Introduction
As the population in the U.S. becomes increasingly more diverse, it’s common to face the challenges of cultural disparities in health care as each culture has its own set of beliefs and values that affect how patients perceive health, illness and treatment. An article by Mandal et al. (2015) revealed that “racial and ethnic minorities tend to receive poorer quality care compared with non-minorities” due to health care disparities. (Mandal et al., 2015). Though there is evidence that culture has an effect on health outcomes, the differences in socioeconomic and environmental factors also significantly presents barriers in the healthcare system, which results in varying degrees of quality care. (Mandal et al., 2015). In order to provide proper care and improve health outcomes, it’s important that health care providers have a solid understanding of varying cultural practices, many of which influenced by ancient traditions, values, and beliefs. One in particular is the ancient Sumerian culture whose achievements and practices continue to impact our lives today. Despite its age in history, there appear to be parallels in its class system, religious beliefs, and gender roles in which modern day societies function.

A Brief History
Between 10,000 and 8300 BCE, early humans known as hunter-gatherers discovered a land in the middle east (modern-day Iraq) where they learned how to farm and domesticate animals. This led to the development of agriculture and formation of settlements, known as the Agricultural/Neolithic Revolution. Due to the consistent food source that farming provided, farm settlements developed into villages, and the villages evolved into cities. Arts, customs, religion, trades, a form of government, and activities that make up a civilized society began to take shape. These social changes and technological advancements paved the way for the development of what’s known to be the world’s first recorded civilization — Sumer. (Algaze, 2008).

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Sumer consisted of a collection of many city-states, a political unit made up of a central city and all of its surrounding farmland, all of which are independent nations ran by leaders and ruled by a local god or goddess. Around 2900 BCE, during its time of political expansion and centralization, the Sumerians constructed walls around their cities, built an army, and adopted the institution of kingship. This led to the collection of taxes and a system of social division by rank or class called a social hierarchy. (Rohrlich, 1980). They engaged in socialism by which produce and cattle were distributed amongst the people of its city and surplus was stored in what the Sumerians called central storehouse. (Skousen, 2014). Nevertheless, the Sumerians believed that the gods and goddesses were in control of the forces of nature and their overall quality of life. Therefore, they worked as a collective whole prioritizing the greater good of its city-states above individual desires by directing much of their political, social, and religious activities to keep their gods and goddesses satisfied. (Rohrlich, 1980).

In summary, the Sumerian civilization arose and flourished in the land between the rivers Tigris and Euphrates in southern Mesopotamia around 5000 BCE. They later lost control of their city-states around 2334 BCE, falling under the Akkadian rule. Though under a new government, much of the Sumerian culture was preserved and integrated into the Akkadian culture and was generally adopted by many civilizations to follow. The last known existence of the Sumerian civilization was around 1772 BCE, when the great empire of Babylonia and Assyria conquered Mesopotamia. (Algaze, 2008).

Values & Religion
Religion is the fundamental conception that underlay all social and political virtues in Sumer. Their philosophy and values were displayed within the framework of religion. Their life is centered upon the power of gods, goddesses, and deities. They were a polytheistic society who believed in the existence of demons, spirits, and ghosts of the underworld. In the center of every Sumerian city, high stepped temples known as ziggurats, were built dedicated to gods for religious offerings and sacred rituals. (Rohrlich, 1980).

Since agriculture was the backbone of the Sumerian civilization, the people of Sumer organized many religious observances in an effort to keep their land fertile. (Charvát, 2013). It was a moral duty of every woman in the land to participate in Sacred Prostitution, a sexual ritual performed at temples by virtue of religious worship. (Leick, 2003, p. 150). The woman was required to wait in the temple until a man presents her with money in exchange for an erotic performance that eventually leads to sexual intercourse held in public. This act was considered to be a prayer to the goddess of love and fertility to ensure good harvests. (Charvát, 2013). In addition, the Sumerians also engaged in sexual role playing in a religious context called Sacred Marriage. This ritual required the high priestess of the city to have sexual intercourse with the high priest or the king, both acting in the capacity of the god and goddess of fertility for the purpose of agricultural growth. (Leick, 2003, p. 132-133).

Significance of The Sumerian Religious Belief in The U.S. Healthcare System
Similar to the ancient Sumerians, Hinduism, Mahayana Buddhism, and Shinto are some of the few polytheistic religions that are still being widely practiced today. (Smart, 2018). Although not as prevalent as it was in the ancient world, the Native Americans, Central and Southern American cultures of today are still known to practice sacred rituals and believe in the existence of spirits and natural forces. While individuals who originated and adopted beliefs of indigenous tribes may prefer to receive care from homeopaths and faith healers over contemporary medicine. Essentially, the role of religion and spirituality are significant concepts health care providers must acknowledge and respect regardless of its eccentricities as these differences directly impact patient health outcomes.

Role of Women in Sumer
The thriving Sumerian civilization saw the economic benefits to procreation, which consequently led to the overlapping of economic and social power. Since women were needed for childbirth to produce more farmworkers and laborers, they were eventually given roles that were less physical and labor intensive. As a result, they lost personal sovereignty and society refused to view them as autonomous individuals unless they’re of noble descent such as a priestess or a member of a royal family. The Sumerian culture perceived men to hold the supreme authority. This gave them the right to make decisions for the ordinary woman. (Rohrlich, 1980). For instance, marriage was treated as a contractual agreement between the father of the bride and the groom. Unlike many modern societies, marriage was not practiced for the purpose of happiness and companionship nor does it fall under any religious sanction, rather as a tool for procreation and “communal continuity for the future.” (Mark, 2014).

The systemic gender bias in Sumer were demonstrated in cases such as adultery, where women were shamed and possibly executed for the crime, while men rarely faced any charges. Infertility was only considered to occur in women and not in men. Men can easily divorce their wives and return her to her family, whereas women were shamed and had to go through extreme measures to obtain divorce. Ultimately, during the latter part of the Sumerian civilization, women’s universal role was to bear children and be a housewife. (Mark, 2014).

Gender Roles in The U.S. Healthcare System
Although reports states that the role of women in America continuously shift to becoming increasingly nontraditional and less definitive, there are still existing cultures and lingering attitudes that view women as inferior to men. It’s common for individual sexism to occur in the healthcare field due to the patient and/or family member’s lack of knowledge about the ranking system in a facility, since many tend to view nurses or any caregiver besides a doctor as someone who holds absolutely no authority, thereby creating trust barriers that greatly affect the quality of care. Nonetheless, health care providers must recognize that patients and relatives are in their most vulnerable and stressful state; and having the ability to manage situations and interactions regardless of the stereotypical and prejudicial attitudes being displayed would only contribute to the greater good.

Conclusion
It is evident the Sumerian culture have striking similarities to current norms and ideologies from religion, social and political practices of those who live in the modern world. In addition to the Sumerians, there are many other ancient cultures and indigenous tribes whose values and beliefs that still exists today, which healthcare providers must take into consideration in order to promote compliance and as well as team work in a healthcare setting.

Furthermore, differing cultural practices presents a wide range of beliefs about health administration that could likely put a healthcare provider under ethical dilemmas on occasions when a patient with limited autonomy refuses treatment that does not align with his/her cultural or religious beliefs. However, a caregiver who can effectively communicate relevant information and take appropriate measures tailored to find common ground with the patient may be the best strategy for accomplishing health goals.

On the other hand, there are also other factors that need to be addressed when it comes to meeting patient demands, essentially in the event a patient’s behavior becomes a form of harassment or abuse. Despite the rewards that comes with being a caregiver, how much of their rights and moral values would really have to be compromised for tolerance?

Overall, as every experience we encounter is interpreted based upon our social position, it’s easy not to understand views different from our own because each individual’s values are relative to their cultural environment from which they originate. And along with a relativistic approach, cultural awareness, and mutual respect of each other’s values and beliefs can help reduce disparities in healthcare.

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