10.

Religion and culture in health and healthcare

10. Culture and religion in health and healthcare
“Social scientists generally agree that culture is learned, shared, transmitted intergenerationally, and
reflected in a group’s values, beliefs, norms, practices, patterns of communication, familial roles, and other
social regularities” Kreuter et al., (2004)

Cultural considerations
Disparities in healthcare between cultures practice may mistake it for physical abuse, and in
Racial bias by doctors fact, there have been many cases of parents
Immigrants used to different medical practice being arrested for employing a folk remedy that is
(e.g., coining) culturally appropriate and designed to help their
Who hears first? children.
When to die?
The custom in many cultures, including Mexican,
Eye contact/non-verbal communication
Filipino, Chinese, and Iranian, is for a patient's
family to be the first to hear about a poor
Coining: In this procedure, a coin, which may or
prognosis, after which the family decides whether
may not be heated or oiled, is vigorously rubbed
and how much to tell the patient. Members of
on a patient's back. The idea is to “draw the
such cultural groups may believe that it would be
illness out of the body,” and the red welts that
insensitive for a patient to be told bad news and
form are taken as a visible sign that the
that this would only cause the patient great stress
procedure was successful. American health
and even hasten death by destroying hope.
professionals who are unaware of this traditional

Culture and healthcare: shared identity

If the source of information comes from someone who is identified as culturally similar, it is more likely to
be trusted and followed.
• HIV testing, 100 African-American women (Kalichamn & Coley (1995).
• Male African-American narrator
• Female African-American narrator
• Female African-American narrator who emphasised family values
• Women who listened to the third narrator were more likely to go and get tested.
Smoking, Lopes et al., (1995) Video of an African-American woman trying to quit smoking.
• African-American women who watched the video found it more exciting, identified more
closely with the character, and found the characters more convincing.

Collectivist vs. individual cultures

In collectivist societies (e.g., Japan), individuals are not distressed by cognitive dissonance at the individual
level (Heine & Lehman, 1997); implications for health: less individualistic stress (but more collective
stress?)
However, in collectivist cultures, the need to conform and respect family/groups may be higher, which in
turn can affect individuals negatively (e.g., higher suicide rates after poor exam results)

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 10. Religion and culture in health and healthcare
Individualist societies: USA
Until the Patient’s Bill of Rights was passed in 1973, many doctors did not tell patients of terminal
diagnoses.
Individualist health care concepts:
• Informed consent – right of patient to understand their diagnosis, prognosis, and treatment options
• Advance directives – patients can influence their course of treatment when incapacitated or unable
to express their wishes.
• Living will
• Durable power of attorney McLaughlin & Braun, 1998

Collectivist cultures
(e.g., japan, Asian and pacific islanders)
• Decisions are made by families or groups, for the good of the larger group in mind. Eldest son may
be in charge of decision making for the family.
• Filial piety – obligation of younger family members to care for older generations (e.g., caring for
grandparent at home). However, may also have to tell them long-term diagnosis which causes
upset.
• Keeping the harmony – less likely to question decisions made by family or health care professional.
Less likely to express health care desires if they think they will burden the family.
• Health care decisions may be delegated to health care professional who is seen as a wise authority
figure who will make decisions based on the best for the group (rather than the individual).
• May delay in seeking healthcare for preventative medicines and minor ailments will be cared for by
the group.

Asian-Indian immigrant women Mann et al., 2017

Asian-Indian women who lived in the USA were surveyed on their attitudes to women’s roles and rights,
birth control, and mental health.
Those who completed the survey in English, had higher education, and lived in the USA for longer were
more likely to have egalitarian attitudes towards societal roles and rights of women.
But – they were conflicted with cultural views and caused tensions in family and within themselves. Not
living with extended family made it easier to have egalitarian views regarding their roles.
Bicultural integration- Women experienced bicultural tensions when trying to integrate both cultures, and
were more likely to have egalitarian views. But – they reported being criticized and stress as they tried to
juggle both.
Having children – gender role expectations and tensions around reproducing were described. Those with
egalitarian views had fewer children but experience community blame, family nagging and meddling with
their decisions that their husbands didn’t.
Mental health – those with tradition views were more likely to report depression and isolation, but – those
with egalitarian views were more likely to experience anxiety. Difficult to access medical help for mental
health.

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 10. Religion and culture in health and healthcare
Chinese Medicine
 Herbal remedies (traditional Chinese  Feng shui
medicines)  Breathing and movement exercises called qi
 Acupuncture or acupressure gong
 Moxibustion (burning moxa – a cone or stick  Movement exercises called tai chi
of dried herb)  Diet
 Massage therapy  Cupping

Religion
“[Religion] Involves beliefs, practices, and rituals related to the transcendent, where the transcendent is
God, Allah, HaShem, or a Higher Power in Western religious traditions, or to Brahman, manifestations of
Brahman, Buddha, Dao, or ultimate truth/reality in Eastern traditions. This often involves the mystical or
supernatural. Religions usually have specific beliefs about life after death and rules about conduct within a
social group. Religion is a multidimensional construct that includes beliefs, behaviors, rituals, and
ceremonies that may be held or practiced in private or public settings, but are in some way derived from
established traditions that developed over time within a community.
Religion is also an organized system of beliefs, practices, and symbols designed (a) to facilitate closeness to
the transcendent, and (b) to foster an understanding of one’s relationship and responsibility to others in
living together in a community.” Koenig, et al., 2012b

Healthcare for lower SES groups

 Subjective (how good do you think your health is) and objective (reporting on whether they had gone
to the doctors or not; reported if they had been out of work due to illness) measures of health
measures.
 Assessed religiousness by self-report - how often participants prayed and attended religious services.
 Assessed spirituality by asking participants how often they felt God’s presence and inner peace or
harmony.
 Subjective health was positively associated with income
 Spirituality was positively associated with subjective health
 Religious practice positively predicted good health, but only for the variable ‘out of work’. Older
respondents and Black people were more likely to report missing work due to injury.
 Income findings:
 Religious practice, spirituality, and social support did not predict health outcomes for above median
income.
 Only religious practice predicted good health (‘out of work’ variable) for lower income groups.

o Is religion and spirituality a health resource for lower SES groups?

o The authors conclude that they are….
o BUT – brief, questions not validated. Were the objective measures really objective?
o Lots of NS findings.
o Not a causal study. Didn’t ask if people attributed their good health to their religion or spirituality.
o Self-report of religion and health behaviours – people may be likely to provide a positive report of
both?

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 10. Religion and culture in health and healthcare
Systematic review Koenig, 2012a
Aimed to summarise the research conducted between religion, spirituality, and health
Religion and spirituality were associated with
 Coping with adversity
 Wellbeing and happiness
 Optimism
 Less smoking behaviours (90% of studies) Lower stress –
 Greater exercise (68% of studies) less burden on
 Healthy diet (62% of studies) the physiological
 Increased weight (39% vs 19% of studies) systems
 Less risky sexual behaviours (86% of studies)
 Lower coronary heart disease
 Less hypertension
 Better cognitive functioning

Anti-vaccination
Children must be vaccinated to attend school in America, unless they have a religious exemption.
Debate between individual preference vs. public health.
Religious objections based on
I. Ethical dilemmas associated with using body tissues for vaccines
II. Belief that the body is scared and shouldn’t receive vaccines but should be healed by God
Media stories that vaccinations cause autism, are a ploy by pharmaceuticals to make more money, children
will get sick from the vaccinations.

6 misconceptions of vaccinations (WHO website)

1. "Diseases had already begun to disappear before vaccines were introduced, because of better hygiene
and sanitation".
2. "The majority of people who get disease have been vaccinated."
3. "There are "hot lots" of vaccine that have been associated with more adverse events and deaths than
others. Parents should find the numbers of these lots and not allow their children to receive vaccines
from them."
4. "Vaccines cause many harmful side effects, illnesses, and even death - not to mention possible long-
term effects we don't even know about."
5. "Vaccine-preventable diseases have been virtually eliminated from my country, so there is no need for
my child to be vaccinated."
6. "Giving a child multiple vaccinations for different diseases at the same time increases the risk of
harmful side effects and can overload the immune system".

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 10. Religion and culture in health and healthcare

Consequences of children not having vaccinations

 Can contract illnesses and diseases more easily.
 More vulnerable in hospitals as immune systems.
 Can pass onto others who are not vaccinated (e.g., people who cannot be vaccinated due to
weakened immune systems).
 Treatments have to be specially tailored, which staff are less experienced in.
Video on ethics – see slides for link

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