Chapter 7- Culture and Health

October 17, 2023

- Read rest of chapter 6 slides by yourself

There are many different definitions of culture

- Formal definition: set of rules/standards shared by members of a society, that when acted on by
members produce behaviour that falls within a range of variation that are considered proper.

The importance of culture to health

- Culture is related to health behaviours
- Culture is an important determinant of people’s perceptions of illness
- Different cultures have different health practices
- Culture affects use of health services

The importance of culture on health

- China has a well articulated system of “traditional medicine” reflected in this Chinese medicine
shop (picture from textbook)

The concept of culture

- Culture (simple def): behaviour and beliefs that are learned and shared
o Influences family, social groups, individual growth, communication, religion, art, politics,
and the economy (everything)
- Health policies and programs must always keep culture in mind
- Critical to note—some cultural practices enable good health BUT some do not
- Example: body language, not making eye contact can mean respect

Health beliefs and practices

PERCEPTION OF ILLNESS
- Illness: personal, interpersonal, and cultural reactions to disease or discomfort
- Vary across groups
- One culture may view certain signs or symptoms as an affliction while others consider them
normal
- Example: worms coming from water source. Some places view it as horrific, other places view it
as part of normal life.
PERCEPTION OF DISEASE
- Disease: malfunctioning or maladaptation of biologic and psychophysiological processes in the
individual
- Some cultures believe illness can be causes by emotional stress, supernatural causes or bodily
imbalance—especially the case in low- and middle-income countries where traditional beliefs
are more common.
FOLK ILLNESS
- Cultural interpretations of physical states that people perceive to be illness, but that do not have
a physiologic cause
 - Efforts to improve health needs to consider these beliefs, because if we don’t consider them it
will be hard to convince local people of health related interventions. Could cause rebellion, so
you want to get them on side. Show respect of all beliefs.
- Example: Emenacho- Latin American culture, food gets stuck to stomach and small intestinal wall
where it causes bloating, constipation….
Table 7-1: selected cultural explanations of illness and disease
- Body balances (temperature, blood, incompatibility of horoscopes)
- Emotional (fright, envy)
- Supernatural (bewitching, soul loss)
- Sexual (sex with forbidden person)

Health beliefs and practices

THE PREVENTION OF ILLNESS
- Many cultures have taboos that concern avoiding illness
- Many concern foods to avoid during pregnancy (avoid sweets, avoid eggs to keep baby from
being a thief, eating snails may lead to dull child with excessive drooling and speech problems)
- Wide variety of ritual practices to avoid illness
THE DIAGNOSIS AND TREATMENT OF ILLNESS AND THE USE OF HELATH SERVICES
- Common to try a home remedy, then visit a local healer, then consult a “western doctor”
- “patterns of resort” manner of which people try to care for an illnesses. Are affected by cost of
services and manner in which the provider treats them socially.
Table 7-2: Selected examples of health service providers
- Indigenous (midwives, shamans herbalists)
- Western (pharmiacists)
- Other medical systems (ayurvedic practioners: Indian traditional doctors)

Health behaviours and behaviour change

- Risk factors for leading causes of death related to culture include:
o Nutrition and eating practices
o Tobacco use
o Unsafe sex
o Hygiene
- How can unhealthy behaviours be changed?
IMPROVING HELATH BEHAVIOURS (in class discussion)
- The ecological perspective
o Health related behaviours are affected by and affect multiple levels of influence
o Behaviour both influences and is influenced by the social environments in which it
occurs
o Factors/levels that influence health related behaviours:
1. Individual: characteristics that influence behaviour such as knowledge, attitudes,
beliefs, and personality traits
2. Interpersonal: interpersonal process and primary groups including family, friends
and peers
3. Institutional: rules, regulations, policies and informal structures
 4. Community: social networks and norms or standards that exist formally or informally
among individuals, groups and organizations
5. Public policy; local, state and federal policies and laws that regulate or support
healthy actions and practices for disease prevention, early detection, control and
management
o Child rearing example
 Individual: personal parenting choices
 Interpersonal: family influence
 Institutional: education curriculum or choosing public, private or homeschool
 Community: only males being allowed to play certain sports and not females in
some communities
 Public-policy: vaccination regulations, driving age
- The health belief model
o People’s health behaviours depend on their perceptions of their likelihood of getting the
illness and the severity of the illness, the benefits of engaging in behaviours that prevent
the illness, and barriers to engaging in preventive behaviours.
o Self-efficacy: whether or not people feel that they could carry out the behaviour.
o Perceived susceptibility: how vulnerable they think they are to the illness
o Perceived severity: how bad they think the illness is
- Stages of change model
o Change is a process and different people are at different stages of the process. This
model is flexible and allows for lots of movement between stages.
o The stages of behaviour change are:
1. Precontemplation
2. Contemplation
3. Decision/determination
4. Action
5. Maintenance
 Possible Sixth stage- termination. Ex.) Smoking- no urge to relapse despite
multiple influences.
- The diffusion of innovations model
o Communication promotes social change
o Diffusion is the process where innovations are communicated over time among
members of different groups
o This model focuses on how people adopt innovation, but not how thy might maintain
what they adopted
- Maslow’s hierarchy of needs
o Humans are motivated to fulfill their needs in a hierarchical order.
 Physiological needs
 Safety needs
 Sense of belonging
 Esteem needs
 Self-actualization
 o Disadvantaged nations- can’t get food and water wont be able to proceed beyond first
step of the hierarchy of needs

Oct 19, 2023

Understanding and engendering behaviour change

Understanding behaviours requires assessment of:
 Behaviours that are taking place
 Extent to which they enable better health or may harm health
 Underlying motivation for these behaviours
 Likely responses to different approaches to changing the unhealthy behaviours
CHANGING HEALTH BEHAVIOURS
- Community mobilization
o Engage the entire community in efforts to identify problems and promote healthy
behaviours
o Leaders in community need to be mobilized, willing to champion change
 Getting gatekeepers of community involved and convincing them of the benefits
to promote change.
- Mass media
o “Education-entertainment” – when using things like soap operas where actors bring in
the main messages to the target population. Ex. Condoms for HIV prevention
o Most people in low- and middle-income countries have access to the radio
o Soap operas are also popular
o The use of mobile technologies for promoting behaviour change is growing
- Social media
o Allows people to engage with content, rather than passively receiving it
o Messages on social media platforms may spread misinformation – hard to control
o Information technologies (social media networks) are becoming increasingly accessible
in low and middle income countries
 2/3 of adults use social media???
- Social marketing
o Application of tools of commercial marketing to promote a behaviour change
o Depends on the four Ps:
1. Attractive product
2. Affordable price
3. Convenient places to buy the product
4. Persuasive promotion
- Health education
o Comes in many forms such as classroom lectures or mass media
o Successful programs are clear, provide accurate information, engage stakeholders and
gear content to target group
o Barber shops are often ‘community centers’ in many countries where men congregate
for discussion. Several countries have created programs in which barbershops and
barbers provide health education messages. Reminiscent of the Men’s Shed program
 here in Manitoba, that is structured to be a community center to allow socialization and
prevent depression.
- Conditional (and not) cash transfers
o A government agency provides an economic incentive (give money) for families who
engage in a certain healthy behaviour. Generally, over a certain time frame. Is a
conditional cash transfer because it relies on the person completing something to get
funds.
o Incentivized behaviours; for example, giving birth in a hospital or participating in
nutrition and baby care programs
o Unconditional transfers might be just as effective in arenas
- Achieving success in health promotion

Social assessment
- Social assessment: process for assessing the social impacts of planned interventions or events
and for developing strategies for the on going monitoring and management of those impacts
o Chinas one child policy—not enough consideration for long term impacts
- Important to include the affected communities in the design and implementation of the
assessment and its follow-up

Main messages
- Culture is an important determinant of health
- Perceptions of illness and disease vary considerably across cultures ( perception of severity of
different conditions differs)
- Many forms of traditional behaviour are conductive to good health but some are not
- It is important to consider how healthy behaviours can be promoted
- There are a number of models of how behaviours can be changed
- Several approaches are often important to changing behaviours
- Social assessment can be an effective tool for setting the foundation for health efforts and
behaviour change.

Short videos
—five ancient medical practices that actually worked on YouTube
1. Mold/fungi
2. Leaches
3. Maggots
4. Trepanation- hole in skull = modern day craniotomy
5. Fecal transplant
- Medical practices were often lots of trial and error, resulting in lots of error

–ted talk: connecting modern medicine to traditional methods

- Aloe vera for skin burns, other problems
- Papaya for digestive problems
- Ribbon for 7 problems
-