Culture is afundamental conceptwithin the disciplineof anthropology.
Culture...is thatcomplex whole whichincludesknowledge, belief, arts, morals, law, custom,and any othercapabilities and habitsacquired by man as amember of society.(1871, E.B.Tylor)
In the past,anthropologistattempted to make asimple distinctionbetween culture andsociety.
Society was said toconsist of the patternsof relationships amongpeople within aspecified territory, andculture was viewed asthe byproducts of thoserelationships.
Now, many anthropologisthave adopted the hybridterm sociocultural sytem-a combination of theterms society (or social)and culture—refer to whatused to be called“society” or “culture”.
“To future generations of health care professionals and medical social scientists—that they may better understandthe roles of culture in health and well-being, and in the care of patients and prevention of disease.”
APPLIED MEDICAL ANTHROPOLOGYAND HEALTH CARE Part 1
LEARNING OBJECTIVES■ Introduce how culture affects health■ Illustrate how anthropological perspectivescan facilitate effective health care■ Introduce the nature of cultural competencein health care■ Illustrate medical anthropology’s majorapplications in addressing cultures’impacts on health■ Illustrate the broad range of concerns peoplehave with respect to their health
Medical anthropology is the primary discipline addressing the interfaces of medicine,culture, and health behavior and incorporating cultural perspectives into clinical settings and public health programs.
Healthprofessionals needknowledge ofculture andcross-culturalrelationship skillsbecause healthservices are moreeffective whenresponsiveto cultural needs.
Cross-cultural skillsalso are importantin relationshipsamong providersof different cultureswhen, for example,African Americanand Filipino nursesinteract with eachother or with Anglo,Hispanic, or Hinduphysicians.
Culture, involves the learnedpatterns of shared group behavior.These learned shared behaviors arethe framework for understanding andexplaining all human behavior.
According to Durch, Bailey, and Stoto (1997),“Improving health is a sharedresponsibility of health care providers,public health officials, and a variety ofother actors in the community.” This requirespeople with an ability to engage communitiesin a culturally appropriate manner andunderstanding of their cultural systems,health beliefs, and practices.
5. Perform health education andpreventive medicine6. Perform epidemiological studiesand community assessments7. Provide health policy analysisand advocacy8. Supply international health andinternational medical relief (aid)9. Perform health systemsintegration (traditional andmodern)
What do health professionals— providers, researchers, social service personnel, educators, and other “helpingprofessionals”—need to know about the effects of culture on health?
They all need systematic ways of studyingcultural effects on health and developingcultural competence.Cultural responsiveness is necessary forproviders, researchers, and educators ifthey are to be effective in relating toothers across the barriers of culturaldifferences.
The cultural perspectives of medicalanthropology are essential for providingcompetent care, effective communityhealth programs, and patient education.For biomedicine to be effective, providersneed to know whether a patient views thephysician as believable and trustworthy,the diagnosis as acceptable, the symptomsas problematic, and the treatment asaccessible and effective.
for example, through producingenvironmental contamination,work activities, contact withanimals, sexual practices, diet,clothing, hygienicpractices, and others.
Ethnomedical studies (seeBannerman, Burton, and Wen-Chieh, 1983) reveal thathealth problems andtreatments are conceptualizedwithin cultural frameworks.Culturedirectly affects themanifestations of conditions,their assessment and socialimplications,and processes of treatment.
Ethnomedical analyses show theimportance of understandinghealing from the cultural perspective of thegroup, their social dynamics, the socialroles of healers, and the conceptual andcosmological systems(Rubel and Hass, 1990).
Many contemporary U.S. health issues illustrateunderlying cultural dynamics:■ Death due to lifestyle (e.g., poor diet andalcohol and cigarette use)■ Political decisions that leave major segmentsof the population without healthservices■ The spread of infectious diseases throughimmigration and lifestyles■ Pharmaceutical companies and physicians’groups lobbying Congress for legislationto deny U.S. citizens access to foreignmedicines
Conceptions of what constitutes healthvary widely.This book takes Durch and colleagues’(1997) perspective that health involvesnot only physical, mental, and social well-being but also the ability to participate ineveryday activities in family, community,and work, commanding the personal andsocial resources necessary to adapt tochanging circumstances.
Ancient meanings of health implicating the sacred (holy,hallowed) illustrate a broad range of concerns still attestedto in contemporary ethnomedical systems: wholeness,morality, wickedness, spiritual crises, soul loss,possession, bewitchment, and other maladiesthat afflict humans.
To some people, health is a generalsense of well-being, “feeling good.”For others, health includes theexpectations that they will notbecome ill or will beable to recover quickly.For most, health involves the abilityto do what they want to do, withone’s body not presenting difficultyin normal activities.For some, health has moralconnotations, with disease theconsequence of immorality.People’s prominent concerns withhealth generally encompassphysical, psychological, emotional,and spiritual dimensions of well-being.
Etymological Views of HealthThese wider concerns of health are reflected in ancient rootmeanings of “heal,” “disease,” “sickness,” and “illness.”Heal means “To restore to health . . . to set right, amend. . . .To rid of sin, anxiety or the like. . . . To become whole andsound”.Heal is derived from the Indo-European root kailo -, whichmeans“whole,” “holy,” and “good men”; Old English derivativeforms include “holy,” “hallowed,” and “whole.” Disease hasits root meaning in “ease” and means a reversal of ease.Sick, meaning “ailing, ill, unwell,” “mentally ill or disturbed,”also refers to suffering or deeply affected byemotions, mental affliction, or corruption. Sick is derivedfrom the Indo-European root seug -, meaning “troubled” or“sad.”
The linguistic roots of ill in the Middle English ill(e) mean “bad” or“sickness of body or mind”; older meanings emphasized evil andwickedness, still reflected in its use to refer to evil, hostileintentions, wrongdoing, wickedness, sin, and disaster.The responses to health maladies represented in the concepts ofmedicine and care also reflect broader concerns.Medicine derives from the Latin medicina and the Indo-Europeanroot med -, which means “to take appropriate measures.”Cure means “restoration of health” from the Indo-European rootcûra, “care” cure also has ecclesiastical or religioussignificance, meaning “spiritual charge or care of souls, as of apriest for his congregation,” from the Medieval Latin curatus,“one having spiritual cure or charge”.
World Health Organization’s Concept of HealthThe World Health Organization (WHO) characterized healthas complete physical, mental, and social well-being andthe capability to function in the face of changingcircumstances. The WHO also emphasized the “highestpossible level of health” that allows people to participate insocial life and work productively(World Health Organization, 1992).Health involves social and personalresources in addition to physical conditions; a sense ofoverall well-being derived from work, family, andcommunity; and other relations, including psychosocialand spiritual(Durch et al., 1997).
Some consider the WHO definition to also have problems.Can people be healthy when others suffer from inequalityand a lack of resources?What about emotional, spiritual, moral, and metaphysicaleffects on one’s sense of well-being?What about one’s sense of ill health from environmentalcircumstances, war, injustice, and violence?Would it make you feel sick to know that children werebeing massacred and tortured in a nearby country byextremists? Others’ pain can be our own.
Critical Medical Anthropology Concepts of HealthCritical medical anthropology adopts perspectives on health thatemphasize the importance of access to resources necessary forsustaining life at a high level of satisfaction.Health is analyzed from the perspectives of the societal factors thataffect the distribution of health resources and threats to health (e.g.,environmental contamination). Health conditions are affected bypolitical decisions regarding resources for immunizations providedfor care, access to care and nutrition, and exposure toenvironmental conditions and socially produced risks such aspoverty and crime.The recognition of health effects in social, economic, andenvironmental factors force attention to be paid to the interactionsof biological and social conditions.
Multiple environmental interactions, including arange of economic, social, political, andideological influences, mold the interactions at themicrolevel of interpersonal dynamics ofcommunity and family that consequentlyshape an individual person’s physiologicalconditions.
PUBLIC HEALTH CONCEPTS OF HEALTHPublic health models (see Healthy Communities2000: Model Standards [American Public HealthAssociation, 1991] and the AssessmentProtocol for Excellence in Public Health [seeDurch et al., 1997]) emphasize communityinvolvement as key to a conceptualization ofhealth. Healthy communities havehealth institutions that areaccountable, incorporating communityinvolvement fromplanning stages through implementation andevaluation activities.
Community health includes services provided(treatment, immunizations) and standardperformance measures. Because availability ofcare is a major aspect of communityhealth, health includes the capacity of thecommunity’s health institutions to respond topotential health problems. Responsivenessrequires thathealth institutions understand cultural and socialeffects on health, incorporate communityperspectives on needs and desired services, andassess perceptions of the quality of services.
EXPERIENCE OF MALADIESThreats to health are discussed as a malady , anumbrella term for unwanted health conditions thatencompasses many concerns about compromisedwell-being. Many things cause health maladies:“germs” such as bacteria, virus, and fungi;our behaviors, such as smoking, drinking, andovereating; our psychological concerns, suchas worries, depression, and anxiety; and evenothers’ behaviors, such as assaults or vehicularmanslaughter.
Different kinds of maladies such as disease,illness, and sickness are consideredsynonyms in English, but there are importantdistinctions among them in medicalanthropology.
LEARNING OBJECTIVES● Present cultural systems models as bases for understanding cultural influenceson health.● Differentiate aspects of cultural systems to emphasize material, social, andmental influences on health.● Present different ideological aspects of culture that can be used to enhancehealth, particularly religious healing approaches that provide healing and care.● Introduce evaluation procedures for ascertaining health needs and programeffectiveness.
Culturally responsive care requires attention tomany cultural effects on health. Medicalanthropology, medicine, transculturalnursing, public health, and social work addressculturethrough similar approaches that involve culturalsystems models.
While sharing core elements,these models also have variation reflectingcontext- and task-specific differences in theparticular aspects of health on which theyfocus.
Culture, the patterns of shared group behaviortransmitted between generations throughlearning, provides the core conceptualframework for understanding all of humanbehavior, including health behavior.
The effects of culture are found throughouthuman life, beginning with basic survivalfunctions and structuring of interactions withthe physical environment.
Culture affects health through what we eat, howwe protect and expose ourselves, patterns of sexand procreation, our hygienic practices, how webond together, and lifestyle behaviors.
Culture produces risk factors, conditionsassociated with an increased likelihood ofdiseases, such as smoking cigarettes or eatingpoorly cooked meats or the blood of animals.
Culture also provides systems that humansuse as protective factors that reduce diseaserisks, such as hygienic rituals of bathing andpurification and prohibitions of sex outsideof marriage and good food.
Culturalconditions arebasic toproducing thehealth problemsand what we doabout them.
Culture guides the experience and managementof health conditions through the classificationof the condition and treatments available. Forexample, biomedicine might diagnose a coldand provide you with a decongestant, whereasan ethnomedical healer might consider you tohave excess dampness and prescribe a tea toheat up your lungs.
1. To examine the ways that culture affectshealth, medical anthropologists, physicians,nurses, and public and community healthpractitioners (e.g., Brody, 1973; Engel, 1977,1980; Blum, 1983; Leininger, 1991, 1995; Baer etal., 1986; Sallis and Owen, 1998) have proposedsimilar conceptual frameworks.
These systems models address health anddisease in relationship to the ecology, the totalphysical and social environments.These models incorporate demographic,technological, economic, political, and othersocial conditions that affect the physicalenvironment. They also describe specific areasof cultural systems affecting health.
2. Cultural systems perspectives prominent incommunity health include the “environment of health”or “force-field paradigm” (Blum, 1983; Evans andStoddart, 1994) that views health as a product of therelationships among many subsystems or fields,emphasizing■ The physical environment, including sanitation,housing, environmental toxicity, and the physicalinfrastructure (roads, water, transportation)■The social environment, including family, work,class, education, and social networks
■ Individual behavior, especially aspects oflifestyle that link people to the environment■ Medical care services, part of the socialenvironment with a special role in health■ The genetic and biological levels
These interdependent subsystems affect oneanother, operating through naturalresources, the population and its ecologicalbalance, and cultural systems mediatinghuman interaction with all of the force fields:resources, social networks, and medicalservices.
CULTURALINFRASTRUCTURE, STRUCTURE, ANDSUPERSTRUCTURE reveal the regularly Systems models helpoccurring features of cultural and social life byproviding a metatheoretical perspective forexamining group influences on individualbehavior.
Harris (1988) characterized the cultural systemas entailing three major aspects:Infrastructure: institutions that mediaterelations to the physical environment such asroads, sanitary water, and housingStructure: social relations with others such asfamilies and community networksSuperstructure: behaviors and ideas or mentalrepresentations, such as beliefs aboutthe causes of diseases and the best means oftreating them
Major Aspects of Cultural Systems Cultural Level Function Activity SystemSuperstruct Mental Ideology, Communication ure beliefs, meaning Structure Social Social Interpersonal relations organizationInfrastructur Material Technology, Behavior e economy
COMMUNITY HEALTH ASSESSMENTThe development of effective health programsrequires resources—physical and intellectual—toengage community involvement, beginning withplanning stages and continuing through healthprogram implementation and evaluationactivities.
Community involvement is necessary becauseeffectiveness must be measured in goals specificto the particular community and its circumstances.Because improving the community’s perception ofits health is part of public health goals,determining community views of desirableimprovements in its health is part of an evaluation.The health of a community is a function not onlyof biological disease rates but also of quality-of-life concerns based on cultural values andexpectations.Community approaches are central to healthbecause they reflect social expectationsregarding quality of life.
A variety of models exist for communityinvolvement in the implementation ofhealth improvement programs (e.g., HealthyPeople, 2010 [National Center for HealthStatistics, 2000]; Healthy Communities, 2000:Model Standards [American PublicHealth Association, 1991]; Assessment Protocolfor Excellence [in Public Health; APEX];Planned Approach to Community Health);Community Oriented Primary Care;and Healthy People and Cities programs[see Lasker et al., 1997; Durch et al., 1997]).
The APEX model focuses on the followingsteps:Community Process Steps■Assess organizational capacities forcommunity relations and organization■Collect and analyze health data■Form community health committee toidentify, prioritize, and analyze communityhealth needs■ Inventory community health resources■ Develop and implement community health plan■ Monitor achievement of health goals
Implementing Model StandardsThe following steps are critical for implementingmodel standards:■ Assess agency capacity for communityengagement■ Develop agency capacity-building plan■ Assess community organization and structures■ Organize community members in healthcoalitions
■ Assess community health needs■ Determine community priorities and health resources■ Select outcome objectives■ Develop intervention strategies■ Implement intervention strategies■ Conduct continuous monitoring and evaluation
A variety of methods are used to assess andadapt to community and cultural factors inassessing health care issues (Brownlee, 1978):■ Practicing direct personal involvement indoing the research■ Building personal relations and involvingcommunity members■ Finding a confidant who can help bridge theculture gap■ Understanding the other culture, particularlyits differences, as normal■ Utilizing community resources and networks
■ Observing and listening before asking andacting■ Finding out if any special rules of protocolneed to be followed■ Getting to know local leaders: residents whoare widely respected■ Talking to ordinary workers and communitypeople■ Getting to know the patients, the recipientsof care
■ Learning through participating, observing,and informal conversations■ Determining cultural attitudes towardquestioning and adapting questions to theculture■ Learning how to interview within the localarea■ Learning when to ask questions and whatquestions not to ask
CREATIVE ASSESSMENT1. By group, or individual2. The scope of health programs (a.k.a., Cultural Systems Models should solely improve the SPUQC community; the works must be give orientation to the importance of health.3. Deadline will be on October 15, 2010.4. Submit it through electronic copy like, DVD