1. Social anthropology and health

2. Session aims To explore what social anthropology as a discipline is To identify how social anthropology contributes to understandings of health and illness To identify how culture as a social context relates to and affects health

3. What is social anthropology? Social anthropology is the study of all aspects of society from a cross cultural perspective Historical anthropology was concerned with other ‘exotic’ cultures Contemporary anthropology is concerned with all cultures The anthropology of health and illness explores the social and cultural dimensions of health, ill health and medicine

4. The contribution of anthropology to understandings of health Ethnographic studies have demonstrated that illness and medical care are socially constructed according to the cultural context in which we live Ethnographic studies have shown how therapeutic interventions can be influenced by cultural practices (Prout 1996) Ethnographic studies have explored the attitudes of professions in relation to health care and health promotion (Kingfisher & Millard 1998) In summary, medical anthropology explores health and illness within its cultural context because culture is important in relation to health

5. Culture and health Individual health is affected by social context including cultural influences Culture is the collective beliefs, assumptions and values that are communicated between people within a society (Boyden 2004) Put simply, culture is how we make sense of and understand the social world in which we live Helman (2000:2) defines culture as ‘…an inherited ‘lens’, through which the individual perceives and understands the world…’ We all live in a specific cultural context which functions as either a positive or negative determinant of health

6. Culture and health Culture determines health and illness in many ways Culture shapes our perceptions of illness and views of how we are expected to behave when we are ill Different societies have varying rules and cultural understandings, leading to an array of illness interpretations and experiences Furedi (2008) argues that people’s perceptions of health and illness are largely shaped by the culture in which they are located ‘...culture does considerably more than shape illness as an experience; it shapes the very way we conceive of illness.’ (Kleinman 1977:4)

7. Different cultural health practices Van Telijingen (2000) illustrates that childbirth in the Netherlands is viewed as a natural and healthy condition, where medical intervention is not necessary and therefore is limited. Women are supported by a midwife and give birth at home. Comparatively the experience in the UK is much more medicalised, viewed in terms of the risk to mother and unborn child and therefore supervised by medical practitioners at regular intervals, with birth taking place in the hospital setting

8. Cultural interpretations of pain People make sense of their symptoms in different ways and act according to their cultural beliefs – how we respond to illness is Zborowski (1950s) argued that pain was viewed differently amongst ethnic groups when he conducted a study in a New York hospital looking at patients, doctors, nurses and parents of children – Old-Americans (by birth) responded with stoicism – Irish patients denied their pain – Italian patients were concerned about getting pain relief – Jewish patients focused upon what the pain meant in terms of their future health

9. Illness behaviour is socially divided Illness behaviour is also influenced by divisions within societies as well as between them Middle class people are more likely to exhibit illness and health seeking behaviour when compared to working class people experiencing the same symptoms (Koos 1954) Blaxter and Paterson (1982) argue that working class children’s symptoms were only recognised as an illness when they interfered with functionality, suggesting that minor symptoms were more likely to be ignored within the lower social classes

10. Experiencing illness – lay perspectives Studying illness accounts has led to useful insights into the meanings attached to specific illnesses Klienmann (1988) distinguishes – Illness problems – practical difficulties caused by the illness related to socio-cultural expectations. These often include shame associated with disfigurement and loss of ‘normal’ functioning and frustration associated with not being able to perform usual roles such as work – Illness complaints – these are the descriptions that the patient brings to the practitioner (these do not necessarily include descriptions of the illness problems) These social experiences of illness and treatment are bounded up with cultural interpretations and meanings. People understand illness and disease in a variety of dynamic ways

11. Example lay beliefs Blumhagen (1980) demonstrates a range of lay beliefs about illness causation in relation to hypertension (high blood pressure) amongst men. For example, one patient cited ‘family arguments’ as the cause leading to symptoms such as ‘ballooning veins’, ‘dizzy spells and flashing lights’. He argues that – ‘Folk’ beliefs can not be entirely separated from ‘formal’ medical ones. – Individual illness beliefs can be inconsistent and change rapidly.

12. What do lay beliefs mean? They help people to make sense of their illness experiences They influence illness behaviour i.e. what foods we eat and the attitudes we believe we should exhibit in order to recover They influence ideas about illness causation They influence attitudes to treatment

13. Culture and treatment Medical anthropology has investigated the use of both medical and alternative treatments and why these are used in a number of different contexts The way in which illness is treated ultimately depends upon how it is culturally understood Illness in some cultures is believed to be caused by external forces, evil spirits and possessions resulting in treatment as ritual based including ceremonies to drive away spirits, witchcraft, voodoo and the use of Shamans and traditional healers (Kirmayer 2004) Western medicine works within the biomedical model, and is individualistic in its treatment approach. This tends to led to a curative approach based upon the diagnosis of diseases. Seeking treatment from ‘professionals’ is however not the first step in many cultures, as individuals often self-medicate prior to this.

14. Cultural representations of health and illness How illnesses are described and understood varies significantly across cultures Many languages do not contain a word to describe cancer (Dein 2006) yet this does not indicate that it does not exist Helman (2007) argues that some diseases, especially those that are difficult to treat, explain and control become symbols for more general anxieties that people have Some conditions become more than just diseases, they become metaphors (Sontag’s 1989) and as a result become stigmatised

15. Illness metaphors In the West cancer is perceived as an uncontrollable, invasive and shameful disease and these views affect both health seeking behaviour, with patients fearful of a cancer diagnosis Cancer is still often used as an adjective in the media to describe an array of problems such as drug abuse, immigration and crime. AIDs is often negatively described metaphorically too, associated with pollution and ultimately stigmatized

16. Culture and mental illness Medical anthropologists demonstrated that there are no universal categories of mental illness across all cultures In Aboriginal culture notions of longing for, crying for and being sick for their country has exactly the same symptom base as depression (Vicary & Westerman 2004). Research has also shown differences in understandings in relation to schizophrenia; in some cultures hallucinatory behaviour and suspiciousness are not necessarily seen as signs of mental illness (Pote & Orrell 2002).

17. Culture and mental illness Cultural context can influence the incidence of mental ill- health Those who exist in a culture that promotes resilience- producing characteristics are much more likely to be able to cope with stress and therefore less likely to experience mental ill-health. Different cultures encourage certain personality types such as hardiness, ego strength, optimism and humour. Mental health problems are heavily socially influenced; feelings such as despair and hopelessness are located in individual brains, but are also related to patterns of interaction with families, communities and indeed wider society (Marsella 2007)

18. Cultural influences upon health – the example of alcohol We are often not consciously aware of the culturally patterned nature of our health behaviour as this is taken for granted and feels normal Cultural influences are negative when for example, they are supportive of health damaging behaviours such as drinking excessive amounts of alcohol The incidence of alcoholism and the regular consumption of alcohol vary significantly between social and cultural groups within and between societies (Helman 2007) Alcohol intake is embedded in a matrix of cultural values and influenced by the expectations of different social groups Alcohol use is inherently cultural; it is related to cultural meanings and specific norms of behaviour. It is also related to the social networks that people have and participate in Alcohol use can be used to create identity, and can be important in social relationships too (Helman 2007) In many senses alcohol consumption may be socially important in some societies but detrimental to health. Health damaging behaviours can therefore be both culturally supported and acceptable

19. Health damaging culturally acceptable behaviours The use of sun-beds and sun-bathing to tan skin, despite the associated risk of skin cancer The culture of obesogenic environments - inactivity, changes in dietary habits and environmental factors combine to support increased rates of obesity Western culture is generally damaging to health – materialism and individualism are detrimental to health and well-being because of their impacts on psychosocial factors (Eckersley 2005) – the 24-hour, round-the-clock culture disturbs sleep patterns and negatively affects health. Shift work, the advent of new technology and the leisure industry boom have all been argued to contribute to sleep deprivation, which is ultimately bad for health (Stanley 2009).

20. Summary Medical anthropology is a sub- discipline of social anthropology that demonstrates the importance of culture as a determinant of individual’s understandings and experiences of both and illness and treatment Medical anthropology when critically analysing health has strongly demonstrated that health is overwhelmingly social, with culture as a key determinant of health beliefs, behaviour and treatment Anthropology shows that health and illness are culturally located and that key social and cultural meanings are associated with health