Power and Healthcare Outcomes (Weeks 9-12)
This module looks at how the cultural structures, institutions and behaviours of health care arise, and
considers the notion of power and the effects it can have on health systems and outcomes. While
these issues can be applied and discussed in any social context, it will become clear that they can
have a greater effect on people whose culture, social class, education, ethnicity or other factors differ
from the dominant group. You will be asked questions about your own cultural assumptions and how
they can affect your work, and also to consider how people can have greater power over their own
health care. Patient self-care, community control of services and your role in developing these will
then provide the basis of your efforts to improve your cultural competence.
On completion of this module you will be able to:
1. Explore the concepts of structural and relational power and associated healthcare
2. Analyse the impact of structural and relational power on health outcomes and the
implications for culturally competent health care.
Topic 1: Structural and relational power
So far this unit has considered the impact of diverse cultural values and beliefs on work practice, the
challenges met in cross-cultural work environments, and the way communication and health literacy
can affect health outcomes. There has also been consideration of how individual cultural
backgrounds fit into the health workplaces. It’s now time to think about power and privilege in the
context of culture; and so to kick this off, there are some important questions to consider:
1. What do you think it means to have control over your own health?
2. Have you ever been to the doctor and felt put down , not listened to or not taken seriously?
3. When someone asks you for advice about his or her health, how do you go about answering
As discussed in Module 1, power over others can be manifested in several ways: established
authority, direct force, coercion and manipulation, persuasion and inducement (think parenting); these
ways of interacting are not limited to everyday relationships, but also can pervade professional
encounters. When people communicate in a health setting, the symbols and language used directly
influence each person. Outcomes are dependent on these communications, and so are trust and
As previously mentioned in an earlier module, symbols like uniforms (white coats?), stethoscopes,
even the system of appointments (show up and wait) can result in confusion, fear, intimidation and
disorientation, and that’s all before the professional encounter even begins. When these factors
combine with cultural differences the outcomes and processes of health care can be haphazard and
less than ideal.
In Australia the system of government and the way healthcare is funded (in theory) affords significant
advantages. Most Australians enjoy almost universal health services, and if a person is financially