisation of risk and behaviour, this will have consequences that may alienate them further.