Culture and Health

1
Culture and Health
2
The Definition of Health Across Cultures

• A state of complete physical, mental, and social
  well-being, and not merely the absence of disease
  or infirmity-World Health Organization
• U.S. view of health is guided by the biomedical
  model, where disease is attributed to a result
  from a specific cause in the body (pathogen).
• Consequently, treatment in the U.S. is focused on
  making a treatment within a person.

3
Definition of Health in Other Cultures

• China and Greece-view health not only as the
  absence of negative states but also the presence
  of positive ones.
• Chinas notion of health is based on religion and
  philosophy, with special emphasis on Ying and
  Yang (positive and negative energies) balance is
  health.
• An imbalance can be caused by foods, social
  relationships, the weather, or supernatural
  forces.
• Maintaining balance involves mind, body, spirit
  and the natural environment.

4
Definition of Health in Other Cultures (cont.)

• Within the U.S.-Native Americans
• Base health on religion, a holistic view, and
  living in harmony with oneself and ones
  environment.
• Incorporating Other Cultures in the U.S.
• Mainstream culture is beginning to accept and
  embrace ideas of health from immigrants.
• Using alternative practices such as acupuncture,
  homeopathy, herbal medicines, and spiritual
  healing.

5
National Institutes of Health (NIH)

• In recent years, the NIH, the worlds leading
  biomedical research operations, added a new
  Center to its long list of Centers and
  Institutes to support research activity dealing
  with complementary and alternative medicine. The
  National Center for Complementary and Alternative
  Medicine is now in full operation!

6
Conceptions of the Body

• Metaphors for Body or Physical Health vary
  across cultures
• Popular Metaphor-Balance (various systems in the
  body are in harmony) and Imbalance within the
  body.
• Suggests that the body is comprised of four
  humors blood, phlegm, yellow bile, and black
  bile-when any of these are not in balance,
  disease occurs.

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Conceptions of the Body Health (cont.)

• Latin American Culture
• A balance between hot and cold-not temperature,
  but the power of different substances in the
  body. Below fever warm is good cold is bad.
• Social and Cultural Factors play a Major role
• In America and Europe, individuals in higher
  social classes have lower body weights and
  individuals in lower classes have higher body
  weights.

8
Psychosocial Determinants of Health and Disease

• The Study of Type A personalities showed an
  increased risk for developing cardiovascular
  disease opened the door to health psychology.
• Studies have documented the link between
  psychosocial factors and health/disease.
• Unemployment and mortality, goal frustration and
  negative life events and gastrointestinal
  disorders, stress and the cold, etc.
• SES is consistently associated with health
  outcomes with people of higher SES having better
  health (in mortality rates and almost every
  disease) then people of lower SES.

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Note of Caution

• Although past research has demonstrated that
  psychosocial factors play an important role in
  the etiology (study of disease causes) and
  treatment of disease, more research is needed in
  identifying the specific mechanisms that mediate
  those relationships.

10
Cultural Dimensions and Disease

• Cardiovascular Disease is important to study
  cross-culturally because of its high incidence in
  the U.S.
• Marmot and Syme Study (1976)
• Grouped Japanese Americans into groups according
  to traditionalism found that the most
  traditional Japanese has the lowest incidence of
  heart disease, and the least traditional had a
  3-5 times higher incidence of heart-related
  health problems.

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Individualism-Collectivism

• Triandis et al. (1988)-extended the study to
  include the Individualism-Collectivism Dimension
• Found that the most individualist groups
  (European Americans) had the highest rate of
  heart disease.
• Triandis suggested that social support buffers
  against stress, reducing the risk of heart
  disease, noting that collectivists cultures have
  stronger and deeper social ties.

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Individualism-Collectivism (cont.)

• Research by Matsumoto and Fletcher (1996)
  investigated the possibility that collectivists
  cultures may be at higher risk for other
  diseases.
• They obtained mortality rates for infections and
  parasitic diseases, tumors, diseases of
  circulatory systems, heart diseases,
  cerebrovasular diseases and respiratory system
  diseases from the World Health Statistics
  Quarterly for 28 countries.

13
Other Cultural Dimensions

• Looked at incidence rates for each disease at
  ages 1, 15, 45, and 65.
• They developed a cultural index previously
  obtained by Hofstede and developed
  classifications Individualism vs. collectivism,
  power distance, uncertainty avoidance, and
  masculinity.

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Hofstedes Dimensions

• Power Distance (PD)
• --the degree to which different cultures
  encourage and maintain power and status
  differences among the members of an organization.
  
• Uncertainty Avoidance (UA)
• --the degree to which different societies
  develop ways to deal with the stress and anxiety
  of uncertainty.

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Hofstedes Dimensions (cont.)

• Individualism-Collectivism (IC)
• --the degree to which a culture encourages,
  fosters, and facilitates the needs, wishes,
  desires, and values of the individual over those
  of a group.
• Members of individualistic cultures see
  themselves as separate and autonomous
  individuals, whereas members of collectivistic
  cultures see themselves as fundamentally
  connected to others.

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Hofstedes Dimensions (cont.)

• Masculinity (MA)
• --the degree to which cultures foster
  traditional gender differences among their
  members, e.g. drawing organizational parallels
  between gender relations that are present in the
  larger society.

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Findings from Matsumoto et al.
Cultural Dimension Rates of Disease
Higher Power Distance Higher rates of infections and parasitic diseases. Lower rates of malignant neoplasm, circulatory disease, and heart disease.
Higher Individualism Higher rates of malignant neoplasm and heart disease. Lower rates of infections and parasitic diseases, cerebrovascular disease.
Higher Uncertainty Avoidance Higher rates of heart disease. Lower rates of cerebrovasular disease and respiratory disease.
Higher Masculinity Higher cerebrovascular disease.
18
Culture Discrepancies

• Although the studies indicate that culture
  influences physical health, it is not the only
  relevant variable.
• Matsumoto et al (1999) studied the impact the
  discrepancy of ones personal cultural values and
  those of society have on health.
• Undergraduates reported their personal cultural
  values, their perceptions of societys values.
• They also reported coping strategies, anxiety,
  and depression.

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Culture Discrepancies (cont.)

• Their physical health and psychological
  well-being were also assessed.
• The results indicated that greater cultural
  discrepancies were associated with greater needs
  for coping.
• Coping strategies were correlated with depression
  and anxiety, which in turn were correlated with
  scores on the physical health symptoms.
• These findings suggest that cultural
  discrepancies mediate health outcomes.

20
Cultural Influences on Attitudes and Beliefs

• Matsumoto et al. (1995) studied Japanese and
  Japanese American women on attitudes and values
  related to osteoporosis and treatment, and found
  many cultural differences.
• For instance, more American women reported people
  other than friends and family would care for
  them. Also, Japanese women were more likely to
  attribute the cause to fate, chance, or luck.

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Attitudes and Beliefs

• Domino and Lin (1993) asked students in Taiwan
  and US to rate cancer related metaphors.
• Taiwanese students had significantly higher
  scores than American on terminal pessimism and
  future optimism.
• Many other studies have documented differences in
  beliefs.
• Edman and Kameoka reported differences between
  Filipinos and Americans in illness schemas
• Poole and Ting found differences between
  Euro-Canadian and Indo-Canadians attitude towards
  maternity.

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• Lifestyles and Behaviors
• Diet
• Exercise/activity levels
• Health/related behaviors
• Smoking
• Tobacco use
• Alcohol use
• Etc.
• Emotion/stress/coping

Culture
Health/Disease
Attitudes and Beliefs Definitions of
health Conceptions of the body Attributions about
disease causality Locus of control Social
networks and support
Genetics Individual history Ancestry
Health Care Systems Quality of
care Systems/organizations Insurance Etc.
Environment Temperature Climate Sanitation Etc.
Model of Cultural Influences on Health and
Disease