The theme for this issue stresses the importance of cultural competence in health delivery and the impact of culture on ill-health and well-being. Everyone has a culture, and everyone operates, lives and breathes their culture either in the family, workplace or is woven into social and community interactions. Pacific peoples in our many Islands and those resident outside the Islands have some cultural similarities and stark differences in culture. I am sure every reader will have examples of how someone’s culture affects their health seeking behaviour.  

It is not uncommon for assumptions of cultural effect when a Pacific person presents late to conventional health care due to trials of traditional remedies. But it is more complex than that. Health carers and systems need to address barriers to access such as distance to the nearest health centre, cost of treatment and trust in the carers. Lack of trust is usually due to other lacks – lack of information that patients can understand, lack of empathy and lack of respect for patients’ autonomy, privacy and views.