Global health Issue
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chapter_6.pdf
Global Health 101
Chapter Six Culture and Health
Define Culture
Early definition: “that complex whole which includes knowledge, beliefs, art, law, morals, custom and any other capabilities and habits acquired by man as a member of society.”
(Skolnik, 2012)
Define Culture • Simple definition: “One may call culture ‘behaviors and beliefs that are learned and shared’” and operate in a variety of domains:
– Family – Social groups – Individual growth and development – Communication – Religion – Art – Music – Politics/law – Economy
The Concept of Culture
• Culture - “behavior and beliefs that are learned and shared”
• Influences family, social groups, individual growth, communication, religion, art, politics, the economy
• Society - “a group of people that occupy a specific locality and share the same cultural traditions”
• Health policies and programs must always keep culture in mind
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
Coining
Coining
Gua Sha (coining)
Health Beliefs and Practices
• Cultures vary in views of what is illness, what causes illness, and what should be done about it
• Different ideas about how to prevent problems, what health care they should seek, and the types of remedies that health providers should offer
Ebola: a cultural challenge
Health Beliefs and Practices
Perceptions of Illness • 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”
• Illness - “personal, interpersonal, and cultural reactions to disease or discomfort”
• Some cultures believe illness can be caused by emotional stress, supernatural causes, or bodily imbalance
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 6.1: Selected Examples of Cultural Explanations of Disease
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, manner in which the provider treats them socially
Insane Remedies
Health Beliefs and Practices
Health Providers • Depend on location • Local practitioners of indigenous medicine -
traditional birth attendants, herbalists, priests • Practitioners of western medicine - community
health workers, nurses, physicians
Table 6.2: Select Examples of Health Services Providers
Health Behaviors and Behavior Change
• Leading causes of death in low- and middle- income countries include ischemic heart disease, cerebrovascular disease, HIV, pneumonia, malaria, TB, diarrhea
• Risk factors include nutrition, tobacco use, unsafe sex, unsafe water and sanitation
• How can unhealthy behaviors be changed?
Health Behaviors and Behavior Change
Improving Health Behaviors • 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”
Ecological Theory
Adapted with permission from Murphy E. Promoting Healthy Behavior, Health Bulletin 2. Washington, DC: Population Reference Bureau; 2005.
Health Behaviors and Behavior Change
Improving Health Behaviors • The Health Belief Model (HBM) • 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, barriers to engaging in preventive behaviors
• Self-efficacy- whether or not people feel that they could carry out the behavior
Health Belief Model (HBM)
Health Behaviors and Behavior Change
Improving Health Behaviors • Stages of Change Model • Change is a process and different people are at
different stages of the process
Table 6-4: Stages of Change
Stages of Change Model
Health Behaviors and Behavior Change
Improving Health Behaviors • The Diffusion of Innovations Model • Communication promotes social change • Diffusion is the process by which innovations
are communicated over time among members of different groups
Diffusion of Innovation Model
Understanding and Engendering Behavior Change
Understanding Behaviors Requires assessment of: • Behaviors that are taking place • Extent to which they are helpful or harmful • Underlying motivation for these behaviors • Likely responses to different approaches to
changing the unhealthy behaviors
Understanding and Engendering Behavior Change
Changing Health Behaviors • 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
Changing Health Behaviors • Mass media • Often uses radio or educational performances
to get a message across
Understanding and Engendering Behavior Change
Changing Health Behaviors • Social Marketing • Application of tools of commercial marketing
to promote a behavior change • Depends on careful market research and
understanding of local culture and values
Mass Media
Understanding and Engendering Behavior Change
Changing Health Behaviors • Health Education • Comes in many forms such as classroom or
mass media • Successful programs are clear, provide
accurate information, gear content to target group
Mass Media
Understanding and Engendering Behavior Change
Changing Health Behaviors • Conditional Cash Transfers • A government agency provides an economic
incentive for families who engage in a certain healthy behavior
Table 6.6: Selected Factors for Success in Health Promotion
Source: Adapted with permission from Murphy E. Promoting Healthy Behavior, Health Bulletin 2. Washington, DC: Population Reference Bureau; 2005.
Social Assessment
• Social assessment - “a process for assessing the social impacts of planned interventions or events or and for developing strategies for the ongoing monitoring and management of those impacts”
• Important to include the affected communities
Assessment
