 One major role of psychology is to improve

the lives of the people we touch.

 Whether through research, service, or

provision of primary or secondary health
care, we look forward to the day when we can
adequately prevent, diagnose, and treat
diseases, and foster positive states of being
in balance with others and the environment.
Comparison Across Cultures

 More than 60 years ago, the World Health

Organization (WHO) developed a definition at
the International Health Conference, at which
61 countries were represented.

 They defined health as “a state of complete

physical, mental, and social well-being, and
not merely the absence of disease or
infirmity.”
 In the United States, our views of health have
been heavily influenced by what many call the
biomedical model of health and disease.

 Traditionally, this model views disease as

resulting from a specific, identifiable cause such
as a pathogen (an infectious agent such as a
virus or bacteria a genetic or developmental
abnormality (such as being born with a mutated
gene),or physical insult (such as being exposed
to a carcinogen—a cancer-producing agent).
 Several decades ago, however, the biomedical
model was strongly criticized by George Engel,
who proposed a biopsychosocial model to
understand health and disease.

 Engel emphasized that health and disease need

to be considered from several dimensions—not
just the biological but also the psychological
and social
 In China, the concept of health, based on
Chinese religion and philosophy, focuses on
the principles of yin and yang, which represent
negative and positive energies, respectively.

 The Chinese believe that our bodies are made

up of elements of yin and yang. Balance
between these two forces results in good
health; an imbalance—too much yin or too
much yang—leads to poor health
 Many things can disturb this balance, such as
eating too many foods from one of the
elements; a change in social relationships, the
weather, the seasons, or even supernatural
forces. Maintaining a balance involves not only
the mind and body, but also the spirit and the
natural environment.

 From the Chinese perspective, the concept of

health is not confined to the individual but
encompasses the surrounding relationships and
environment—a view of health that is holistic
 A theory first developed by Hippocrates, which
heavily influences views of the human body and
disease in most industrialized countries and
cultures today, suggests that the body is
comprised of four humors: blood, phlegm, yellow
bile, and black bile. Too much or too little of any
of these throws the body out of balance,
resulting in disease.

Derivatives of these terms—such as sanguine,

phlegmatic, and choleric—are widely used in
health and medical circles today.
 Incorporating balance as a positive aspect of
health is also emphasized in the United States. We
often hear about the importance of having a
“balanced diet” and a “balanced lifestyle”

 The concept of homeostasis is all about balance—

maintaining steady, stable functioning in our
bodies when there are changes in the environment,
for example, being able to keep blood pressure
down when you are experiencing a high level of
stress (such as before taking an exam).
 From this brief review of how different cultures define health,
we can see how different attributions of what leads to good
health will affect how diseases are diagnosed and treated.

 If we believe that health is determined primarily by biological

disturbances and individual choices, treatment may primarily
focus on individual level factors.

 If we believe that health is determined by an individual’s

relationship with others, nature, and supernatural forces,
treatment may primarily focus on correcting those
relationships. Importantly, our choices of coping and
treatment are closely tied to our attributions of the causes
determining health, illness, and disease.
 Concepts of health may differ not only between
cultures but also within a pluralistic
culture such as the United States or Canada.

 Mulatu and Berry (2001) argue that health

perspectives may differ between individuals from
the dominant or mainstream culture and those of
the nondominant social and ethnocultural group.
They cite the example of Native Americans, who,
based on their religion, have a holistic view of
health and who consider good health to be living
in harmony with oneself and one’s environment.
 When one does not live in harmony and
engages in negative behaviors such as
“displeasing the holy people of the past or
the present, disturbing animal and plant life,
misuse of sacred religious ceremonies, strong
and uncontrolled emotions, and breaking
social rules and taboos”
Life Expectancy

 refers to the average number of years a

person is expected to live from birth (as
opposed to calculating life expectancy from,
for example, age 65)
 In 2010, a comparison of 224 countries showed that the countries with the longest average life
expectancies are :
 Monaco (90 years)
 Macau (84),
 Japan (82),
 Singapore (82),
 Hong Kong (82),
 Australia (82),
 Canada (81).

 The United States is ranked 49th, at 78 years of age.

 Countries with the shortest life expectancies are

 South Africa (49 years),
 Swaziland and Zimbabwe (48),
 Afghanistan (45)
 Angola (38)

 CIA, The World Factbook, 2010)

Infant Mortality

 is defined as the number of infant deaths

(one year old or younger) per 1,000 live
births
 Comparing across 224 countries in 2010, Angola
(178 infant deaths per 1,000 live births),
Afghanistan (152), and Niger (115) had the
highest rates of infant mortality while Bermuda
(3), Singapore (2), and Monaco (2) had the
lowest. The United States was ranked 46th, with
6 infant deaths for every 1,000 live births.

 Compared to other industrialized countries,

infant mortality rates in the United States are
among the highest.
Subjective Well-Being

 In contrast to life expectancy and infant

mortality, subjective well-being (SWB) focuses
on one’s perceptions and self-judgments of
health and well-being. Subjective well-being
encompasses a person’s feelings of happiness
and life satisfaction (Diener & Ryan, 2009).
Diener and Ryan (2009) state the importance of
this subjective aspect of health:
 While some diseases can be linked to mutations of
a single gene (e.g., cystic fibrosis, sickle cell
anemia), most diseases are linked to complex,
multiple factors that include mutations in multiple
genes that interact with environmental factors
(e.g.,stress, diet, health-related behaviors).

 Some of the most common complex-gene

diseases are cancer, high blood pressure, heart
disease, diabetes, and obesity (NIH,
Genetics Home Reference).
 Research that examines how genes and environment interact over time (for
instance, by adopting a biopsychosocial approach) is our best chance at
illuminating why some diseases appear more often for some cultural groups
compared to others.

 Francis (2009) argues for multilevel, interdisciplinary research programs to

address questions such as how community, social, and societal forces
contribute
to how genes are regulated and expressed. By multilevel, Francis is arguing
for an investigation on how genes interact with environments on various
levels— cellular, individual, group, and societal. And by interdisciplinary,
she is arguing that a collaboration of researchers should come from various
fields—genetics, biology, psychology, sociology, and public policy. Ideally,
future research should adopt multilevel, interdisciplinary research efforts to
clarify the complex relation of how genes, environment, and culture interact
and contribute to health and disease.
 In the last two decades, psychology as a whole
has becoming increasingly aware of the
important role that culture plays in the
maintenance of health and the production of
disease processes. This awareness can be seen
on many levels, from more journal articles
published on these topics to the establishment
of new journals devoted to this area of research.
This increased awareness is related to a growing
concern with psychosocial determinants of
health and disease in general
 An important psychosocial factor that may
contribute to health disparities by ethnic
group is perceived racism and discrimination.
One striking health disparity is the high rate of
infant mortality for African American babies
compared to other ethnic groups, as presented
earlier in the chapter. Research indicates that
this dis- parity may be linked to stress-related
health outcomes such as high blood pressure
(hyptertension) due to perceived racism and
discrimination
 Cultural Dimensions and Diseases

In addition to psychosocial factors, parallels can

be drawn linking cultural factors and the
development of diseases such as cardiovascular
disease. Marmot and Syme (1976) studied
Japanese Americans, classifying 3,809 subjects
into groups accord- ing to how “traditionally
Japanese” they were (spoke Japanese at home,
retained traditional Japanese values and
behaviors, and the like).
 They found that those who were the “most”
Japanese had the lowest incidence of
coronary heart disease— comparable to the
incidence in Japan. The group that was the
“least” Japanese had a three to five times
higher incidence. Moreover, the differences
between the groups could not be accounted
for by other coronary risk factors. These
findings point to the contribution of cultural
lifestyles to the development of heart disease.
 Although the studies described so far suggest
that culture influences physical health, other
research suggests that culture per se is not the
only nonbiologically relevant variable
 Indeed, the discrepancy between one’s personal
cultural values and those of society may play a
dominating part in producing stress, which in
turn leads to negative health outcomes.
Matsumoto, Kouznetsova, Ray, Ratzlaff, Biehl,
and Raroque (1999) tested this idea by asking
university undergraduates to report what their
personal cultural values were, as well as their
perceptions of society’s values and ideal values.
 Social and cultural factors are central in the
perception of one’s own and others’ body
shapes, and these perceptions influence the
relationship between culture andhealth. Body
shape ideals and body dissatisfaction (e.g., the
discrepancy between one’s perception of body
shape with one’s ideal body shape) has been
widely studied because of links to eating
disorders.
 For instance, greater body dissatis- faction is
considered to be one of the most robust
predictors of eating disorders (Stice, 2002).
Evidence shows this link in several cultures such
as the United States (Jacobi et al., 2004; Stice,
2002; Wertheim, Paxton, & Blaney, 2009),
Greece, (Bilali, Galanis, Velonakis, Katostaras, &
Theofanis, 2010) and China (Jackson & Chen,
2011).
 Body weight ideals and body dissatisfaction
have been heavily researched because of their
robust link to eating disorders. Although there
is a perception in the United States that
disordered eating occurs only with affluent,
European American women, more recent
evidence suggests that this is not the case. In a
recent review of the literature, researchers
reported that ethnic minority females are also at
risk for developing eating disorder symptoms
or syndromes
 In addition to eating disorders, increasing
attention has been paid to the rapidly growing
rates of overweight and obesity around the
world, especially among chil- dren and
adolescents. This is a concern, as most
overweight and obese children and adolescents
become overweight and obese adults and are
subsequently at much greater risk for serious
health problems such as cardiovascular disease,
diabe- tes, and cancer. Obesity has been an
increasingly important public health concern
across many countries in recent years
 No other behavior has health consequences as
final as suicide—the taking of one’s own life.

 Psychologists, sociologists, and anthropologists

have long been paying careful attention to
suicide, and have studied this behavior across
many cultures. The research to date suggests
many interesting cross-cultural differences in
the nature of suicidal behavior, all of which point
to the different ways in which people of different
cultures view not only death, but life itself. And
although risks for sui- cide are complex, the
role of culture may also be important
 Among the most glorified acts of suicide in
Japan (called seppuku or harakiri— the slitting
of one’s belly) were those of the masterless
samurai swordsmen who served as the basis for
the story known as Chuushingura. In this
factual story, a lord of one clan of samurai was
humiliated and lost face because of the acts of
another lord. In disgrace, the humiliated lord
committed seppuku to save the honor of
himself, his family, and his clan.
 His now masterless samurai—known as ronin—
plotted to avenge their master’s death by killing
the lord who had humili- ated him in the first
place. Forty-seven of them plotted their
revenge and carried out their plans by killing
the lord. Afterward, they turned themselves into
authori- ties, admitting to the plot of revenge
and explaining the reasons for their actions. It
was then decided that the only way to resolve
the entire situation was to order the 47 ronin to
commit seppuku themselves—which they did
 In doing so, they laid down their lives,
voluntarily and through this ritualistic
method, to preserve the honor and dignity of
their clan and families. Although these events
occurred in the late 19th century, similar acts
continue in Japan today. Some Japanese
businessmen have committed suicide as a
way of taking responsibility for the
downturns in their companies resulting from
the economic crisis in Japan and much of Asia
 China has one of the highest suicide rates in
the world. And in contrast to almost every
other country in the world, females in China
are more likely to com- mit suicide than
males. Zhang et al. (2010) argue that one
reason for this unique gender difference is
that females living in rural areas of China face
intense psycho- logical strain because of
conflicting social values
 National health systems can be divided into four
major types: entrepreneurial, welfare-oriented,
comprehensive, and socialist (Roemer, 1991).
Within each of these general categories, individual
countries vary tremendously in terms of their
economic level. For instance, the United States is
an example of a country with a relatively high
economic level that uses an entrepreneurial system
of health care, characterized by a substantial
private industry covering individuals as well as
groups. The Philippines and Ghana also use an
entrepreneurial system of health care, but have
moderate and low economic levels, respectively.