Health care curricula in multicultural societies

Globalisation has led to increasing diversity worldwide. The rapid rise in the number of international migrants over the last 15 years has been unprecedented and currently accounts for more than 10% of the European and 16% of the Norwegian populations. Most countries in Europe attempt to provide equitable health care services to their citizens regardless of their ethnicity, religion, country of origin and other characteristics.1 Still, a large body of literature describes challenges in providing healthcare for multicultural populations for doctors and other health care professionals.2,3 Furthermore, European health professionals are not at ease providing adequate health care in multicultural societies and in many countries they are still to receive systematic training to tackle this new and complex situation.4 Intercultural challenges are often attributed to the immigrant patients alone. However, the responsibility of health professionals in initiating, maintaining or inadequately tackling these challenges cannot be ignored. Although international recommendations to improve cross-cultural care exist,5 health professionals still perform differently in diagnostic procedures undertaken,6,7 number of consultations needed for referral to secondary care,8,9 specificity of diagnoses provided or treatments given10,11 for immigrant patients compared to non-immigrants. Furthermore, immigrants from low and middle-income countries in Europe seem to be less satisfied with health care services than the majority population.12,13 The so-called refuge-crises in 2015 actualised the necessity of dealing with intercultural consultations as a part of everyday work for healthcare professionals. Not surprisingly the authors have frequently been contacted to lecture about migration and health for different audiences. This demand responds to self-perception of lack of knowledge, skills or competencies necessary to give equitable health care to a growing number of immigrant patients.14,15 This paper aims to present and argue the need for a profound change in the healthcare curricula by describing our observations and experiences within medical education.