CULTURE, HEALTH AND DISEASE

BY
DR. LWIN MIE AYE
COMMUNITY MEDICINE DEPARTMENT
Learning Outcomes

• Describe the concept of Health illness and Behaviour

• Describe the concept of Changing pattern of disease in society
• Describe the Social cause of disease
• Explain the Cultural factors in health and disease
• Explain the meaning Self care, self help and treatment
• Describe the Beneficial, harmless and harmful customs and the
importance in medicine

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Content
Explain the definitions and terms in  Sociology
• Social sciences
• Sociology
• Community
• Society, social institutions, social structure
• Medical Sociology
• Acculturation
• Culture shock
• Components of culture
• Ethnocentrism
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Medical Sociology

A specialization within the field of sociology

Study of health, health behaviour and medical institutions
Defined as “the study of health care as it is institutionalized in a
society, and of health, or illness, and its relationship to social
factors” by Ruderman (1981:927)
Include studies of
- medical profession
- the relationship of medicine to public
- the social factors in the aetiology, prevalence and incidence
and interpretation of disease
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Terms and Definitions
No. Terms Definitions
1. Social science Applied to those disciplines which are committed to the
scientific examination of human behaviour
2. Sociology Sociology deals with the study of human relationships
and of human behaviour for a better understanding of
the pattern of human life
3. Community A social group determined by geographical boundaries
and/ or common values and interest
4. Society An organization of member agents
5. Social institutions An organized complex pattern of behaviour in which a
number of persons participate in order to further group
interest. (eg. Family, school, church)
6. Social structure Pattern of inter-relations between persons

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Introduction
Health in general is influenced by
o environment
o genetics
o socioeconomic
o social and cultural factors
Different cultural beliefs and practices worldwide,
Which have important implications for public health practice
Perceptions of physical and psychological wellbeing differ substantially
across and within societies
Cultures often merge and change different lifestyles and beliefs will persist
Culture: not only habits and beliefs about perceived wellbeing, but also
political, economic, legal, ethical, and moral practices and values
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Social Factors Influencing the Health of People
Definition of culture

Defined as “Learned behaviour which has been socially acquired”

Culture is the product of human societies
Man is largely a product of his cultural environment
Culture is transmitted from one generation to another through learning
process, formal and informal
Provides norms of behaviour and mechanisms which secure for an
individual his personal and social survival
It stands for customs, beliefs, laws, religion and moral precepts, arts and
other capabilities and skills acquired by man as a member of society
It includes values, ideas, techniques for dealing with the environment that
are shared among people and passed on
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Influences of culture on health

Cultural factors in health and disease have gained the attention

of medical scientists and sociologists
Culture impacts on
• individual’s perception of health and illness
• health behaviour
• beliefs of what is a health issue
• reasons they have the illness
• influences how people perceive they should talk about the illness

Example:
• In developed countries, lung cancer from smoking and liver cirrhosis from drinking are the result of social habits
• In India, oral cancer  chewing pan
• Cultures factors deeply involved in personal hygiene, nutrition, immunization, seeking early medical care, family planning,
child rearing, disposal of refuse and excreta, outlook on health and disease

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Importance of culture in Healthcare

Effective delivery of health care services

Provide service within a cultural context
 when a patient walks in the door of a clinic, we cannot know if he or
she as an individual adheres to the beliefs described for his or her
culture
 A practitioner needs understand belief system in specific culture
Evaluation of health programs must take cultural beliefs and behaviours
into account

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Importance of culture in Healthcare

Effect of cultural systems of values on health outcomes is huge

• within and across cultures
• in multicultural settings
Crucial to understand the relation between culture and health,
especially the cultural factors that affect health-improving
behaviours
• national
• worldwide
• biomedical

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Cultural factors that influence health and
disease
Role of family (roles of members, hierarchy, key decision-
maker)
Role of community
Views on disease
• behaviour of the individual reflects on the family, mental illness or any
behaviour that indicates lack of self-control may produce shame and
guilt
• reluctant to accept a diagnosis of severe emotional illness or mental
retardation because it severely reduces the chances of other members
of the family getting married

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Cultural factors that influence health and
disease
Views on death and dying
Sexuality, fertility, childbirth
Eastern/western/alternative/traditional medicine
Beliefs about causes and treatments of illness, disease
Gender roles and relationships
Food beliefs and diet

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Cultural Views of Health & Illness

• A condition that is endemic in a population may be seen as

normal and may not be defined as illness
• Ascariasis in young children is perceived as normal condition
in many populations
• Malaria is seen as normal in some parts of Africa because
everyone has it or has had it
• In Egypt, where schistosomiasis was common and affected
the blood vessels around the bladder, blood in the urine was
referred to as “male menstruation” and was seen as normal

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Cultural Views of Health & Illness

Illness definitions may also vary by age and by gender

In most cultures, symptoms, such as fever, in children are seen
as more serious than in adults
Men may deny symptoms more than women in some cultures,
but women may do the same in others

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Types of Culture Explanations of Disease
Causation

Body • Temperature: Hot, cold

Balances • Blood: pollution from menstrual blood

• Wind
Weather • Change of weather

• Properties of food: hot, cold,

Food • Incompatible food

• Spirit possession
Supernatural • Evil eye
• Bewitching

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“Self care” or informal sickness behaviour

“Self care” refers to the actions on a layperson’s par to prevent,

detect, and treat his or her own health problems
Self initiated and self-managed which is most common response
to symptoms of illness
Health seeking is not a process of getting professional medical
care
Self-prescription, self-imposed restriction of activities (cutting
down on errands and chores), talking to family or friends,
neighbours, colleagues, friends
Internet, advice from peers, support groups
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Dealing with different cultures

Understand without prejudice every custom that affects health

Classify the customs according to evidence based medicine,
which customs are:
• beneficial
• harmful
• harmless
• uncertain

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Customs

Beneficial customs Harmful customs

Breastfeeding until 2 Roasting of mothers body
years after delivery
Food restriction during
Balanced meals pregnancy-hot and cold
Avoidance of alcohol foods
and smoking in certain Betel nut chewing
cultures, premarital Obesity as beauty and
sex prosperity in certain cultures
Female genital mutilation
Avoidance of sunlight

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Female Genital Mutilation

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Customs
Harmless custom
Pregnant mothers should not be
allowed to go near ugly or bad
luck activities
Mother wears gold and
ornaments to bring good luck to
the infant
Customs that are uncertain
Mother is not allowed to take
the child out of the house for 40
days
Eating certain foods for
hypertension e.g. star fruit and
bitter gourd for diabetes
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Acculturation
Acculturation means “Culture contact”
Diffusion of culture both ways when there is contact between
two cultures
It takes place due to
• trade and commerce
• Industrialization
• propagation of religion
• Education
• Conquest (eg. British brought their culture into India)
• Others (radio, TV, cinema)
Food habits of people, tobacco use through acculturation 22
Strategies for Working With Patients In
Cross-Cultural Settings
Learn about the cultural traditions of the patients
Look for body language, lack of response, or expressions of
anxiety that may signal that the patient or family is in conflict
Ask the patient and family open-ended questions to gain more
information about their assumptions and expectations
Remain non-judgmental when given information that reflects
values that differ from yours

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Cultural competence

Awareness of diverse patient needs

Some awareness of own cultural practices, including its
prejudices, assumptions, and institutional values
Awareness of the cultural factors that influence another’s views
and attitudes, and an assimilation of that awareness into
professional practice
• culturally affected perceptions of wellbeing
• competence should be reconsidered across all cultures and
systems of care
• building of trust in health care should be prioritised as a
cultural value 24
Conclusion

Different cultural beliefs and practices have important

implications for public health practice
Crucial to understand the relation between culture and health
to have effective health care services

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References

• Rachel E. Spector. Cultural Diversity in Health and Illness. 8 th

Edition. Pearson, 2013
• Gregory LW, Lynne EL. The Sociology of Health, Healing and
Illness. 7th Edition. Prentice Hall, 2012

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THANK YOU