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.
China’s 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 one’s 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 it’s 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.

7. 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.

9. 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.

11. 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.

12. 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.

14. Hofstede’s 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.

15. Hofstede’s 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.

16. Hofstede’s 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.

17. 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 one’s personal cultural values and those of society have on health.
Undergraduates reported their personal cultural values, their perceptions of society’s values.
They also reported coping strategies, anxiety, and depression.

19. 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.

21. 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.

22. 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