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Chinese societal structure throughout history and diverse geographical locations is based on the centrality of the family. This puts importance on specific values - namely, respect for parents, adherence to family and societal norms, an avoidance of shameful behaviour, emotional self control, striving for achievement for the good of the family and commitment to hard work. Individuals are usually dependent on the family as a whole and will often defer personal desires for the benefit of the entire group.
China has a long history of labour migration. However, Chinese have regularly been discriminated against throughout history and particularly so in the various locations outside China in which they have settled.
There are 58 ethnic groups in China and seven major language groups. Of these, Mandarin is the official language of China with Cantonese being the second most widely spoken language.
Many Chinese have religious adherence to Buddhism and a philosophical leaning toward Confucianism and Taoism. Thus Buddhism, Confucianism, and Taoism can all affect the health/illness experience and health decision-making of Chinese people.
Pre-marital pregnancy is shameful and while abortion will not usually be discussed openly it will often be sought out as a solution.
Chinese people traditionally list their family name first, and their given name last. Many Chinese in the west, however, adopt the western naming convention and reverse the traditional order to comply with western norms. Similarly, Chinese people in the west will often adopt a new western name for themselves as they feel their own name is unpronounceable.
Many Chinese parents believe that the only viable means of survival in the larger mainstream society is through educational attainment and excellence. Therefore, many Chinese parents instill in their children from very early on the idea that parental acceptance is contingent on the child's educational performance. Low performance by the child can elicit not only parental disapproval and criticism, but also disappointment and sometimes shame among the relatives. On the other hand, high educational performance by other Asians is often given prominence and recognition in the community. This may partially explain why many Chinese children do well in school.
With overtly critical parents, however, Chinese youth--especially those whose educational performance falls short of parental expectations--not only can get involved with antisocial behavior but also may want to move away from their cultural identity. Chinese youths who find themselves in a gap between what is expected of them and what they have actually achieved can experience a high degree of emotional stress and a fear of failure, which they may try to relieve through use of alcohol and other drugs.
In Ireland, where large numbers of Chinese in Ireland have come as students and migrant workers, the strong family structure that is prevalent both back home in China and in other countries where the Chinese have traditionally settled is often absent. This lack of structure may give Chinese youth the opportunity to experiment with alcohol and drugs and present them with other challenges to their cultural norms.
Chinese often work long hours, and may live in communities where housing is overcrowded and of poor quality. This is more likely among recent migrants and student populations. Unemployment and underemployment are serious problems, and many people are trapped in dead-end jobs, or are limited by poor English ability. Students who overstay their visas often live in extremely poor circumstances and work for low pay under very harsh conditions. The prospects for Chinese business migrants are considerably better.
Many older Chinese immigrants rely on their children and relatives who speak better English to help them communicate with health service providers and others. This has meant that the children have taken over many of the parents' traditional duties like reading the mail, relaying school news and information, answering the phone, assisting in shopping, making appointments, and interpreting. However, even though the children can speak English fluently they often have a difficult time conveying information completely back to the parents because of their lack of sophistication with the Chinese language or because the subject is inappropriate for a child to interpret. For example, open discussion about sexuality is considered taboo. The issue of language knowledge has created a lot of tension and frustration in Chinese households and has led to power struggles between the parents and the child or family member.
Non-verbal communication can also lead to cultural misunderstandings. It is important for health service providers to be aware that some Chinese may smile when they are discussing something sad or uncomfortable. Be aware that a lack of facial expression or a low level of verbal communication may not indicate a lack of emotion or opinion. Neither does it indicate agreement with the diagnosis or recommended treatment. Try to ascertain your clients' true feelings or opinions before accepting their apparent acquiescence at face value.
Also a lot of Chinese consider winking to be rude, as is using the forefinger to point - so many Chinese people will point with their entire hand. Some Chinese may be uncomfortable with physical contact. Although many Chinese will use a handshake (usually limp) to greet a Westerner, any other contact may be considered inappropriate. This is especially important to remember when dealing with older people or those in positions of authority. Equally, when greeting an older Chinese person, it is best to avoid prolonged eye contact as a sign of respect and deference.
Chinese believe in the concept of Yin (female, cold) and Yang (male, hot). These dynamic and complimentary forces cannot exist without the other and they must be kept in harmony. In terms of health and illness, a lack of harmony or balance leads to trouble and illness. Disharmony may be connected to foods, to cosmic forces, to moral retribution from ancestors for wrong doing, to Feng Shui (disharmony in the external environment) or to malevolent spirits.
Medicines and foods are often considered as either "hot" or "cold." Western medicines are more often hot than cold; while traditional Chinese medicines may be either. Food properties are sometimes subject to debate with respect to which are hot and which are cold. Hot foods are generally high in protein, fat, and calories. Examples of hot foods include chicken, pork, organ meats, eggs, brown sugar, ginger, and alcohol beverages. Cold foods include cold drinks, fruits, most vegetables, and soy products (Chan et al, 2000; Cheung, 1997; Liu & Moore, 2000).
A second important (and related) concept is that of traditional Chinese medicine (TCM). TCM is a complex and well-established therapeutic tradition that uses acupuncture, acupressure, and herbs, often in combination with dietary therapy, Western medicine, and supernatural healing. TCM is based philosophically on Taoism and operationally on a channel (meridian) system, in which various body channels carry vital or life energy called qi or ch'i, blood, and other body fluids (Nestler, 2002). There are numerous channels, with internal organs connected to these channels, and acupuncture points determined by the channels. Imbalance or disruption in the channels leads to illness; and the treatment goal of TCM is to restore balance. The two primary means of TCM treatment are acupuncture and the use of compounds (Nestler, 2002). While some of the latter are herbal in nature, heavy metals are also used, and may, in some cases lead to toxicity - most commonly lead and mercury poisoning (Ernst & Coon, 2001).
A third concept important in understanding Chinese approaches to health and illness is a belief in western allopathic medicine. In China, TCM and western medicine may be practiced side by side, with patients utilizing one or the other - or both - according to illness or patient inclination (Nestler, 2002). Indeed, in much of Southeast Asia, a typical pharmacy has one (physical) side of the business devoted to Western medicine and the other side devoted to compounding and dispensing TCMs.
Chinese people therefore view health from a variety of different perspectives, sometimes simultaneously. These perspectives thus involve an interaction of spiritual factors, internal balance inequities, and biological factors. Chinese people may, therefore, combine diagnostic and treatment elements from different perspectives with the goal of getting maximum health benefits. However, Chinese patients may be reluctant to say that they have been using TCM approaches to treat their illness, fearing the disapproval of Western health care providers.
Folk beliefs are very strong in Chinese communities. Many older and some younger people from Southern China will not make important decisions until they check with an astrologer or an almanac to find a lucky day and hour. Equally numbers are very important for Chinese people with 3 and 8 being especially lucky and 4 being extremely unlucky. These beliefs may affect decisions made by Chinese on a daily basis, including decisions that are health related.
Because respect for elders is the cornerstone of Chinese values a young person may say `Yes' to a health service provider out of politeness rather than to correct their seemingly strange questions. It is therefore preferable for health service providers not to ask questions with an expected `yes'/'no' response. In some cases a health care provider's assertiveness may be interpreted as aggressiveness or hostility.
When a child is ill, the first recourse may be to a folk or family remedy. A common remedy is rubbing the location of the illness (chest, back, forehead, neck, stomach) with a spoon or a coin and some kind of unguent, such as Tiger Balm or "heating" oil, until bruising results. This kind of cure is called cao gio ("rubbing off the bad wind"). It is reputed to work by getting rid of the "wind" (gio or phong), which has caused the cold, sore throat, stomach or back pain, headache or flu. Since bruising is an effect of this, it can be mistaken for child abuse. Marks caused by cao gio are in straight lines, usually on the forehead, neck, back, arms or chest. The "Mongolian blue spot", a bluish pigmentation in the lumbo-sacral region common among Indo-Chinese babies, may also be misdiagnosed as child abuse. It is commonly present at birth and persists until the age of 18 months or 2 years.
The Chinese will expect to be given a prescription after seeing a doctor. The idea of undergoing a checkup when not ill may seem strange to many Chinese.
Prenatal care is highly valued among Chinese women. Traditional Chinese Medicine (TCM) remedies may be used during pregnancy for nausea, fatigue, oedema, and other conditions.
Chinese can be particularly superstitious especially in relation to the growing foetus and will act according to deeply held beliefs - none of which are harmful. They include avoiding scissors on the bed, listening to classical music, avoiding contact with dishonest people, performing charitable deeds such as feeding the poor, etc.
It is not uncommon, whenever possible, for some immigrant Asian women to return to their parents' home in their country of origin to deliver their baby, especially their first born child (Assanand, Dias, Richardson, & Waxler-Morrison, 1990; Dinh, Ganesan, Waxler-Morrison, 1990). Therefore, a health service provider should be alert to the chance that the patient may have her baby delivered by another health provider. While this poses some problems with delivering continuity of care, the comforts of home and of her social network may be best for her at delivery. Therefore, at every visit, the health service provider should try to effectively communicate to the patient any health related information regarding her prenatal care so that she can accurately convey her medical history to her new health service provider. This can improve the continuity of care.
Women want to eat to get the energy before going through the labour. Western culture, however, discourages eating for fear a full stomach will induce nausea especially during active labour phase. This has been a common complaint for Chinese women. Many do not understand why they are not allowed to eat and think that the hospital policy too strict. Chinese women prefer warm water at this time. Many Chinese women will endure thirst for fear that cold water will upset their internal hot/cold balance and subsequently increase their risk of developing arthritis in old age.
Many women prefer to give birth in a sitting or squatting position. Traditionally husbands are not allowed at the birth. The woman must not cry out or scream during labour. Expectant fathers usually remain outside of labour room till the baby is born. Female family members such as mother, mother-in-law, aunts or sisters provide much needed support during this time. This tradition is slowly changing as extended family members are not readily available and nuclear families are becoming more prevalent. Younger and more western acculturated couples will want to attend childbirth classes. Expectant fathers are now more willing to stay in the labour room with their wives to provide support and serve as labour coaches.
In contrast to most other "hot-cold" medical systems, the Chinese believe that pregnancy is a "cold" condition, and therefore, an expectant mother should consume hot foods to keep herself in balance for good health (Taylor, Ko, & Pan, 1999). However, during childbirth, heat is thought to be lost. Thus, during the postpartum period, mothers are protected from cold by physical confinement, restrictions on bathing, by eating "hot" foods and being forbidden "cold" foods (Queensland Health Information Network, 1998).
Postpartum, many women practice Zuo yuezi (sitting in for the first month) for 30 days. Zuo yuezi includes staying in the house; avoiding cold foods, drinks, wind, water, and any other cold substance or contact; diet based on balance (of yin-yang); abstinence for physical work; and abstinence from excessive pleasurable activities. Bathing (and especially washing the hair) is limited because of the belief that it will further render the woman's body "cold" and therefore prevent her from a timely and proper recovery. But sponging with warm water is acceptable and this may include having a warm bath with ginger wine or other "hot" alcoholic beverage (Cheung, 1997).
Inpatient care can prove difficult for Chinese mothers as much of the food offered is `cold'. It is not unusual for hospital staff to find the food served left untouched. Inpatient women prefer to have their food brought in from home.
Women who have a Caesarian section avoid not only "cold" food but also beef or seafood. Beef and seafood are believed to prolong the healing process. For women who have an episiotomy, nurses will often advise women to use ice packs to reduce swelling and inflammation. Young Chinese women who have been exposed to Western culture will heed the advice and adopt the practice. For the majority of Chinese women, however, the practice is considered contradictory to their Chinese health belief. Traditionally, women avoid using anything cold for fear that cold compress will increase their risk of incontinence, headache, backache and/or arthritis in old age.
Infant mortality rates amongst the Chinese immigrant community is extremely low.
Traditionally, babies were breastfed on demand and for as long as the baby wanted. However, women in the elite often used wet-nurses, and bottle-feeding has been common throughout the twentieth century. In Ireland, Chinese women may have difficulty with breastfeeding because of lack of family support and language difficulties, and may give up earlier than recommended. The tradition has been that nutritious Chinese food was given when the baby could take solids. Now, a combination of Chinese and Western food may be used.
There is a low rate of SIDS among the Chinese. Even so, Chinese mothers may not be aware that overheating, over-wrapping and prone sleeping are risk factors for SIDS, and may not be aware of this cause of death. Some of the risk reduction messages regarding SIDS may contradict common practices, such as making sure the baby is kept warm and away from cold and wind.
Women are expected to follow certain traditional practices advocated by older female relatives. However, practical constraints mean that many Chinese women opt for a middle-of-the-road approach to child-rearing, combining practices from both Western and Chinese culture. Moral training, filial piety, physical punishment, maintaining peace and harmony in the family, and role modeling are important factors in rearing children. There is no age of independence, and elderly parents can still have considerable influence over their adult children.
Food is very important to the Chinese. Traditional Chinese meals include a high intake of fruit and vegetables, and rice and noodles are a staple. Many Irish born Chinese, and younger Chinese migrants, have modified their diets to include a lot of "fast foods" and European foods. The major proteins are pork, fish and soy-bean. Tea is the common beverage.
Diets emphasise balance, and are based on the traditional ideas of yin and yang "hot" and "cold" foods. Many Chinese are particularly careful about the foods they eat when they are sick, and avoid "raw" foods such as salads.
Mental health services are not readily availed of. Denial and delay while traditional treatments are tried often results in late presentation to mental health services, to the point where involuntary admission is necessitated. Chinese have a strong tendency to somaticise their social and psychological problems; for instance, people may complain of physical health problems such as a headache instead of directly addressing mental health problems. A tendency to repress feelings may also increase the mental health burden. Vocabulary to express psychosocial issues may be limited. Mental illness is not clearly differentiated from physical illness and often shares the same explanatory models (but also can be ascribed to heredity or poor guidance and discipline from the family head).
Chinese family structure is traditionally hierarchal and patriarchal, with the oldest adult male the primary decision-maker in health and other matters. Bearing a son is preferred in Chinese culture. Where the one-child policy prevails abortion of a female foetus is common. Older children have precedence over younger children and male children over female (Chang, 1999). In family matters there also is significant influence from elders - including women. Families tend to be very private, and few are willing to discuss family issues or conflict with non-family members.
The family is often the first and sometimes only source of health care. Health decisions may be made by the family based as much or more on what is best for the family as on what is best for the patient (Tong & Spicer, 1994). It may be appropriate for health service providers, to first address the oldest male in a group or family before greeting the other members.
The basic social and economic unit is the family, with parents living with their son and daughter-in-law. Although this is a common practice in some Chinese speaking countries, it is less common abroad. People of Chinese descent still have a strong cultural identity and celebrate traditional calendar festivals, especially Chinese New Year. Marriage is still largely within the Chinese community, so community members remain relatively ethnically distinct. Within marriage a woman becomes part of her husband's family.
The status of women is in transition. In traditional households women are subordinate and expected to be passive and obedient to men. Even within this traditional household, however, older women may have considerable power with respect to the running and functioning of a household and the conduct of its members. Younger women now tend to have much greater economic and personal freedom in their daily lives, and many of them will have worked prior to migration. Among Hong Kong and Taiwanese economic migrants, many of the women will be well educated and have had professional careers prior to their arrival.
Use of hospitals is generally low, and use of doctors is very low especially by women. A doctor of the same sex is preferred by most Chinese, this is particularly true for women. Chinese women may not be familiar with breast self-examination or screening, Pap smears or pelvic examination, or they may have different ideas about the appropriate age for the commencement of screening. Mammographic breast screening services can be effectively utilised if culturally appropriate outreach and education programs are implemented.
End-of-life care for Chinese patients and families centers around family and communications (Tang, 2001). Symptom management may be complicated by patient and family reluctance to complain and respect for others - especially those in positions of authority. Barriers to pain and other symptom management by family caregivers may also be related to other issues, including a lack of knowledge about pain and pain management, fatalism, fear of addiction, desire to be a good patient, and fear of distracting the physician from treating the disease (Lin, 2000; Lin, Wang, Lai, Lin, Tsai, & Chen, 2000; Tang, 2001).
Communications related to end of life issues are often complicated by reluctance to discuss prognosis and in some instances, diagnosis (Kagawa-Singer & Blackhall, 2001; Tong & Spicer, 1994). To a greater extent than in other cultures, it remains a norm among Chinese patients and families for (1) the family to withhold information or even lie to the patient and (2) for the patient to pretend that she or he does not know what is really happening (Kleinman, 1988; Lapine, Wang-Cheng, Goldstein, Nooney, Lamb, & Derse, 2001). The family is expected to help prepare the body for burial. Traditionally, there is always an older relative or person from the temple to instruct the oldest son or daughter on what to do regarding washing and dressing the body.
Talking to the deceased is part of the grieving process and may not be hallucinatory.
This is a very good American site that describes traditional health seeking practices as well as giving useful facts (i.e. outlining prevalent diseases amongst the target community). It specifically looks at refugee populations and includes excellent links to other sections that give more detail on issues such as women and health, refugee experiences and health, infectious diseases etc. Recommended. ۞ ۞ ۞ ۞ ۞
This is an excellent Australian 2003 government sponsored site that gives a cultural profile in a very concise and approachable way. It gives practical advice on how to approach patients who have settled in Australia. It also covers health seeking practices and traditional health beliefs. Recommended. ۞ ۞ ۞ ۞ ۞
This is a very approachable American site (2006) that gives cultural profiles on 12 different ethnic groups in relation to health. It also presents cultural barriers in seeking effective health care. There are also invaluable links from this site that are related to special interest topics such as cultural considerations for those dealing with death and dying. There are also excellent links for those developing cultural competency, and cultural competency training. This is an invaluable resource site for health care providers. ۞ ۞۞ ۞۞
This very readable Canadian site gives a short account of the county's geography, history, sports, arts, work, family and health. It is socially orientated rather than health focussed, as it is designed to initiate communication and integration between habitual Canadian residents and newly arrived immigrants. It will therefore not explain aspects of culture to a depth that some health care providers would need. However, it does offer avenues and ideas that could be used to open up a productive communication process between health care providers and clients that would lead to relevant information being exchanged. ۞ ۞ ۞
This reliable UNICEF site gives background information and health related statistics that could prove especially useful for health care providers who need to determine the health and social history of their clients. Some cultural information can also be deduced relatively easily from the statistical detail. There is an emphasis on children's and women's health due to UNICEF's focus on children. ۞ ۞
This Scottish NHS site (2005) is refreshing in its hands-on approach, but it is focussed particularly at the situation in Scotland. It includes some leaflets in translated form on topics such as carers, bowel cancer, etc. Its value is predominantly in its short outline of religious attitudes in relation to health provision. However these are very limited and do not include anything on naming rights or death rites etc. ۞ ۞
This 2005 cultural profile is an American `library of congress' government file. As such it is concise and factual and it offers sections on health, education, and human rights. However, it is lacking in any data on traditional health seeking practices and cultural beliefs that would increase opportunities to develop cross cultural understanding. ۞ ۞
This BBC site will give you a brief overview of the current political situation in each country. This may help you to know what political situation your client may have left behind and what their relations are currently living with. It also gives a brief overview of statistics - population, religions, languages, life expectancy and exports. ۞
This site gives you basic facts and a map of each country. It gives basic demographic details that include religion, ethnicities, health risks, mortality rates etc. which may be useful, especially if comparative material is required. A short synopsis of the political situation in the country is included. ۞
http://www.health.qld.gov.au/multicultural/cultdiv/chinese.asp
http://www3.baylor.edu/~Charles_Kemp/chinese.htm
http://www.health.qld.gov.au/multicultural/cultdiv/chinese.asp
http://www.health.qld.gov.au/multicultural/cultdiv/chinese.asp
http://www.health.qld.gov.au/multicultural/cultdiv/chinese.asp
http://www.health.qld.gov.au/multicultural/cultdiv/chinese.asp
http://www.health.qld.gov.au/multicultural/cultdiv/chinese.asp
http://www.health.qld.gov.au/multicultural/cultdiv/chinese.asp
http://www3.baylor.edu/~Charles_Kemp/chinese.htm
http://www3.baylor.edu/~Charles_Kemp/chinese.htm
http://www3.baylor.edu/~Charles_Kemp/chinese.htm
http://www3.baylor.edu/~Charles_Kemp/chinese.htm
http://www3.baylor.edu/~Charles_Kemp/chinese.htm
http://www3.baylor.edu/~Charles_Kemp/chinese.htm
http://www3.baylor.edu/~Charles_Kemp/chinese.htm
SPIRASI does not necessarily agree with the facts and opinions presented in this guide or any linked websites.
This Cultural Profiles web-site was designed to be fully compliant with modern standards for web publication (as specified by the W3C). The pages will be accessible and readable on any display using any web browser, old or new.