Transcript Cultural Dimension Rates of Disease

Culture and Health
The Definition of Health Across
Cultures
• A state of complete physical, mental, and social wellbeing, and not merely the absence of disease or
infirmity”-World Health Organization
• U.S. view of health is guided by the biomedical
model, where disease is attributed to a result from a
specific cause in the body (pathogen).
• Consequently, treatment in the U.S. is focused on
making a treatment within a person.
Definition of Health
in Other Cultures
• China and Greece-view health not only as the
absence of negative states but also the presence of
positive ones.
• China’s notion of health is based on religion and
philosophy, with special emphasis on Ying and Yang
(positive and negative energies); balance is health.
– An imbalance can be caused by foods, social
relationships, the weather, or supernatural forces.
– Maintaining balance involves mind, body, spirit and the
natural environment.
Definition of Health
in Other Cultures (cont.)
• Within the U.S.-Native Americans
– Base health on religion, a holistic view, and living
in harmony with oneself and one’s environment.
• Incorporating Other Cultures in the U.S.
– Mainstream culture is beginning to accept and
embrace ideas of health from immigrants.
– Using alternative practices such as acupuncture,
homeopathy, herbal medicines, and spiritual
healing.
National Institutes of Health (NIH)
• In recent years, the NIH, the worlds leading
biomedical research operations, added a new
Center to it’s long list of Centers and Institutes
to support research activity dealing with
complementary and alternative medicine. The
National Center for Complementary and
Alternative Medicine is now in full operation!
Conceptions of the Body
• Metaphors for Body or Physical Health vary
across cultures
– Popular Metaphor-Balance (various systems in the
body are in harmony) and Imbalance within the
body.
• Suggests that the body is comprised of four
humors: blood, phlegm, yellow bile, and black
bile-when any of these are not in balance,
disease occurs.
Conceptions of the Body Health
(cont.)
– Latin American Culture
• A balance between hot and cold-not
temperature, but the power of different
substances in the body. Below fever “warm” is
good; cold is bad.
– Social and Cultural Factors play a Major role
• In America and Europe, individuals in higher
social classes have lower body weights and
individuals in lower classes have higher body
weights.
Psychosocial Determinants of
Health and Disease
• The Study of Type A personalities showed an
increased risk for developing cardiovascular disease
opened the door to health psychology.
• Studies have documented the link between
psychosocial factors and health/disease.
– Unemployment and mortality, goal frustration and
negative life events and gastrointestinal disorders,
stress and the cold, etc.
– SES is consistently associated with health outcomes
with people of higher SES having better health (in
mortality rates and almost every disease) then people
of lower SES.
Note of Caution
• Although past research has demonstrated that
psychosocial factors play an important role in
the etiology (study of disease causes) and
treatment of disease, more research is needed
in identifying the specific mechanisms that
mediate those relationships.
Cultural Dimensions and Disease
• Cardiovascular Disease is important to study
cross-culturally because of its high incidence
in the U.S.
• Marmot and Syme Study (1976)
– Grouped Japanese Americans into groups
according to traditionalism; found that the “most”
traditional Japanese has the lowest incidence of
heart disease, and the “least” traditional had a 3-5
times higher incidence of heart-related health
problems.
Individualism-Collectivism
• Triandis et al. (1988)-extended the study to
include the Individualism-Collectivism
Dimension
– Found that the most individualist groups
(European Americans) had the highest rate of
heart disease.
– Triandis suggested that social support buffers
against stress, reducing the risk of heart disease,
noting that collectivists cultures have stronger and
deeper social ties.
Individualism-Collectivism (cont.)
• Research by Matsumoto and Fletcher (1996)
investigated the possibility that collectivists
cultures may be at higher risk for other
diseases.
– They obtained mortality rates for infections and
parasitic diseases, tumors, diseases of circulatory
systems, heart diseases, cerebrovasular diseases
and respiratory system diseases from the World
Health Statistics Quarterly for 28 countries.
Other Cultural Dimensions
– Looked at incidence rates for each disease at ages
1, 15, 45, and 65.
– They developed a cultural index previously
obtained by Hofstede and developed
classifications: Individualism vs. collectivism,
power distance, uncertainty avoidance, and
masculinity.
Hofstede’s Dimensions
•
•
Power Distance (PD)
--the degree to which different cultures
encourage and maintain power and status
differences among the members of an
organization.
Uncertainty Avoidance (UA)
--the degree to which different societies
develop ways to deal with the stress and
anxiety of uncertainty.
Hofstede’s Dimensions (cont.)
• Individualism-Collectivism (IC)
--the degree to which a culture encourages, fosters,
and facilitates the needs, wishes, desires, and values
of the individual over those of a group.
Members of individualistic cultures see themselves
as separate and autonomous individuals, whereas
members of collectivistic cultures see themselves as
fundamentally connected to others.
Hofstede’s Dimensions (cont.)
• Masculinity (MA)
--the degree to which cultures foster
traditional gender differences among their
members, e.g. drawing organizational
parallels between gender relations that are
present in the larger society.
Findings from Matsumoto et al.
Cultural Dimension
Rates of Disease
Higher Power Distance
•Higher rates of infections and
parasitic diseases.
•Lower rates of malignant neoplasm,
circulatory disease, and heart
disease.
Higher Individualism
•Higher rates of malignant neoplasm
and heart disease.
•Lower rates of infections and
parasitic diseases, cerebrovascular
disease.
Higher Uncertainty
Avoidance
•Higher rates of heart disease.
•Lower rates of cerebrovasular
disease and respiratory disease.
Higher Masculinity
•Higher cerebrovascular disease.
Culture Discrepancies
• Although the studies indicate that culture
influences physical health, it is not the only
relevant variable.
• Matsumoto et al (1999) studied the impact the
discrepancy of one’s personal cultural values and
those of society have on health.
– Undergraduates reported their personal cultural
values, their perceptions of society’s values.
– They also reported coping strategies, anxiety, and
depression.
Culture Discrepancies (cont.)
– Their physical health and psychological well-being were
also assessed.
– The results indicated that greater cultural discrepancies
were associated with greater needs for coping.
– Coping strategies were correlated with depression and
anxiety, which in turn were correlated with scores on the
physical health symptoms.
– These findings suggest that cultural discrepancies
mediate health outcomes.
Cultural Influences on
Attitudes and Beliefs
• Matsumoto et al. (1995) studied Japanese and
Japanese American women on attitudes and
values related to osteoporosis and treatment,
and found many cultural differences.
– For instance, more American women reported
people other than friends and family would care
for them. Also, Japanese women were more likely
to attribute the cause to fate, chance, or luck.
Attitudes and Beliefs
• Domino and Lin (1993) asked students in Taiwan and US to
rate cancer related metaphors.
– Taiwanese students had significantly higher scores than American on
terminal pessimism and future optimism.
• Many other studies have documented differences in beliefs.
– Edman and Kameoka reported differences between Filipinos and
Americans in illness schemas
– Poole and Ting found differences between Euro-Canadian and IndoCanadians attitude towards maternity.
Lifestyles and Behaviors
Culture
Diet
Exercise/activity levels
Health/related behaviors
• Smoking
• Tobacco use
• Alcohol use
• Etc.
Emotion/stress/coping
Genetics
Individual history
Ancestry
Health/Disease
Health Care Systems
Quality of care
Systems/organizations
Insurance
Etc.
Model of Cultural Influences on Health and Disease
Attitudes and Beliefs
Definitions of health
Conceptions of the body
Attributions about
disease causality
Locus of control
Social networks and
support
Environment
Temperature
Climate
Sanitation
Etc.