Understanding the cultural determinants of health: A scoping review

Purpose

Current approaches to Indigenous health education are predominantly deficit-based, with limited inclusion of the cultural needs of Indigenous communities. This approach has widespread impacts on education by influencing healthcare students’ societal views and clinical healthcare delivery to Indigenous peoples, potentially contributing to Indigenous health inequities. Social determinants of health (SDH) have been used in literature to describe these inequities, yet this concept contributes to the deficit discourse narrative. Implementing the cultural determinants of health alongside the SDH shifts the focus to a strengths-based approach and provides a holistic and comprehensive lens to Indigenous health and wellbeing. However, cultural determinants of health is a new concept and there is still an unclear understanding of the term within literature. This scoping review aimed to develop an understanding of how the cultural determinants of health are represented in the literature and their role within healthcare curricula.

Methods

This scoping review was guided by Indigenous ways of knowing, being and doing, and systematically followed the five scoping review phases outlined by Westphaln et al. (2021).

Main findings

Forty-two publications were included in the scoping review and seven emerging themes were used to represent the findings: Shared definition of the cultural determinants of health; Mutual understanding of factors; Cultural determinants of health promote a strengths-based approach to holistically enhance health; Ambiguity associated with broader determinants; Research should be by, with and for Indigenous peoples; Limited literature supporting cultural determinants of health in curricula; and Future research needs to consider the cultural determinants of health.

Principal conclusions

The themes provided a thorough representation of the cultural determinants of health within literature, although some ambiguities are still prominent. Future research conducted by, with and for Indigenous peoples, particularly in addressing the cultural determinants of health within education, may contribute to a clearer representation of the cultural determinants of health in the literature.