What is Culture?
Culture is all around us and pervades our very being. An inclusive definition of
culture has been provided by Corin who defines it as:
a system of meanings and symbols. This system shapes every area of life, defines
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
As societies evolved they have developed various health belief systems,
knowledge of which is sometimes confined to those who undergo specialized
Kleinman (1980) distinguished between three overlapping sectors of any health-
1. The popular sector refers to the lay cultural arena where illness is first defined
and health care activities initiated;
2.The professional sector refers to the organized healing professions, their
representations and actions; and
3. The folk sector refers to the non-professional, non-bureaucratic, specialist
sector that shades into the other two sectors.
Although this threefold division is widely cited, other researchers have preferred a
simpler two-fold division into professional and popular realms. Systematicity,
coherence and interdependence are aspects of the professional belief systems
Western Health Belief Systems
Classical Views of Health
The classical view of health and illness in the West is derived from the Graeco-
Arabic medical system.
Galenic medicine provided an expert system developed from the Greeks, in
particular the work of Hippocrates and his colleagues.
The central concept in Galens formulation was the balance of four bodily fluids or
humours: bile, phlegm, blood and black bile.
Balance was equated with health and imbalance implied ill health. These fluids
have been linked with the four seasons (e.g. an excess of phlegm was common in
the winter leading to colds, while an excess of bile led to summer diarrhea); the
four primary conditions (i.e. hot, cold, wet and dry); and the four elements (i.e.
air, fire, earth and water).
Medieval scholars also added four temperaments (i.e. choleric, sanguine,
melancholic and phlegmatic). Christian Ideas
During the Middle Ages in Europe, Galens work became confined more to the
learned few and other ideas based upon religion became more commonplace.
Illness was often seen as punishment for humankinds sinfulness.
The Churchs seven deadly sins even came to be associated with pathological
conditions of the body. For example, tumors and inflammations symbolized pride
while sloth led to dead flesh and palsy
Christianity drew upon different traditions. The ascetic tradition scorned concern
for the body and instead promoted acts such as fasting and physical suffering,
which supposedly led to spirituality.
With the Protestant Reformation this belief was replaced with the idea that the
body had been given to humans by God. It was the individuals religious duty to
look after and care for the body. Illness was seen as a sign of weakness and
To honor God required living a healthy life and abstaining from excess, especially
in terms of sex and diet.
Despite the authority of the Church, these religious interpretations began to decline
with the growth of medical science.
Two streams of thought in knowing the world dominated during the Enlightenment.
The first was the acceptance of the distinction between superstition and reason.
The second was the emergence of positivism that emphasized that science based
upon direct observation, measurement and experimentation gave direct access to
the real world. This approach concentrated attention on material reality and a
conception of the body as distinct from the mind.
The eighteenth century saw the rise of individualism in Western society. In
previous eras the group or collective organized ways of thinking and acting,
which in turn was interconnected with the physical and spiritual world.
Professional understanding of health and illness became more closely entwined
with knowledge of the individual physical body.
Biomedicine came to dominance for several reasons, including the fact that it was
in accord with a broader view of humans, its alliance with physical science and
the steady improvement in the health of the population that was attributed to
medical intervention. The focus on the body is in accord with the Western
emphasis on the individual. Further, the separation of mind and body offers a
subtle articulation of the persons alienation from the body in Western society, but
this alienation is found, as well, in every sphere of economic and political life.
Biomedicine separates the person from the body
The biopsychosocial model of health
The dominance of this biomedical system has come in for substantial challenge
both from the scientific establishment and the public. Initially, this was reflected
in a call for more attention to the psychological and social aspects of health. According to Engel (1980) the various aspects of health and illness can be
organized in a hierarchy from the biosphere and society down through the
individuals level of experience and behaviour to the cellular and subatomic level.
All of these levels interact and need to be considered if we are to under- stand
health and illness. With varying degrees of enthusiasm this model has in some
respects replaced the basic biomedical model
Popular views of health in the West
Evidence from a series of studies of popular beliefs about health and illness in
Western society illustrates the interaction of what can be described as the classic,
the religious, the biomedical and the lifestyle approaches to health and illness.
The most influential study of Western lay health beliefs was carried out by Herzlich
(1973). She conducted interviews with a sample of French adults and concluded
that health was conceived as an attribute of the individual a state of harmony or
balance. Illness was attributed to outside forces in our society or way of life.
Blaxter analyzed the definitions of health provided by over 9000 British adults in
the health and lifestyles survey. She classified the responses into nine categories:
1. Health as not-ill (the absence of physical symptoms)
2. Health despite disease
3. Health as reserve (the presence of personal resources)
4. Health as behaviour (the extent of healthy behaviour)
5. Health as physical fitne