This document discusses health culture and practices among Indian immigrants. It outlines that India has a large and diverse population facing major health challenges like infectious and cardiovascular diseases. When Indians immigrate to New Zealand, they initially display healthier profiles than locals due to selection biases, though health declines over time with reduced physical activity and diet changes. Barriers to healthcare include language issues and unfamiliarity with the New Zealand system. Developing cultural competence among providers, understanding traditional Indian practices, employing visual communication methods, and involving family can help improve healthcare for Indian immigrants.

1. Culture and Health: Understanding Indian
Health Culture
Arindam Basu MB BS MPH PhD
School of Health Sciences,
University of Canterbury,
Christchurch, New Zealand,
arin.basu@gmail.com

2. Outline of the Presentation
• South Asian/Indian Health Culture
• Health Profiles of South Asians/Indian Immigrants in NZ
• Communication and Understanding

3. South Asia
India and Neighbouring
Countries (India, Pakistan,
Bangladesh, Nepal, Sri Lanka,
Bhutan, Maldives)
Total Population ~ 1.7 Billion
About 9 Trillion US Dollar
Economy

4. Major
Languages and
Religions
Hindi, Bengali, Urdu, Punjabi
World’s second largest English
Speaking Country
Diversity of religions - Hinduism,
Islam, Christianity, Buddhism,
Sikhism,

5. Distribution of Death and Disability Adjusted Life Years
Infectious, Cardiovascular, Neonatal, Respiratory, and
Behavioural Diseases are Top 5 Serious Risks in India
0
22500
45000
67500
90000
Infectious and
parasitic
Neonatal Mental and
Behavioural
Diseases
Malignant
Neoplasms
Digestive
Diseases
Neurological
Conditions
Genitourinary
Diseases
Diabetes Mellitus Maternal
Conditions
Nonmalignant
Neoplasms
Distribution of DALYs based on Disease Conditions

6. Distribution of DALYs from Noncommunicable,
Communicable, and Injuries in India, 2012
In India, currently, death and disability from noncommunicable diseases have
exceeded the mortality and morbidity from communicable diseases; the burden of
injuries is still low.
0
75000
150000
225000
300000
Noncommunicable Diseases Communicable Diseases Injuries

7. Organisation of Health Care Services in India. Note that patients
may have several pathways of entry and interacting with the system

8. An Indian Drugstore: patients or “patient party” submit prescriptions that are
then filled and refilled and given back to the patients or their caregivers

9. A Prescription by an Indian Doctor within India on his
writing pad: this sheet is for the patients to keep

10. Other Systems: Homeopathy
In addition to “Western Medicine”, Indians also rely on Homeopathy, Ayurvedic,
“Unani”, and other systems of “health services”, here a homeopathy clinic face is
shown.

11. An Ayurvedic procedure named ‘Shirodhara’ is being conducted
on a patient - I am not sure what that means or why that is done.

12. A Unani procedure named “Turkish Bath” is being done
on a patient

13. Moving from India to New Zealand

14. Healthy Migrant Effect
• Better quality of health of the
first generation migrants
compared with natives in the
country
• Possible causes - selection
bias, medical tests during
immigration and visa
procedures
• The effect dissipates in about
10-15 years of adoption in the
new country in some cases

15. Patterns of Indian Immigration (Auckland Region, 2004-
2011)

16. Causes of Potentially Avoidable Hospitalisations among
Indian Immigrants in Auckland Region, 2008-2010

17. Pattern of Medication Dispensing to Indian Immigrants in
the Auckland Region, 2010-2011

18. Profiles of Health Behaviours of First Generation
Immigrant Indians in NZ (2012 Auckland DHB Report)
• Lower Prevalence of Fruits and
Vegetable Intakes
• Low Prevalence of Physical
Activities
• Higher Prevalence of Adult
Obesity
Image Courtesy: http://www.cadiresearch.org/wp-content/uploads/2011/10/052-Fig.jpg

19. Patterns of Health Services Utilisation among Indians
• High Coronary Procedure Rates
• High Needs for Dispensing of Pharmacotherapy for
CVD
• High Care Plus or Chronic Disease Management
Enrolment
• High Proportion of Diagnosed Diabetes who receive
annual reviews
• But also healthy migrant effects

20. Barriers: Access to Health
Services
• Language related barriers
• Lack of Knowledge about NZ
Health System
• Cultural Differences in
Assessment and Treatment
• Lack of Cultural Competency
among Caregivers

21. What can be done?
• Develop Cultural Competency
• Understand the health practices
among Indian immigrants
• Being Visual or Using Visual
Methods May Work
• Skills of working with support
persons or guardians
• Nonverbal messages of
reassurance and good eye
contact

22. Statement on Cultural Competence (Medical Council of New Zea

23. A Useful Resource

24. Continuum of Cultural Competency
[source: http://www.asianhealthservices.co.nz/documents/Publications/bestpracticeCALD.pdf]

25. Source:
http://www.asianhealthservices.co.nz/documents/Publications/bestpracticeCALD.pdf
Competency Instance of Competency Actions
Cultural
Destructiveness
Genocide/Ethnocide, Forced Assimilation
Cultural
Incapacity
Lowered Expectations, Unchallenged
Stereotypical Beliefs
Cultural Pre-
Competence
Delegate diversity work to others, false sense of
accomplishment, inconsistent policies
Cultural
Competence
Advocacy, on-going education, equal access is
NOT equal treatment
Cultural
Proficiency
Interdependence, Fight social discrimination,
advocate for social diversity

26. Understanding Health Practices among Indian
Immigrants
Example: Patients can use a mix of
traditional Indian medical practices
and modern medicine.
‘A big problem is the management of burns.
Application of toothpaste was common
when I worked in Birmingham – and it is
also fairly common here to find toothpaste
applied to burns and scars. It’s not a good
idea, you have to take it all back off again.
They need to know how to cool it with water
and use lint free dressing, cling film
perhaps...Turmeric is a popular one as well,
on cuts and grazes’ (nurse 7).
[SP Taylor, C Nicolle, and M Maguire. Cross-cultural communication barriers in
healthcare. Nurs- ing Standard, 27(31):35–43, 2013.]

27. The Power of Visual
“Medication was also prepared in Dosette
boxes for patients – as required by the (UK)
Equality act 2010 – to make it easier for them
to remember to take their medication and to
confirm, visually, whether or not they had
taken the dose for the time of the day:
‘Visually, it looks much easier than popping
something out of a blister or opening a bottle
and taking something out and reading a
label’ (Pharmacist 3).”
Source:
SP Taylor, C Nicolle, and M Maguire. Cross-cultural communication barriers in healthcare. Nursing Standard, 27(31):35–43, 2013.

28. In Summary …
India and South Asia is a complex region with several different
Migration from the Indian subcontinent to NZ is increasing
Cultural Competence to interact with patients from the Indian s
Individuals from the Indian Subcontinent have characteristic he
Understanding language barriers, use of visual cues, and othe