Chapter Seven: Culture and Health
Introduction – pg. 180
- Cultures vary in their perceptions of illness and how they define/consider “healthy” vs “disease”
- Disease: “malfunctioning/maladaptation of biological and psychophysiologic processes in the
- Illness: “personal, interpersonal, and cultural reactions to disease or discomfort”
- Therefore, how we view health, disease, and illness is strongly shaped by our [Western] culture.
Cultural Differences in the definition of health – pg. 180
- Health: “a state of complete physical, mental and social well-being, and not merely the absence of
disease or infirmity”… “the enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being, without distinction of race, religion, political beliefs or
economic/social conditions” – WHO (world health organization) definition of health (which
represented 61 countries). *still used today
- In the USA, views of health influenced by biomedical model of health and disease… 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/developmental abnormality (such as being born with a
mutated gene), or physical insult (such as being exposed to a carcinogen – a cancer-producing
agent)… the biological root of disease is treatment focusing on addressing biological aspects of
- Biopsychosocial model – (Engel, 1977) health and disease need to be considered from several
dimensions (bio, psyc, and social)..
• Biological – genetics, physiological functioning of the body
• Social – lifestyles and activities, quality of friendships, living conditions (ie. Poverty)
• Psychological – beliefs and attitudes towards health, emotions, positive thinking
(* a more accurate, complete understanding of health)
- In China, concept of health based on Chinese religion focuses on Yin and Yang – resprenting
negative and positive energies, respectively.. Our bodies are made up of of yin and yang elements
– balance between the 2 = good health; imbalance (too much yin or too much yang) = poor health.
Things that disturb these balance: eating too many foods from one of the elements, a change in
social relationships, weather, the seasons, supernatural forces, etc. Thus, balance between mind,
body, spirit, and natural environment.. a HOLISTIC view. Balance creates a positive state – a
synergy of the forces which is called health. (*common concept [balance vs imbalance] across
- Hippocrate’s theory: the body in comprised of 4 humors: blood, phlegm, yellow bile, and black
bile. Too much of too little throws body out on balance = disease. Influences views of the human
body and health in most industrialized societies today.. still use derivatives of the 4 humors today
such as sanguine, phlegmatic, and choleric.
- Latin American Cultures: involves a balance between hot and cold – NOT temperature wise; but
the intrinsic power of different substances in the body. Some illnesses/states are hot, others are
cold. (* similar to yin & yang concept of balance)
• When a person is in a HOT condition (ie. fevers), they are given cold foods to counteract
the situation. & vise versa when in a COLD condition; give hot foods.
- In the USA, incorporating balance in a positive aspect of health (ie. Balanced lifestyle – optimal
balance between work and play). Homeostasis – maintaining steady, stable functioning in our
bodies when there are changes to the environment. When homeostasis is not maintained, could result in illness.
- Although there are many different perspectives of health across cultures, also many similar
- Ie. If illness due to individual choices or biologically disturbed, treatment focus on individual-
level factors.. if illness due to relationships, nature forces, then treat by focusing on correcting
- Coping and treatment closely tied to our attributions of the causes determining health, illness &
Comparisons Within Cultures - pg. 182
- Perspectives differ due to dominant/mainstream culture vs. nondominant/ethnocultural groups (ie.
Natives – view health as being in harmony with self and environment)… WHO’s definition
(above) does not mention spiritual well-being – feeling connected to and in balance with the
spiritual world. *which is the cornerstone of good mental AND physical health.
• Circle of Wellness – health model used by Natives.. spirit well-being is focal point for the
other 4 domains (physical, social, emotional, and mental).
-Good because rise/interest in alternative health practices such as homeopathy, herbal
medicines, spiritual healing, etc. Especially growing field in Complementary and
Alternative Medicine (CAM): incorporates medical and health care systems and practices
that are NOT considered conventional medicine to treat illness/promote health. **In
health survey, 38% of USA adults used CAM.. Asians used it 40%, African-americans
used it 26%, Latino’s used it 24%. In Asians, majority preferred using CAM vs
- Therefore, with the increase of migration, immigration, and globalization, changes our views on health.
3 Indicators of Health.. [2 objective, 1 subjective] (Worldwide) – pg. 183
• Life Expectancy (L.E)
-the average number of years a person in expected to live from birth (*Refer to Fig. 7.2
for life expectancy rates in selected countries.. Monaco – longest @ 90 yrs.. Angola –
shortest @ 40 yrs.. Canada – long @ 81 yrs).
- Wealth and resources of a country explain the differences in life expectancy rates.
Wealthier countries have more resources and better access to diet, nutrition, advanced
technology, etc. Poor nations with fewer resources have lack of access to water,
- In the USA, L.E differs by ethnicity (due to socioeconomic status) & gender.. Euro-
americans: L.E is 78.3 yrs (females = 80.5 yrs).. African-americans: L.E is 73.2 yrs
(males = 69.5 yrs).
- TREND: in general, we are living LONGER across the globe.. in 1950’s, L.E was 46
yrs.. in 2009, L.E was 69 yrs, by 2050, expected L.E is 75 yrs.
• Infant Mortality
-the number of infant deaths (one year old or younger) per 1,000 live births.
- Angola has highest I.M rates @ 178 infant deaths per 1,000 live births. Monaco has
lowest I.M rates at 2 infant deaths per 1,000 births.
- *compared to other industrialized countries, I.M rates in the USA are among the higest
- TREND: steady decrease in I.M rates in the USA.. in 2010 – 6 infant deaths per 1,000
births.. African-american infants have the highest I.M rates @ 14 deaths per 1,000 births..
Natives – 6 deaths, Euro-Amer’s – 6, Latino – 6, Asians – 5.
• Subjective Well-Being (SWB) -one’s perceptions, and self-judgments of health of well-being.. encompasses a person’s
feelings of happiness and life satisfaction.
- Goal: To improve people’s lives beyond the elimination of misery
- high levels of subjective well-being beneficial to effective functioning of societies..
FIG.7.4 pg. 186.
- Study (Cohen et all, 2003): healthy people injected with cold virus.. those who reported
high SWB were less susceptible to the virus, had stronger immune systems, & fewer
heart attacks. Therefore, those with high SWB may lead to long life expectancy. Why?
High SWB people tend to engage in healthier lifestyles.
- relation to per capita gross domestic product.. economic factors account for some of the
variation in SWB differences.
Genetic Influences on Physical Health – pg.187
- Most diseases linked to complex, multiple factors such as gene mutation interacting with
environmental factors such as stress, or diet.
- Most common gene diseases: cancer, high blood pressure, diabetes, obesity.
- Ie. Sickle cell anemia most common among African-americans and Mediterranean populations..
cystic fibrosis most common in northern Europeans.
- Humans living in the same geographical locations tend to me more genetically similar to one
- More genetic variation within racial/cultural groups than between.
- Examining how genes and enviro. Interact overtime is our best chance to understanding why some
diseases are more apparent in some cultures than others.. use multilevel, interdisciplinary research
- Genes can interact with enviro. On various levels – cellular, individual, group, &/or societial.
Psychosocial Influences on Physical Health – pg.188
- Studies linking psychosocial factors and health/disease states: Steptoe (2008) – ie. Stress and the
common cold, negative life events and gastrointestinal disorders.
- Health Disparities: differences in health outcomes by groups, people of different ethniciti