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9781284145403_SLID_CH07.pptxChapter Seven
Culture and Health
Learning Objectives
Define culture
Describe the most important conceptual relationships between culture and health
Outline some of the theories of how behavior change occurs in health
Describe some key measures to promote behavior change for better health
The Importance of Culture to Health
Culture is related to health behaviors
Culture is an important determinant of people’s perceptions of illness
Culture affects usage of health services
Different cultures have different health practices
The Importance of Culture on Health
China has a well articulated system of “traditional medicine” reflected in this Chinese medicine shop.
© Barry Austin/Photodisc/Getty Images.
The Concept of Culture
Culture: “behavior and beliefs that are learned and shared”
Culture influences family, social groups, individual growth, communication, religion, art, politics, and the economy
Health policies and programs must always keep culture in mind
Critical to note – some cultural practices enable good health but some do not
Health Beliefs and Practices
Perceptions of Illness
Illness: “personal, interpersonal, and cultural reactions to disease or discomfort”
Vary across groups
One culture may view certain signs or symptoms as an affliction while others consider them normal
Health Beliefs and Practices
Perceptions of Disease
Disease: “malfunctioning or maladaptation of biologic and psychophysiologic processes in the individual”
Some cultures believe illness can be caused by emotional stress, supernatural causes, or bodily imbalance
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Health Beliefs and Practices
Folk Illness
Cultural interpretations of physical states that people perceive to be illness, but that do not have a physiologic cause
Efforts to improve health need to consider these beliefs
Table 7-1: Health Beliefs and Practices
Modified from Scrimshaw, S. C. (2006). Culture, behavior, and health. In M. H. Merson, R. E. Black, & A. Mills (Eds.), International public health: Diseases, programs, systems, and policies (pp. 53–78). Sudbury, MA: Jones and Bartlett.
Health Beliefs and Practices
The Prevention of Illness
Many cultures have taboos that concern avoiding illness
Many concern foods to avoid during pregnancy
Wide variety of ritual practices to avoid illness
Health Beliefs and Practices
The Diagnosis and Treatment of Illness and the Use of Health Services
Common to try a home remedy, then visit a local healer, then consult a “western doctor”
“Patterns of resort” affected by cost of services and manner in which the provider treats them socially
Health Beliefs and Practices
Modified from Scrimshaw, S. C. (2006). Culture, behavior, and health. In M. H. Merson, R. E. Black, & A. Mills (Eds.), International public health: Diseases, programs, systems, and policies (pp. 53–78). Sudbury, MA: Jones and Bartlett.
Health Behaviors and Behavior Change
Risk factors for leading causes of death related to culture include:
Nutrition and eating practices
Tobacco use
Unsafe sex
Hygiene
How can unhealthy behaviors be changed?
Health Behaviors and Behavior Change
Improving Health Behaviors
The Ecological Perspective
The Health Belief Model
Stages of Change Model
The Diffusion of Innovations Model
Health Behaviors and Behavior Change
The Ecological Perspective
“Health related behaviors are affected by, and affect, multiple levels of influence”
“Behavior both influences and is influenced by the social environments in which it occurs”
—E. Murphy
Health Behaviors and Behavior Change
Modified with permission from Murphy, E. (2005). Promoting healthy behavior. Health bulletin 2. Washington, DC: Population Reference Bureau.
Health Behaviors and Behavior Change
The Health Belief Model
People’s health behaviors depend on their perceptions of their likelihood of getting the illness, the severity of the illness, the benefits of engaging in behaviors that prevent the illness, and barriers to engaging in preventive behaviors
Self-efficacy: whether or not people feel that they could carry out the behavior
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Health Behaviors and Behavior Change
Stages of Change Model
Change is a process and different people are at different stages of the process
The stages of behavior change are:
Precontemplation
Contemplation
Decision/determination
Action
Maintenance
Health Behaviors and Behavior Change
The Diffusions of Innovations Model
Communication promotes social change
Diffusion is the process by which innovations are communicated over time among members of different groups
This model focuses on how people adopt innovation, but not how they might maintain what they have adopted
Understanding and Engendering Behavior Change
Understanding behaviors requires assessment of:
Behaviors that are taking place
Extent to which they enable better health or may harm health
Underlying motivation for these behaviors
Likely responses to different approaches to changing the unhealthy behaviors
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Understanding and Engendering Behavior Change
Changing Health Behaviors
Community Mobilization
Mass Media
Social Media
Social Marketing
Health Education
Conditional Cash Transfers
Achieving Success in Health Promotion
Understanding and Engendering Behavior Change
Community Mobilization
Engage entire community in efforts to identify problems and promote healthy behaviors
Leaders in community need to be mobilized, willing to champion change
Understanding and Engendering Behavior Change
Mass Media
“Entertainment-education”
Most people in low- and middle-income countries have access to radio
Soap operas are also popular
The use of mobile technologies for promoting behavior change is growing
Understanding and Engendering Behavior Change
Social Media
Social media allows people to engage with content, rather than passively receiving it
Messages on social media platforms may spread misinformation
Information technologies are becoming increasingly accessible in low- and middle-income countries
Understanding and Engendering Behavior Change
Social Marketing
Application of tools of commercial marketing to promote a behavior change
Depends on the four Ps:
Attractive product
Affordable price
Convenient places to buy the product
Persuasive promotion
Understanding and Engendering Behavior Change
Health Education
Comes in many forms such as classroom or mass media
Successful programs are clear, provide accurate information, engage stakeholders, and gear content to target group
Understanding and Engendering Behavior Change
Barber shops in many countries are “community centers” in which men congregate for discussion. Several countries have created programs in which barbershops and barbers provide health education messages
Courtesy of Mark Tuschman.
Understanding and Engendering Behavior Change
Conditional ( and not) Cash Transfers
A government agency provides an economic incentive for families who engage in a certain healthy behavior
Incentivized behaviors; for example, giving birth in a hospital or participating in nutrition and baby care programs
Unconditional transfers might be just as effective in arenas
Social Assessment
Social assessment: “a process for assessing the social impacts of planned interventions or events and for developing strategies for the ongoing monitoring and management of those impacts”
Important to include the affected communities in the design and implementation of the assessment and its follow-up
Main Messages
Culture is an important determinant of health
Perceptions of illness and disease vary considerably across cultures
Many forms of traditional behavior are conducive to good health but some are not
It is important to consider how healthy behaviors can be promoted
Main Messages
There are a number of models of how behaviors can be changed
Several approaches are often important to changing behaviors
Social assessments can be an effective tool for setting the foundation for health efforts and behavior change
