Natural selection and adaptation in disease and health • Nutrition in an evolutionary and cultural perspective • Individual physiological adaptations • Cultural adaptations and health • Disease in ecological context. Placebos versus nocebos • History of the placebo effect • What placebos affect • Placebos and total drug effects • Total drug effects in the social dynamics of psychedelics • Cultural effects on drug addiction and addiction • Theories of placebo mechanisms • Information and meaning as placebo mechanisms.
APPLICATIONS
BIOCULTURAL INTERACTIONS
Hypercholesterolemia as a Medically Constructed Disease 187 Body Image and Symptom Recognition as Contributing Factors in CVD 199.
CASE STUDIES
CULTURE AND HEALTH
PRACTITIONER PROFILES
I wrote this text on culture and health to present basic anthropological perspectives for understanding illness and disease and promoting healing and health. The text has two main audiences: health science students, particularly medical anthropology, nursing and public health students, and health care professionals, including physicians, nurses, psychologists and counselors, and public health and social workers.
MEDICAL ANTHROPOLOGY’S PERSPECTIVES
Education about cultural patterning of health and health care is a fundamental aspect of preparing health professionals. Cultural systems models provide tools to organize our understanding of the many factors that affect health.
CHAPTER OVERVIEWS
Cultural influences on illness illustrate the limitations of the biomedical model and the socially constructed nature of health ailments. These biocultural interactions are also exemplified in cross-cultural differences in emotions and in the cultural shaping of emotional responses.
SPECIAL FEATURES OF THE TEXT
Glossary items in bold in the text and compiled with definitions at the end of the book are provided to facilitate learning of specialized concepts from medical anthropology. A greater awareness of social and cultural contexts that affect health and healthcare makes us better informed suppliers and consumers. state the roles of culture in health and well-being, and in the care of patients and the prevention of disease.".
ACKNOWLEDGMENTS
CULTURE AND HEALTH
APPLIED MEDICAL ANTHROPOLOGY
LEARNING OBJECTIVES
Health care providers and patients are more effective in managing their health and care with cultural awareness and the ability to manage the many factors that affect well-being. This contributed to her seizures and repeated visits to the emergency department, which left Lia's doctors frustrated and angry.
CASE STUDY
The Hmong have changed in many ways, taking on influences from other cultures that have served them well. Experimental procedures and treatments unrelated to her complaints reinforced many of the Hmong's worst fears: that doctors would eat the livers, kidneys and brains of their patients.
CULTURE, ETHNOMEDICINES, AND BIOMEDICINE
Health concerns often feature prominently in the most important cultural institutions from birth to death. Health choices in the United States are strongly influenced by biomedicine, but people around the world, including many in this country, also use other ethnosystems.
CULTURAL COMPETENCE IN THE HEALTH PROFESSIONS
The many different areas of medical anthropology reflect a growing trend of applying cultural knowledge to solve health problems; a variety of aspects are listed below in "Applications: Areas of Medical Anthropology." Cultural knowledge and intercultural perspectives help facilitate relationships between provider cultures, patient cultures, and institutional cultures. Identify or develop "cultural healing": psychological, social and spiritual healing processes. Study cultural anthropology of ethnic health practices.
CONCEPTS OF HEALTH
PRACTITIONER PROFILE
Health is analyzed from the perspective of social factors that affect the distribution of health resources and threats to health (eg, environmental pollution). This has required an expansion of the concept of health from the "absence of disease" to views that reflect culturally valued functional abilities and concepts of well-being.
SYSTEMS APPROACHES TO HEALTH
A more inclusive scientific approach to the study of health requires addressing biological, psychological, social and other cultural determinants that affect health and the physical environment. Cultural systems approaches to health examine the interaction of the physical and sociocultural environments.
SUMMARY
Construction perspectives emphasize that culture influences health, exemplified in the relationship of symptom recognition to cultural values and social norms. Additional models are also provided in Chapter Six in the coverage of the psychocultural model.
CHAPTER SUMMARY
This requires an understanding of patients' models of health and skills in negotiating between doctor and patient perspectives. Interdisciplinary understanding of the ways in which cultural beliefs have effects on physiological processes (Chapter Nine).
KEY TERMS
What are some of the physical and environmental conditions in your community that affect health status? No Yes Social service agencies should have advisory and review committees that include representatives of all major ethnic groups in their service area.
ADDITIONAL RESOURCES
DISEASE, ILLNESS, SICKNESS, AND
THE SICK ROLE
EXPERIENCE OF MALADIES
Lia jerked and twitched with her eyes rolled back and fainted, symptoms of a condition the Hmong call quab dab pen, the meaning of which gives the title to Anne Fadiman's book: "the spirit catches you, and you fall down." The ways in which Lia's parents and the Hmong community viewed her condition (a potential blessing of spirit powers) and her medication (something that caused her problems) were never recognized by the doctors.
BIOMEDICAL ASSUMPTIONS ABOUT DISEASE
This problem is illustrated in a cross-cultural review of the DSM's diagnostic category of somatoform disorders. The political functions of medicine are illustrated in the social processes of diagnosing mental retardation.
SOCIAL MODELS OF MALADIES AND DIAGNOSES
Constructivist perspectives emphasize cultural influences, including social relationships, as fundamental in the causation of biological disorders. It would seem that way today, given the amount of circumcision being performed in the United States.
ILLNESS AND SICKNESS ACCOUNTS
Pennebaker's (2003) research on the effects of illness stories on sufferers illustrates that they are powerfully healing. Creating an illness story provides a narrative that helps cope with trauma-induced anxiety.
THE SICK ROLE AND SICKNESS CAREER
Consequently, the patient is not relieved of responsibility, even if the illness is attributed. The social benefits of the sick role can make African Americans and the sick role.
AIDS AS DISEASE, SICKNESS, AND ILLNESS
Experiences of AIDS patients and HIV positive persons include consequences of the social perceptions of these conditions. Relatively secretive and hidden aspects of high-risk behavior Social reactions that influence the perception of AIDS.
HEALTH BELIEFS AND EXPLANATORY MODELS
They can also reveal patients' "hidden agendas," as shown in "Applications: Retrieving an Explanatory Model." Providers need to understand patients' explanatory models in order to tailor treatment plans to patients' beliefs and expectations, and to reach consensus about the nature of disease and treatment of African American CVD and disease beliefs.
CULTURAL COMPETENCE IN HEALTH CARE
CROSS-CULTURAL ADAPTATIONS IN HEALTH CARE
Being illiterate, they were unable to keep track of the information relevant to the medication of their child. Translators are often ineffective because the Hmong language does not express many of the concepts used by doctors.
CULTURAL COMPETENCE
These involve increasing degrees of awareness of cultural influences on the self and the abilities to effectively adapt to cultural differences. Cultural Awareness and Acceptance Awareness of the importance of cultural differences and knowledge of their influence on behavior is the beginning of intercultural adaptation and effectiveness.
ANTHROPOLOGICAL PERSPECTIVES ON CROSS-CULTURAL ADAPTATION
CONCEPTS OF CULTURE
Physical stress management and maintenance of one's physical well-being are important for cross-cultural adaptation. Self-awareness must include consideration of the nature and sources of one's attitudes toward other ethnic groups.
INTERPERSONAL SKILLS FOR INTERCULTURAL RELATIONS
In provider-client relationships, active listening can only occur with the acquisition of the patient's perspective. This requires knowledge of the culture's social interaction rules, including appropriate social distance and personal space, touch, culturally appropriate eye contact, and other social dynamics.
SPECIALTY CROSS-CULTURAL APPLICATIONS OF MEDICAL ANTHROPOLOGY
Prevention programs require an understanding of the cultural conceptions of disease that increase risk as well as the actual disease risks. Old hospital culture and social structure prevent effective communication and collaboration, which affects patients' perceptions of the quality of care.
USING CULTURE TO CARE FOR PATIENTS AND PROVIDERS
Using an interpretive model helps bridge the conceptual gap between providers and patients, improves understanding of the patient's illness and illness behavior, and in turn enables providers to be more responsive. This is based on an understanding of patients' everyday life experiences and broader social conditions that affect their well-being.
CULTURAL SYSTEMS MODELS
CULTURAL MODELS FOR HEALTH ASSESSMENT
Aspects of cultural systems models discussed in this chapter focus on nutrition, reproductive behaviors, family structures, and ideological culture. The principles of religious healing and traditional ethnomedical practices - the "legacy of the witch doctor" - are treated as part of anthropological medicine.
CULTURAL SYSTEMS APPROACHES TO HEALTH
The effects of health practices and beliefs, particularly as reflected in illness beliefs and illness behaviors, were discussed in Chapter Two. Specific cultural characteristics, including identity, self-concept, social norms, and behavioral and communication patterns, illustrated in the psychocultural model and indigenous psychology (Chapter Six).
CULTURAL INFRASTRUCTURE, STRUCTURE, AND SUPERSTRUCTURE
The Political Sphere: Economy, Division of Labor, Class Systems, and Political Structures The family provides the context for many aspects of health and disease, from genetic inheritance to high-risk behaviors acquired through socialization. Social structure is linked to infrastructure through labor and resources, which affects the nature and distribution of health care resources and risks, and directly affects individual and group health status.
INFRASTRUCTURE
Work provides resources for purchasing health care and is the leading source of health benefits in the United States. The development of modern midwifery practices led to the adoption of the lithotomic position, with the mother on her back with her feet in the air in stirrups.
FAMILY INFLUENCES ON HEALTH AND DEVELOPMENT
The expectation in some cultures that women should be subordinate to men can have a number of effects in health care settings. Providers must recognize cultural gender expectations and construct interactions that facilitate the achievement of health care goals.
UNDERSTANDING WORLDVIEW AND SYMBOLIC RESOURCES
These help in letting go of dysfunctional identities and developing a new sense of self that emerges from the effects of experience and knowledge. We begin to experience the saints as comforters who give a sense of the presence of others who are there to help.
COMMUNITY HEALTH ASSESSMENT
Minimum IOM indicators for community health profiles include sociodemographic characteristics, the health status of the population and its subgroups, major risk factors in the environment, and the resources and health status of the population. Assessments of the effects of intervention also focus on political leaders and policy makers who have the potential to bring about long-term changes.
RAPID ASSESSMENT, RESPONSE, AND EVALUATION (RARE)
A community advisory group provides the context for community consideration of relevant data and the identification of a specific project focus. The field assessment team is familiar with the health consequences of the disease under investigation.
SELF-ASSESSMENTS
A participatory action research pilot study of urban health disparities using rapid assessment response and evaluation. Rapid assessment of the HIV/AIDS crisis in racial and ethnic minority communities: an approach for timely community interventions.
ETHNOMEDICAL
SYSTEMS AND HEALTH CARE SECTORS
POPULAR, FOLK, AND PROFESSIONAL HEALTH CARE SECTORS
But many traditional rituals involve animal sacrifice, which is banned in this country. Biomedicine has achieved structural superiority in almost all countries of the world, but functional strength varies greatly between countries.
POPULAR-SECTOR HEALTH RESOURCES
