Topic:
Culture and
Health
Course:
Public health
Program:
BS English Linguistics
Submitted to:
Miss Abida Tehreem
Submitted by:
Fatima Noor
CULTURE AND
HEALTH
What is health:
According to World Health
Organization (WHO) health is “a state of complete physical,
mental and social. well-being and not merely the absence of
disease or infirmity”
In 1986, the WHO made further clarifications:
“A resource for everyday life, not the objective of living.
Health is a positive concept emphasizing social and personal
resources, as well as physical capacities.”
What is culture:
The anthropologist Robert Redfield once elegantly defined
culture as “conventional understandings, manifest in act
and artefact”.
“Culture can also be defined as all the ways of life
including arts, customary beliefs, social forms, and
material traits of a racial, religious, or social group that
are passed down from generation to generation.”
Culture has been called "the way of life for an entire society."
As such, it includes codes of manners, dress, language, religion,
ideas, values, rituals and art.
Factors of Culture that affect health:
Culture was defined earlier as the symbols, language,
beliefs, values, and artifacts that are part of any society.
The influence of culture on health is vast.
It affects perceptions of health, illness and death, beliefs
about causes of disease, approaches to health promotion,
how illness and pain are experienced and expressed, where
patients seek help, and the types of treatment patients
prefer.
To improve health care delivery and outcomes,
providers should know the patient’s cultural views
on:
1. Role of family (roles of members, hierarchy, key
decision-maker)
2. Role of community
3. Religion (impact on diet, beliefs about illness, treatment)
4. Views on health and wellness
5. Views on death and dying
6. Eastern/western/alternative/traditional medicine.
7. Beliefs about causes and treatments of illness, disease
(physical and mental)
8. Gender roles and relationships
9. Sexuality, fertility, childbirth
10.Food beliefs and diet
Culture: The hidden and the
obvious: Culture has been described as an
iceberg, with its most powerful features hidden under the ocean
surface. Explicit cultural elements are often obvious but possibly
less influential than the unrecognized or subconscious elements
providing ballast below.
In 1976, Edward T Hall developed the "Iceberg Model of
Culture" – where he explains that organizational culture
is like an iceberg found in polar seas. In an iceberg,
nearly 10% of the iceberg is visible above the water
surface, while most of the iceberg is hidden below the
waterline.
Layers of the Iceberg Model of culture
Let’s now deep dive into these various layers of culture - both
surface and deep aspects - and understand how it helps achieve
health goals.
Surface culture
Some aspects of culture are easily perceived from the outside,
often called the “surface culture.”
These are the perceptions formed by people based on what they
see, hear, or feel about health culture and believes.
Aspects like workplace ambiance, dress code, systems,
policies, processes, etc. are visible on the surface. Such visible
aspects of a society's culture usually provide clues about what
the population believes is crucial and how the society is running.
Deeper culture
what forms the foundation of a strong culture is often
submerged deeper in the values and beliefs of the organization,
called the underlying “deeper culture.”
Elements like shared values and beliefs, attitudes towards
authority, competition, underlying assumptions, etc., form
the deeper culture.
Every society is built on a set of distinctive rules and
characteristics that define it. Though not visible to the outside
world, these characteristics can affect health at a very large
extent. These are the aspects of a deeper culture built on beliefs
and values, bias and coercion, authority and competition, health
and wellbeing, and various other factors that cannot be easily
perceived or evaluated as external factors.
The cultural continuum:
Culture is commonly divided into two broad categories at
opposite ends of a continuum: collectivistic or individualistic.
Most cultures fall somewhere between the two poles, with
characteristics of both.
Effect on human health:
Collectivistic and individualistic cultures can give rise to
different views on human health, as well as on treatment,
diagnoses and causes of illness. Depending on where a patient
‘fits’ along their cultural continuum, including extended family
in discussions about disease origin, diagnosis and treatment may
be helpful. Consent for certain diagnostic and therapeutic
interventions may be needed from extended family members.
• Relation between Culture
and Health:
Health is a cultural
concept because culture frames and shapes how we perceive
the world and our experiences. Along with other
determinants of health and disease, culture helps to define:
How patients and health care providers view health
and illness.
What patients and health care providers believe about
the causes of disease. For example, some patients are
unaware of germ theory and may instead believe
in fatalism, the 'evil eye', or a demon.
What types of health promotion activities are
practiced, recommended or insured?
How illness and pain are experienced and expressed.
In some cultures, stoicism is the norm, even in the face
of severe pain. In other cultures, people openly express
moderately painful feelings.
Patient interaction with health care providers.
The degree of understanding and compliance with
treatment options recommended by health care providers
who do not share their cultural beliefs. Some patients
believe that a physician who doesn’t give an injection may
not be taking their symptoms seriously.
Which diseases or conditions are stigmatized and why? In
many cultures, depression is a common stigma and seeing a
psychiatrist means a person is “crazy”.
IMPACT OF CULTURE ON
HEALTH:
Culture also affects health in other ways, such as:
Acceptance of a diagnosis, including who should be
told, when and how.
Acceptance of preventive or health promotion
measures (e.g., vaccines, prenatal care, birth control,
screening tests, etc.).
Perception of the amount of control individuals have in
preventing and controlling disease.
Perceptions of death, dying and who should be
involved.
Use of direct versus indirect communication. Making
or avoiding eye contact can be viewed as rude or polite,
depending on culture.
Willingness to discuss symptoms with a health care
provider, or with an interpreter being present.
Influence of family dynamics, including traditional
gender roles, filial responsibilities, and patterns of
support among family members.
Perceptions of youth and aging.
How accessible the health system is, as well as how
well it functions.
Functional aspect of society:
A society's culture and social structure also affect health
and health care. The functionalist approach emphasizes that
good health and effective health care are essential for a
society's ability to function, and it views the physician-
patient relationship as hierarchical.
Theoretical
Major assumptions
perspective
Good health and effective medical care are essential
for the smooth functioning of society. Patients must
perform the “sick role” in order to be perceived as
Functionalism legitimately ill and to be exempt from their normal
obligations. The physician-patient relationship is
hierarchical: The physician provides instructions,
and the patient needs to follow them.
Theoretical
Major assumptions
perspective
Social inequality characterizes the quality of health
and the quality of health care. People from
disadvantaged social backgrounds are more likely to
Conflict theory become ill and to receive inadequate health care.
Partly to increase their incomes, physicians have
tried to control the practice of medicine and to define
social problems as medical problems.
Health and illness are social constructions: Physical
and mental conditions have little or no objective
Symbolic reality but instead are considered healthy or ill
interactionism conditions only if they are defined as such by a
society. Physicians “manage the situation” to display
their authority and medical knowledge.
Key domains that need attention:
It is believed that these points are imperative to the
advancement of health worldwide and are the greatest
challenges for health. Together, they constitute an agenda
for reversal of the systematic neglect of culture in health,
the single biggest barrier to advancement of the highest
attainable standard of health worldwide.
1. Medicine should accommodate the cultural construction
of wellbeing.
2. Culture should be better defined.
3. Culture should not be neglected in health and health-care
provision.
4. Culture should become central to care practices.
5. Clinical cultures should be reshaped.
6. People who are not healthy should be recapacitated
within the culture of biomedicine.
7. Agency should be better understood with respect to
culture.
8. Training cultures should be better understood.
9. Competence should be reconsidered across all cultures
and systems of care.
10. Exported and imported practices and services should be
aligned with local cultural meaning.
11. Building of trust in health care should be prioritized as
a cultural value.
12. New models of wellbeing and care should be identified
and nourished across cultures.
Executive summary:
Perceptions of physical and psychological wellbeing differ
substantially across and within societies. Although cultures
often merge and change, human diversity assures that
different lifestyles and beliefs will persist so that systems of
value remain autonomous and distinct. In this sense, culture
can be understood as not only habits and beliefs about
perceived wellbeing, but also political, economic, legal,
ethical, and moral practices and values.
Although culture can be considered as a set of subjective
values that oppose scientific objectivity, we challenge this
view in this Commission by claiming that all people
have systems of value that are unexamined.
Ideas about health are, therefore, cultural. They vary widely
across societies and should not merely be defined by
measures of clinical care and disease. Health can be defined in
worldwide terms or quite local and familiar ones. Yet, in
clinical settings, a tendency to standardize human nature can
be, paradoxically, driven by both an absence of awareness of
the diversity with which wellbeing is contextualized and a
commitment to express both patient needs and caregiver
obligations in universally understandable terms.
We recommend a broad view of culture that embraces not
only social systems of belief as cultural, but also
presumptions of objectivity that permeate views of local and
global health, health care, and health-care delivery.
If the role of cultural systems of value in health is ignored,
biological wellness can be focused on as the sole measure of
wellbeing, and the potential for culture to become a key
component in health maintenance and promotion can be
eroded. This erosion is especially true where resources are
scarce or absent. Under restricted and pressured conditions,
behavioral variables that affect biological outcomes are
dismissed as merely sociocultural, rather than medical.
Especially when money is short, or when institutions claim to
have discharged fully their public health obligations, blame
for ill health can be projected onto those who are already
disadvantaged.
As a result, many thinkers in health-care provision across
disciplines attribute poor health-care outcomes to factors that
are beyond the control of care providers—namely, on
peculiar, individual, or largely inaccessible cultural systems of
value. Others, having witnessed the ramifications of such
thinking, argue that all health-care provision should, rather,
be made more culturally sensitive. Yet others declare merely
that multiculturalism has failed and the concept should be
abandoned, citing its divisive potential.
1
However, the effect of cultural systems of values on health
outcomes is huge, within and across cultures, in multicultural
settings, and even within the cultures of institutions established
to advance health. In all cultural settings—local, national,
worldwide, and even biomedical—the need to understand the
relation between culture and health, especially the cultural
factors that affect health-improving behavior’s, is now crucial.
