Transcript Social anthropology and health

Social anthropology and health
Session aims
• To explore what social anthropology as a
discipline is
• To identify how social anthropology
contributes to understandings of health and
illness
• To identify how culture as a social context
relates to and affects health
What is social anthropology?
• Social anthropology is the study of all aspects
of society from a cross cultural perspective
• Historical anthropology was concerned with
other ‘exotic’ cultures
• Contemporary anthropology is concerned with
all cultures
• The anthropology of health and illness
explores the social and cultural dimensions of
health, ill health and medicine
The contribution of anthropology to
understandings of health
• Ethnographic studies have demonstrated that illness
and medical care are socially constructed according to
the cultural context in which we live
• Ethnographic studies have shown how therapeutic
interventions can be influenced by cultural practices
(Prout 1996)
• Ethnographic studies have explored the attitudes of
professions in relation to health care and health
promotion (Kingfisher & Millard 1998)
• In summary, medical anthropology explores health and
illness within its cultural context because culture is
important in relation to health
Culture and health
• Individual health is affected by social context including
cultural influences
• Culture is the collective beliefs, assumptions and values
that are communicated between people within a
society (Boyden 2004)
• Put simply, culture is how we make sense of and
understand the social world in which we live
• Helman (2000:2) defines culture as ‘…an inherited
‘lens’, through which the individual perceives and
understands the world…’
• We all live in a specific cultural context which functions
as either a positive or negative determinant of health
Culture and health
• Culture determines health and illness in many ways
• Culture shapes our perceptions of illness and views of
how we are expected to behave when we are ill
• Different societies have varying rules and cultural
understandings, leading to an array of illness
interpretations and experiences
• Furedi (2008) argues that people’s perceptions of
health and illness are largely shaped by the culture in
which they are located
• ‘...culture does considerably more than shape illness as
an experience; it shapes the very way we conceive of
illness.’ (Kleinman 1977:4)
Different cultural health practices
• Van Telijingen (2000) illustrates that childbirth in
the Netherlands is viewed as a natural and
healthy condition, where medical intervention is
not necessary and therefore is limited. Women
are supported by a midwife and give birth at
home. Comparatively the experience in the UK is
much more medicalised, viewed in terms of the
risk to mother and unborn child and therefore
supervised by medical practitioners at regular
intervals, with birth taking place in the hospital
setting
Cultural interpretations of pain
• People make sense of their symptoms in different ways
and act according to their cultural beliefs – how we
respond to illness is
• Zborowski (1950s) argued that pain was viewed
differently amongst ethnic groups when he conducted
a study in a New York hospital looking at patients,
doctors, nurses and parents of children
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Old-Americans (by birth) responded with stoicism
Irish patients denied their pain
Italian patients were concerned about getting pain relief
Jewish patients focused upon what the pain meant in
terms of their future health
Illness behaviour is socially divided
• Illness behaviour is also influenced by divisions within
societies as well as between them
• Middle class people are more likely to exhibit illness
and health seeking behaviour when compared to
working class people experiencing the same symptoms
(Koos 1954)
• Blaxter and Paterson (1982) argue that working class
children’s symptoms were only recognised as an illness
when they interfered with functionality, suggesting
that minor symptoms were more likely to be ignored
within the lower social classes
Experiencing illness – lay perspectives
• Studying illness accounts has led to useful insights into the
meanings attached to specific illnesses
• Klienmann (1988) distinguishes
– Illness problems – practical difficulties caused by the illness related to
socio-cultural expectations. These often include shame associated
with disfigurement and loss of ‘normal’ functioning and frustration
associated with not being able to perform usual roles such as work
– Illness complaints – these are the descriptions that the patient brings
to the practitioner (these do not necessarily include descriptions of
the illness problems)
• These social experiences of illness and treatment are bounded up
with cultural interpretations and meanings. People understand
illness and disease in a variety of dynamic ways
Example lay beliefs
• Blumhagen (1980) demonstrates a range of lay
beliefs about illness causation in relation to
hypertension (high blood pressure) amongst
men. For example, one patient cited ‘family
arguments’ as the cause leading to symptoms
such as ‘ballooning veins’, ‘dizzy spells and
flashing lights’. He argues that
– ‘Folk’ beliefs can not be entirely separated from
‘formal’ medical ones.
– Individual illness beliefs can be inconsistent and
change rapidly.
What do lay beliefs mean?
• They help people to make sense of their
illness experiences
• They influence illness behaviour i.e. what
foods we eat and the attitudes we believe we
should exhibit in order to recover
• They influence ideas about illness causation
• They influence attitudes to treatment
Culture and treatment
• Medical anthropology has investigated the use of both medical and
alternative treatments and why these are used in a number of
different contexts
• The way in which illness is treated ultimately depends upon how it
is culturally understood
• Illness in some cultures is believed to be caused by external forces,
evil spirits and possessions resulting in treatment as ritual based
including ceremonies to drive away spirits, witchcraft, voodoo and
the use of Shamans and traditional healers (Kirmayer 2004)
• Western medicine works within the biomedical model, and is
individualistic in its treatment approach. This tends to led to a
curative approach based upon the diagnosis of diseases.
• Seeking treatment from ‘professionals’ is however not the first step
in many cultures, as individuals often self-medicate prior to this.
Cultural representations of health and
illness
• How illnesses are described and understood varies
significantly across cultures
• Many languages do not contain a word to describe
cancer (Dein 2006) yet this does not indicate that it
does not exist
• Helman (2007) argues that some diseases, especially
those that are difficult to treat, explain and control
become symbols for more general anxieties that
people have
• Some conditions become more than just diseases, they
become metaphors (Sontag’s 1989) and as a result
become stigmatised
Illness metaphors
• In the West cancer is perceived as an
uncontrollable, invasive and shameful disease
and these views affect both health seeking
behaviour, with patients fearful of a cancer
diagnosis
• Cancer is still often used as an adjective in the
media to describe an array of problems such as
drug abuse, immigration and crime.
• AIDs is often negatively described metaphorically
too, associated with pollution and ultimately
stigmatized
Culture and mental illness
• Medical anthropologists demonstrated that there are
no universal categories of mental illness across all
cultures
• In Aboriginal culture notions of longing for, crying for
and being sick for their country has exactly the same
symptom base as depression (Vicary & Westerman
2004).
• Research has also shown differences in understandings
in relation to schizophrenia; in some cultures
hallucinatory behaviour and suspiciousness are not
necessarily seen as signs of mental illness (Pote &
Orrell 2002).
Culture and mental illness
• Cultural context can influence the incidence of mental illhealth
• Those who exist in a culture that promotes resilienceproducing characteristics are much more likely to be able to
cope with stress and therefore less likely to experience
mental ill-health.
• Different cultures encourage certain personality types such
as hardiness, ego strength, optimism and humour.
• Mental health problems are heavily socially influenced;
feelings such as despair and hopelessness are located in
individual brains, but are also related to patterns of
interaction with families, communities and indeed wider
society (Marsella 2007)
Cultural influences upon health – the
example of alcohol
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We are often not consciously aware of the culturally patterned nature of our
health behaviour as this is taken for granted and feels normal
Cultural influences are negative when for example, they are supportive of health
damaging behaviours such as drinking excessive amounts of alcohol
The incidence of alcoholism and the regular consumption of alcohol vary
significantly between social and cultural groups within and between societies
(Helman 2007)
Alcohol intake is embedded in a matrix of cultural values and influenced by the
expectations of different social groups
Alcohol use is inherently cultural; it is related to cultural meanings and specific
norms of behaviour. It is also related to the social networks that people have and
participate in
Alcohol use can be used to create identity, and can be important in social
relationships too (Helman 2007)
In many senses alcohol consumption may be socially important in some societies
but detrimental to health. Health damaging behaviours can therefore be both
culturally supported and acceptable
Health damaging culturally acceptable
behaviours
• The use of sun-beds and sun-bathing to tan skin, despite
the associated risk of skin cancer
• The culture of obesogenic environments - inactivity,
changes in dietary habits and environmental factors
combine to support increased rates of obesity
• Western culture is generally damaging to health
– materialism and individualism are detrimental to health and
well-being because of their impacts on psychosocial factors
(Eckersley 2005)
– the 24-hour, round-the-clock culture disturbs sleep patterns and
negatively affects health. Shift work, the advent of new
technology and the leisure industry boom have all been argued
to contribute to sleep deprivation, which is ultimately bad for
health (Stanley 2009).
Summary
• Medical anthropology is a sub- discipline of social
anthropology that demonstrates the importance of
culture as a determinant of individual’s understandings
and experiences of both and illness and treatment
• Medical anthropology when critically analysing health
has strongly demonstrated that health is
overwhelmingly social, with culture as a key
determinant of health beliefs, behaviour and treatment
• Anthropology shows that health and illness are
culturally located and that key social and cultural
meanings are associated with health