Joumal of Advanced Nursing, 1996,23, 564-570

A critique of multiculturalism in health care:

the challenge for nurse education
Lon-aine Culley BA MA PhD
Pnncipal Lecturer, Department of Health and Continuing Professional Studies,
De Montfort University, Scraptoft, Leicester LE7 9SU, England

Accepted for publication 5 Apnl 1995

CULLEY L (1996) Joumal of Advanced Nursmg 23, 564-570

A critique of multiculturalism in health care: the challenge for nurse education
This paper is concemed with the way m which discussions of the health status
of people from minority ethnic groups and the delivery of health care to such
groups has been constructed, m the nuxsmg literature m particular, withm a
culturalist framework which has many serious drawbacks The paper reviews
the argument for a 'multicultural' approach to health care and also discusses
some of the mam implications of this analysis for the education of health
professionals It suggests that health workers and those responsible for the
education of such workers, need to reassess leaming needs in the light of a
critique of the effects of an analysis based on 'cultural pluralism' and 'ethnic
sensitivity' The paper suggests ways m which the nursing cumculum must be
broadened to take into account the limitations of a culturalist approach and to
debate the interplay of racism and other structures of inequality and their
influence on health and on service delivery

TvrTBr»nTTr"rTnivr Within a culturalist framework, certain aspects of the

issue of race and health have been ignored or played down
A common theme m the nursmg press m recent years has The experience of living m a society which is structured
heen an apparent desire on the part of health professionals hy gender, socio-economic and racial inequalities and the
for information on 'cultural aspects of care' It is argued inter-relation hetween the living and working conditions
here that this reflects the dominant way in which the issue of mmonty groups and their health status have heen given
of 'race' and health is constructed withm nursing dis- lessprominencethantheissuesof'cultural'difference and
course With few exceptions, addressing the needs of a prohlems of communication Not only are very important
multiracial society in the United Kingdom has heen con- issues largely excluded from dehate, the dominant way of
structed as one relating almost exclusively to the need for conceptualizing issues of 'race' and health has many sen-
health professionals and health services to he more sensi- ous flaws which may serve to obstruct the attainment of
tive to cultural difference and provide 'care' which takes equitable health and health care This paper will discuss
into account the cultural hackgroimd of the patient/chent some of these conceptual prohlems and also draw out the
Indeed, such a reqmrement is now mcluded m the UKCC implications of this cntique for educational programmes
Code of Professional Conduct (Thomas & Dmes 1994)
Whilst an understandmg of cultural difference is undouht- ^^^ DOMINANCE OF MULTICULTURALISM
edly of crucial importance, it is argued here that the way
this IS conceptualized within a discourse of multicultural- Even a cursory examination of the nursing literature dem-
lsm and 'transcultural care', represents a limited view of onstrates that it is now axiomatic that nurses and other
what IS required if health workers cire to he mvolved m health professionals should be aware of the fact that the
improving access to health care and service provision, and Umted Kingdom (UK) is a multiracial society The nature
the health status of pabents/clients from minority ethnic of this awareness, however, is constructed withm a par-
groups ticular ideology which has definite effects on the ways m

564 © 1996 Blackwell Science Ltd


which health workers are encouraged to translate this
awareness mto practice
The issue of 'race' and health is constructed as centring
on the discourse of 'culture' and the distinct ethnicities of
different groups Health workers are seen to require a better
understanding of the existence of different cultural pat-
terns and their effects on health status and access to health
care An ideology of multiculturalism has been insti-
tutionalized withm welfare services and a model of 'ethnic
sensitivity' has become the dominant way of conceptualiz-
mg issues of 'race' and service dehvery (Stuhhs 1993) The
culturahst framework is premised on the argument that
the UK, lai^ely as a consequence of post-war immigration,
IS now a society with a vanety of groups which can be
distinguished hy their distinct cultures, which differ m
crucial ways from an alleged majority 'white' culture The
National Health Service (NHS), it is ai^ed, was estab-
lished to meet the needs of this white culture and thus,
until steps are taken to rectify this, the service provided
may not be in tune with the needs of people who are not
part of this dominant white culture For nursmg, the pro-
fessional requirement is for skills in transcultural care, as
classically defined hy Leuunger (1978, 1991)
Cortis (1993) has argued that 'Inevitahly, many of the
people now hvmg m Bntam have different social and
family pattems, different religious and cultural heliefs and
different healthcare expectations and needs compared to
the white population' The NHS it is argued, is hased on
the 'Western, Bntish culture' and healthcare workers dis-
play a lack of awareness of cultures other than their own
Professional perspectives need to be reconceptualized,
away from a traditional, umcultural perspective towards
a multicultural view Cortis argues that without a study of
cultures as an integral part erf all nursing education, a sen-
ous gulf in providmg professional services will occur 'To
understand, care and work effectively with people of
different cultures, values and beliefs necessitates a full and
conscious study of culture which can hest be attained
through formal educational programmes' (Cortis 1993)
As Stubbs (1993) has argued, the basic assumptions of
the multiculturahst, ethnic sensitivity model clearly imply
that 'with greater knowledge of different cultures, with
improved skills m cross-cultural communication, and
through the creation of particular ethnic specialisms, ser-
vices will be improved' Withm the 'ethmc sensiUvity'
model, the emphasis widun educational programmes
therefore, should he on teachmg health professionals about
'ethmc nunonty cultures' and encouragmg health edu-
cation programmes aimed at ethnic nunonty commumties
The task ofthe professional educator is thus pnmanly one
of increasing nurses' 'awareness' of cultural differences in
dress, diet, health hehefs, religious worship, ntes and nt-
uals, illness behaviour, child rearmg pattems, personal
hygiene, naming systems, etc , teachmg the importance of
a respect for cultural pattems different from one's own and
© 1996 BlackweU Science Ltd, Joumal of Advanced Nursmg, 23, 564-570
Multiculturalism in health cars
providing mformation on specific conditions which affact
mmonty groups disproportionately Essentially the prob-
lems facing nunonty ethnic groups are reduced to cultural
msensitivity on the part of health professionals This can
be remedied by appropnate professional 'education'
Health professionals can be educated to imderstand and
respect cultures different from their own and thereby to
deliver appropnate care
Whilst this ideology has been very vociferously chal-
lenged withm other welfare services, particularly social
work and education (Dommelli 1988, Troyna 1992), it
clearly dominates much contemporary wntmg and prac-
bce withm health care m the UK and within nursii^ m
particular Most multiculturalists stress the importance of
professional education m this arena Appropnate edu-
cation, coupled with mt^ration on the part of the more
'alien' minonty commimities becomes the obvious solu-
tion to raciahzed mequalities in both health and access to
health care Withm this discourse, the solutions to prob-
lems facing minonty groups are 'essentially technical and
professional rather than pohtical' (Stubbs 1993)
The NHS and health professionals are seen to be mtoler-
smt of nunonty groups, non-white groups in particular,
and the key issue is how to create tolerance in our now
culturally diverse society Within multicultural discourse
more generally, intolerance is conceptuahzed as hasically
a matter of attitudes and is charactenzed by prejudice
Prejudice is largely seen as a consequence of ignorance
Therefore, m the context of health care, the rationalist pos-
ition asserts that we need to inform health workers about
other cultures to dispel ignorance, dislodge prejudice
and thereby improve health care Although most commen-
tators would today acknowledge the existence of insti-
tutionalized racism, the key prmciples of the culturalist
framework still dommate professional debate A per-
ception of nurses as less than fully equipped to res-
pond adequately to the cultural needs of a multicultural
society IS of course, one that is substantiated by several
studies, Foster 1988, Murphy & Macleod Clarke 1993,
Papadopoulos et al 1994)
The findings of a survey earned out by the Traimng m
Health and Race Project (Higham 1988) indicated consider-
ahle gaps m the knowledge of health workers and ident-
ified serious problems with the attitudes of many health
workers towards the needs of black and ethnic minonty
communities This survey mcluded many different pro-
fessional groups, including admimstrators, medical offi-
cers, nurse tutors, hospital doctors, general practitioners
and commumty nurses, m four health distncts The
majonty of the respondents were white and tramed m the
UK The majonty of respondents did not feel that their
training had equipped them for working in a multiracial
society This was particularly pronounced for the nurse
respondents and the health visitors Many nurse respon-
dents gave the impression that they had received little or
565
L CuUey
no mformaUon in their training for working m a multira-
cial society At the same time, however, the survey found
that 'front lme' health workers did not, on the whole,
acknowledge their own role m creating bamers to the
needs of black and ethmc minority patients being met
Indeed, the authors of the survey described themselves as
'overwhelmed and disturbed by the many respondents
who, when answering questions, expressed certain racist
attitudes' (Higham 1988) Considerable misinformation
about minority groups was also reported
One interesting finding from this survey concemed the
perceived educational needs of the health workers them-
selves Very few nurses or health visitors saw a need for
training which addressed attitudes and prejudice, nor did
they voice a need for change in the nature or structure of
their work 'Service routines were accepted as the best and
only practice by the largely white educated health workers
who implemented them and no concessions were made to
different patients' and clients' needs — whoever they were'
(Higham 1988) The majonty of nurses and health visitors
saw their needs as relating to information about different
cultures and religions A similar finding emerged from a
study of health visitors in London, England (Foster 1988)
and research conducted by the author of this article with
a sample of nurses entering post-basic education m
Leicester
This demonstrates not only some of the inadequacies of
the education of health professionals, but the dominance
and pervasiveness of the 'ethnic sensitivity' model of race
and health In all these studies, the respondents were
locked into a culturahst perspective, with httle under-
standing of institutionalized racism and discrimination
mside the health service or m society m general The con-
ceptual and practical problems arising from this perspec-
tive, however, are considerable and it is vital for nursmg
and nurse education to address these issues
A CRITIQUE OF CULTURAL PLURALISM
AND HEALTH CARE
Pearson (1986) has located the concept of multicultural
health care withm the general social theory of cultural
pluralism Whilst acknowledgmg the dangers of overg-
eneralizing, she characterizes this school of thought m the
context of health as follows
The relationship between culturally 'distinct' minorities and
majonty white society is seen exclusively in terms of cultiire,
apparently autonomous although interacting with other social
processes It is diversity and difference in languages, religions and
cultural 'norms' or expectations which prevent effective com-
munication and create misunderstandings between the majority
and the 'distinct' mmonties 'Problems' are therefore the result of
mismatches between minority and majonty cultures, which
according to the pluralist view, meet on equal terms
566 © 1996 Blackwell Science Ltd, foumal of Advanced Narsmg, 23, 564-570
In this view, Pearson argues, society and its ideology are
seen as improblematic The only necessary ingredient for
improving health care is good sound information on cul-
ture It IS assumed that both sides of the equation are sub-
ject to the same political and economic forces and that
'tinkering with cultural differences until there aie "equal
components" on each side will get the balance — and
therefore communication and imderstandmg — nght and
solve the "problem"' (Pearson 1986) The focus on culture,
she argues, denies the significance of the political and
structural aspects of society and ultimately makes culture
Itself problematic 'It is then a small and almost impercep-
tible step to locate the cause of the mismatch and problems
m the mmonties themselves and their culture which is
different' (Pearson 1986)
The fact of cultural difference is not contested What the
culturalist framework tends to ignore, however, is the
power relations which exist between 'cultural groups'
Clearly differences can prevent effective commumcation
The difficulty anses with 'the value judgements placed on
that difference as deviant, alien and stubborn — m short,
a problem' (Pearson 1986) It is not merely that black
people are seen as different, but that they are seen as
mfenor and subordinate — as alien, deviant and pathologi-
cal 'Problems' are constructed as generated by mappropn-
ate customs and traditions and complex social phenomena
are reduced to grossly overgeneralized stereotypes — the
Asian girls 'caught between two cultures', the Muslim
women who are the 'victims of purdah', and so on In
concentrating on these kinds of issues, Pearson (1986)
argued, the culturahst view plays down or ignores the
importance of power, inequality and racism as embedded
m structures or institutions — factors which fundamen-
tally affect the health of minonty ethnic groups and their
access to good quality health care
Since Pearson's original interventions m this area, the
very defimte assimilationist tendencies of earlier contn-
butions to the literature have now been tempered by a
more relativistic stance Minority cultures are not always
viewed as pathogemc m more enlightened discussions and
the tendency to ascnbe an lnfenonty to minonty cultures
IS perhaps less exphcit m contemporary discourse What
has been termed the 'new racism' appeals more to notions
of cultural incompatibility rather than mfenonty/supenor-
ity (see Balibar 1991 and Mason 1994) The tendency to
problematise cultural difference, however, remains
common and cultural essentialism and reductionism is
still very prevalent in nursing discourse

CULTURAL ESSENTIALISM
In a cntique of multiculturalism as it operates within edu-
cation, Rattansi (1992) has argued that this approach is
based on a cultural essentialism Whilst Rattansi is pnnci-
pally concerned with educational discourse, the same
criticisms can be applied to the culturalist project m health
care Ethnicities are conceived as absolute categones
Hence, the multicultural perspective is apt to collapse mto
gross oversimplifications of 'other' cultures and generate
harmful stereotypes — the 'passive Asian woman', the
'tightly kmt Asian community', the 'arrogant and violent
Afro-Canbbean youth' Multiculturalism assumes a simple
additive model of Bntish cultural diversity There is an
implied homogeneous 'British white culture' to which a
variety of 'other cultures' have been added These too, tend
to be seen as homogeneous and fixed categories The
reality, however, is that there is a highly complex drawing
and redrawmg of boundanes within and between groups
'The shape and character of ethnic cultural formations is
too complex to be reduced to formulas around festivals,
religions, world-views and lifestyles These fail to grapple
with the shifting and kaleidoscopic nature of ethnic
differentiations and identities and their relabon to internal
divisions of class and gender' (Rattansi 1992) Yet so much
of the call for multicultural or transcultural care relies on
a reductionist discussion of stereotjrpes of the needs,
behaviours and expectations of ethnic categories as homo-
geneous wholes and fails to address the contmumg hier-
archies of power and legitimacy between different centres
of cultural authonty (Rattansi 1992)
Ethnicity is a very problematic concept and the theor-
etical and technical difficulties of operaUonahzing this
concept are considerable Nevertheless, m the nursing
literature and m epidemiological studies, ethnic categories
are used m a very uncritical way The common ethmc
categones such as those used in the national census and
those now part of the NHS minimum data set, are
descnbed by Ahmad & Sheldon (1992) as a confusmg mix-
ture of culturalist, geographical and nationalist noUons of
race dressed up as ethnicity 'The confusion is evident in
the mixture of categones m the census, based on colour
(black, white), notions of 'nationality' (Pakistam, Indian)
and geographical ongm (Africa, Canbbean)' (Ahmad &
Sheldon 1992)
These authors senously question the utility of 'ethnic'
data, based on these kinds of categones for research or
planning health services They a i ^ e that the uncntical
collection and use of ethmc data may mdirectly reinforce
the oppression of the very mmonties which the data were
meant to support Ahmad & Sheldon do not argue for the
rejection of ethmc data collection per se, but for careful
consideration of the need for and pohcy relevance of such
data 'The basic question to ask is "what information do I
need and why''"167' (1992) For example, if a hospital
© 1996 Blackwell Science Ltd, Joumal of Advanced Nursmg, 23, 564-570
Multicultumltsm in health care
wishes to improve the acceptability of hospital food, the
categones 'Indian' or 'Black-Canbbean' are not useful van-
ables since they tell us nothing about food/dietary habits
'An "Indian" may be a Punjabi, Bengah, or Gujararti,
Muslim, Hindu, Sikh or Chnstian, vegetarian, or meat
eater, and amongst meat eaters requmng (or wanting) halal
meat or non-halal meat, nee eater or chapati eater' (Ahmad
& Sheldon 1992) Nor would this category be of any use
in pleinning interpreting services, since it does not indicate
which language is spoken
Despite these and similar problems, such ethnic data
will be readily available from the mid-1990s and this is
likely to reinforce the uncntical and unthinking use of an
ethmcity paradigm, measuring a variety of outcomes
'Despite the grave doubts over their epistemological status,
when the data are presented for analysis and mterpret-
ation, the issue of what the variables actually mean will
get lost There is nothmg so powerful as a large and avail-
able data set for encouraging the suspension of disbehef'
(Sheldon & Parker 1992) The issues surrounding concepts
and terminology in this area are important and complex
and are only now beginning to be debated m the health
arena (Gilroy 1987, 1990, Sheldon & Parker 1992, Brah
1992, Madood 1994)
If the criticisms of wnters such as Sheldon, Parker and
Ahmad are valid, then nurses and other health care work-
ers need to approach cntically research which adopts the
'ethmcity paradigm' This research tends to be one-
dimensional, ignoring the fact that ethnic groups are strati-
fied by gender and by socio-economic factors both of
which may be very important determinants of health status
and health care The concentration on ethmcity as a single
vanable means that alternative explanations for differ-
ences between groups are not explored Sheldon & Parker
(1992) have shown that m epidemiological studies m par-
ticular, the importance of ethmcity as a vanable is often
overstated At the same time issues relating to poverty,
unemplojTnent, mfenor housing, racial harassment and
violence, etc , receive much less attention
Socio-economic factors
Sheldon & Parker (1992) demonstrate that several studies
(many from the USA) which do attempt to include socio-
economic factors as a vanable, have shown that differences
commonly ascnbed to ethmcity are often social in ongm
and reflect the key role of social conditions For example,
Manson & Ridker (1990), discussing differences m the inci-
dence of mortality from myocardial infarction m black
(African-Amencan) and white subjects in the USA, con-
cluded that higher rates among black people could be larg-
ely explained by socio-environmental factors influencing
susceptibility to infarction and poorer access to medical
care Other US studies have shown that because certain
mmonties are represented disproportionately m the lower
567
 L CuUey
socio-economic status cat^ones, many ethnic differences
m preventive health behaviours (e g take-up of screening)
are clearly due to economic and educational disadvantages
(Stem et al 1991)
The poor of all ages and races are less likely to undergo
preventive screening m the US and the evidence for the
UK seems to suggest (despite the existence of 'free' health
care) a similar pattern Some investigators have suggested
that uptake in breast screenmg among Asian women m the
UK IS substantially lower than white women (Tucker et al
1991), but studies which include social class as a vanable
have shown that Asian women do not necessarily have a
lower attendance for either breast screenmg or cervical
screening when compared with women from similar (dis-
advantaged) backgrounds (Lancaster & Elton 1992, Bradley
& Fnedman 1993)
As Ahmad et al (1989) have documented in a review of
the literature on the health of Bntish Asians, few studies
have attempted to mterpret their findings against the dis-
advantaged background of Asian communities Whilst it
seems unlikely that all differences can be explamed with
reference to social class background alone (Marmot 1989),
It IS important for studies to take mto accoimt the social
constraints on allegedly culturally determined 'lifestyles'
Nutntionai deficiencies m adults and children, for
example, are related to poverty and depnvation m inter-
action with culture or religion (Douglas 1989) It is crucial
to examine the interplay of material and cultural factors
m the context of the marked increase m the numbers of
families living at or below the poverty lme over the last
15 years (George & Howards 1991, Blackburn 1992) The
failure to address the socio-economic and political context
of a racist society means that health promotion campaigns
based on a pnmanly culturahst approach will have linuted
success (Rocherson 1988, Bhopal & White 1993)
There are relatively few Bntish studies which have
attempted to evaluate the direct effect of racism on health
status (Ahmad et al 1989) However, Amencan research
on race and gender discrimination as nsk factors for high
blood pressure suggests an important area of public health
research largely ignored m the UK (Armstead et al 1989,
Kreiger 1990)
Multifactoral aetiology
In pointing to the multifactorsil nature of patterns of ill-
health m nunority ethnic groups it is not suggested that
cultural difference is unimportant and it is not intended
to undermine the argument that services offered to min-
onty group clients are often culturally lnappropnate and
unacceptable Concentrating solely on ethnic group, how-
ever, may mask other important charactenstics Clearly the
aetiology of differential rates of illness and mortality is
likely to be multifactoral and result from a complex mter-
play of health beliefs and actions, socio-environmental
568 © 1996 Blackwell Science Ltd, foumal of Advanced Nursmg, 23, 564-570
conditions, and issues of access and utilization of health
care In general, however, the culturalist framework dis-
places the exploration of the very complex ways in which
race, socio-economic status, gender and age may intersect
Sheldon & Parker (1992) are largely concemed with the
extent to which 'class' as a vanable is displaced Gender
IS also an important vanable to consider, smce racist
effects can be gender specific However, the issue of gender
differentiation between and within ethnic groups is not
commonly addressed
There is a paucity of detailed information on the health
of women from non-white or other mmonty groups m the
UK, especially women of African and African-Canbbean
background Where gender differences are discussed they
£tre often conceived m grossly stereot5rpical ways (Knowles
& Mercer 1992) Research on the health status of black
elders and the general hesJth of ethmc minonty children
IS relatively sparse but existing studies demonstrate an
urgent need to question some of the generalizations and
assumptions on which current thinking is often based
(Blakemore & Boneham 1994)
CULTURALISM AND EDUCATION
Multiculturalists argue that the education of health pro-
fessionals must be directed towards overcoming prejudice
and intolerance by reducing ignorance and bringing cul-
ture mto care (Cortis 1993) Whilst it is not possible to
discuss at length the problems associated with conceiving
of the role of education in this way, it is important to note
three thmgs
Firstly, the idea of the 'prejudiced mdividual health
worker' tends to neglect the ways in which racism is
embedded m structures and institutions Secondly, and
perhaps more fundamentally, there is, as Rattansi (1992)
heis pointed out, mountmg evidence to suggest that the
notion of the 'prejudiced individual', who consistently
holds prejudiced views and expresses them m an uncon-
tradictory manner, is far too simplistic a picture — 'many
people who might be labelled racially prejudiced on the
basis of attitude surveys or expressive behaviour in par-
ticular contexts turn out to be more ambivalent and contra-
dictory m their discourses and practices' (Rattansi 1992)
Racist practices are significantly affected by social context
Thirdly, despite the populanty of an educational prescnp-
tion of a cumcular dose of knowledge about other cultures,
and an introduction to cultural empathy, there is very httle
consideration about how 'cultural understandmg' might
actually occur, what form it might take, what its hmits are
and indeed if such teaching actually has any significant
impact in reducing prejudice (Troyna & Camngton 1990,
Rattansi 1992)
'Cultured awareness' education is important smce some
aspects of culture are likely to have a beanng on health
(Kanm 1992), but it is vital that this is conducted m a way

which promotes the interests of minonty groups It is
important to recognize the potential limitations of such
educational mterventions and it is also vital for nurses and
other health professionals to understand the context of
health mequahty and the necessity for structural/insti-
tutional as well as mdividual change
CONCLUSION
It has not been the intention of this paper to argue that all
notions of culture and cultural difference should be
Ignored by nurses, or nurse educators It is clear that many
nxirses do find their lack of knowledge about how to inter-
act with patients frustratmg and distressmg (Murphy &
Macleod Clark 1993) Good quality care must, by defi-
mtion, be a product of negotiation with patients which
must include aspects of culture However, this paper has
sought to signal some of the ways m which a simplistic
notion of culture and health care can in fact damage the
interests of those it is mtended to help The issue of culture
and its relevance to race and health is extremely complex
and requires much more thorough analysis than is evident
m much of the nursing literature at the present time
It IS important for nurse educators to avoid a situation
where a cumcular dose of 'other cultures', is seen as an
adequate way to address these complexities This is not to
argue against the need for cultural sensitivity Rather, it is
suggested that the cntique of the way m which health care
IS currently delivered cannot be confined to a consider-
ation of cultural awareness and that there are dangers m
uncritically accepting a culturahst perspective on race and
health inequalities
The inclusion of social scientific concepts and analyses
into the nurse education curriculum provides an oppor-
tumty to discuss the more complex ways m which social
relations and social structures impact upon mmonties
Nurses and other health care workers should have an
understanding of concepts of culture and cultural differ-
ences and an understanding of the way m which services
must be made more accessible to minonty groups if health
care is to be non-racist Excellent examples of cumculum
matenals of value are available (Health Education
Authonty 1994) At the same time, however, nurses need
to be aware of the dangers of attributmg cause directly and
solely to 'ethmcity', to be aware of the poor quality of
much research on ethmc mmonties, and encouraged to
discuss the conceptual confusion and mconsistency which
exists m the operationahzation of concepts of ethmcity
and race They need to be wary of the reification of ethnic
categones which so often leads to the perpetuation of
racial stereotypes of the needs, behaviours and expec-
tations of 'Pakistams', 'Indians', etc , as homogeneous
wholes (Ahmad 1992)
Nurse educators must assist practitioners to identify
ways m which they can hsten to and work with minority
© 1996 Blackwell Science Ltd, foumal of Advanced Nursing, 23, 564-570
Multiculturahsm m health care
commumties, which may require health mitiatives which
are relatively unfamiliar to many nurses (Jeyasingham
1992) Most importantly perhaps, nurses and nurse edu-
cators need to contexualize the health of minonty ethnic
groups, exploring the dynamics of discriminatory prac-
tices which structure many aspects of everyday life Health
professionals would be greatly aided m this task bv
research which focused on the complex ways in which
'race', culture, gender, age and socio-economic dimensions
may interact m lnfiuencing both patterns of health status
and utilization of health services
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