**5. Cultural targeting vs. cultural tailoring: striking a balance**

Questions have been raised as to whether it is logical to expect a consideration of what is common to a group while still laying emphasis on individual peculiarities. In fact, some authorities have referred to the idea as a paradox [4]. In practice, it is probably unnecessary to expect that one will have to choose between cultural tailoring and cultural targeting when designing and delivering a health service. Instead, it is more important to carefully decide to what extent both approaches need to be combined in order to get the most benefit each offers. There will be situations when the health needs within a target population are so similar that identifying subgroups becomes difficult. In such situations, health tailoring loses its necessity, while targeting becomes the more important approach.

A basic understanding that must be borne in mind is that while a group may have certain characteristics in common (beliefs, values, attitudes, etc.), individuals within the group have imbibed these ideas to different extents, a few not at all. A typical example is the widespread belief in God in African societies.

Therefore, strategies for achieving cultural appropriateness should match the nature of the problem being addressed. The World Health Organization's Sustainable Development Goal Number 10 which seeks to eliminate health disparities can only be achieved by programs which have been adapted based on cultural considerations. This way they will succeed where other programs have failed.

Previous research abounds to prove that minority groups within populations are at a much higher risk of suffering from adverse health conditions such as cardiovascular disease, cancer, etc. While the epidemiology of these conditions indicates that several factors are at play, sociocultural factors have been found to exert a very strong influence on the occurrence of these diseases. Many indices of poor health situations such as socioeconomic strata, level of education, job-related hazards, and environmental pollution have been found to be more prevalent among minority groups [21, 22]. These poorly represented groups have also been found in greater numbers among the uninsured than among people with insurance. They have higher rates of emergency department use and avoidable hospitalizations, later-stage diagnosis of cancer, and the inability to obtain prescription medications [23, 24].

"Unequal treatment: confronting racial/ethnic disparities in health care," a report by the Institute of Medicine in 2002 identified more than 175 studies which demonstrated the link between minority groups and several disease conditions. These associations were observed even after the effect of possible confounders such as age, disease stage, socioeconomic status, and treatment facility was eliminated [25].

Furthermore, this groundbreaking research exposed factors which had been initially overlooked as playing important roles in the observed disparities between minority groups and the rest of the population. These included health beliefs, values, personal preferences, ability to identify clinical features of disease, ability to communicate effectively with health workers, level of adherence to preventive measures, and health outcome expectations among others. It is believed that all these factors influence health outcomes via their effect on the way the patient interacts with the health system, whether it be the way services are designed or the people who deliver them [26–28].
