Clinicians also need to affirm the relevance to health care of all determinants of health and affirm the value of health policy in community education, public safety, transportation, and so on. She was not taken to the doctor because back pains are a common complaint and not considered serious. Finally, when the pain became too great, she was taken to the hospital, where she was diagnosed with metastatic breast cancer. Because she had never married, she had never had a breast exam or Pap smear. To do so would have been an acknowledgment of her sexuality, the idea of which was not only immodest but repugnant to her as a single woman.
Cultural norms can affect care after entry into the system as well.
In some cultures, taking medication when one does not feel or appear sick is considered pointless. In a family with tuberculosis, the parents may not think it appropriate for a child to take prophylactic medication when the child does not seem to be ill, resulting in further illness and disability. Language barriers and legal issues e.g., fear of having one's illegal alien status discovered compound the problems involved in cross-cultural health care.