Culture & Health
Ch 4. P. 64-78
What is culture?
- a system of meanings and symbols. This system shapes every area of life,
deifnes a world view that gives meaning to personal and collective
experience, and frames the way people locate themselves within the world,
perceive the world, and believe in it. Every aspect of reality is seen as
embedded within webs of meaning that define a certain world view and that
cannot be studied or understood apart from this collective frame
Health belief systems
- given rise to the separation of what have become known as expert or
technical belief systems as opposed to traditional folk or indigenous systems
- these systems are not discrete but interact and are in a process of constant
evolution
- Kleinman distinguished between 3 overlapping sectors of any health care
system
1) the popular sector – the lay cultural arena where illness is first defined
and health care activities initiated
2) the professional sector – the organized healing professions, their
representations and actions
3) the folk sector – the non-professional, non bureaucratic, specialist sector
that shades into the other 2 sectors
- can appear disconnected
- draws upon a more general worldview
Western health belief systems:
Classical views of health
- derived from the Graeco-Arabic medical system
- Galenic medicine provided an expert system developed from the Greeks
(Hippocrates)
- The central concept in Galen’s formulation was the balance of four bodily
fluids or humours (yellow bile, phlegm, blood, black bile) – balance was
paired with health, and imbalance implied ill-health
- The fluids have been linked with
o The four seasons
An excess of phlegm was common in the winter leading to
colds, while and excess of bile lead to summer diarrhea)
o The four primary conditions – hot, cold, wet & dry
o The four elements – air, fire, earth, water
o The four temperaments – choleric, sanguine, melancholic and
phlegmatic
- The Galenic tradition also placed responsibility in individuals to look after
themselves – his views continue to influence much of contemporary beliefs Christian Ideas
- illness was seen as punishment for humankind’s sinfulness
- the church’s 7 deadly sins came to be associated with pathological conditions
of the body
- Christianity drew upon different traditions
- The individual’s religious duty to look after and care for the body, illness was
a sign of weakness and neglect
Biomedicine (cosmopolitan or allopathic medicine)
- emergence of positivism that emphasized that science based upon direct
observation, measurement and experimentation gave direct access to the
real world
o put attention on material reality and a conception of the body as
distinct from the mind (separates person from body)
- rise of individualism in Western society – knowledge of individual physical
body
- the symptoms of illness became signs of underlying pathophysiology
o “how do you feel?” “where does it hurt?”
- required strong political action to organize the profession of medicine and
take legal action against other health practioners
- biomedicine was based on a positivist epistemology that supposedly gave it
access to an outside reality
Biopsychosocial model
- more attention on psychological and social aspects of health
- according to Engel, the aspects of health and illness can be organized in a
hierarchy from the biosphere and society down through the individual’s level
of experience and behavior down to the cellular and subatomic level
o all of these levels interact and need to be considered to understand
health and illness
- to some degree this model has replaced the basic biomedical model
Popular views of health in the west
- the interaction between the classic, the religious, biomedical and the lifestyle
approaches to health and illness
- Herzlich – concluded that health was conceived as an attribute of the
individual – a state of harmony or balance (this provoked further research)
- Blaxter analysed the definitions of health - she classified responses into 9
categories
1) health as not-ill (absence of physical symptoms)
2) health despite disease
3) health as a reserve (the presence of personal resources)
4) health as behavior (the extent of healthy behavior)
5) health as physical fitness
6) health as vitality
7) health as psychosocial well-being 8) health as social relationships
9) health as function
- social representation theory – people rarely confine their definition of
concepts to the descriptive level
- lay perceptions of health and illness can be rooted in the social experience of
people in particular sub cultures
- in Canadian baby boomers, it was found that there is a very activity oriented
conception of health
- in western society the metaphor that is associated with health is that of “self
control”
o infused with moral connotations such that to become ill is not to take
care of oneself
Non-western views of health:
Chinese views of health
- chinese medicine is greatly influenced by the religion and philosophy of
Taoism
o the universe i
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