The Impact of Social, Political and Organisational Influences on Health Psychology Practice

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Lecture 2 Cultural influences on health beliefs,
experience and behaviour
P.corcoran_at_city.ac.uk
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Outline of lecture

• medical history and medical anthropology
• Western expert health belief systems
• non-Western health belief systems
• contemporary belief systems

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Cross-cultural images of health

• The way people think about health
• and react to illness is rooted in their broader
  health belief systems, which,
• in turn, are culturally immersed.

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Race and Ethnicity
The terms, race and ethnicity, are in reality of
social construction. It is not these which
determine health differentials but it is the
social and economic consequences which arise
directly or indirectly out of the classification,
which supports the causal relationship with these
differentials.
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What is culture?

• A system of meaning and symbols.
• A world view.
• Perceptions, beliefs and values.
• An embedded system of thinking about reality.

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Causal ontologies of suffering

• Biomedical
• Interpersonal
• Sociopolitical
• Psychological
• Astrophysical
• Ecological
• Moral
• (Source Shweder et al., 1997)

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Moral discourses of suffering

• Discourse Focus Content
• Autonomy Individual Harm, rights, justice
• Community Family Duty,
  interdependence
• community
• Divinity Divine design Sacred natural
• order

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Biomedicine

• Acknowledges the physical constitution of nature-
• the human being is a body (but not the person)
• Improvements in health attributed to medical
  discoveries, e.g.penicillin
• Political and professional development of
  medicine as an institution

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Health belief systems

• Medical model
• Biomedical model (Engel, 1977)
• Alternative models
• e.g. homeopathy, phytotherapy,
• chiropractic, homeopathy
• Non-western models
• e.g. traditional Chinese medicine,

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Popular health beliefs

• Herzlich (1973)
• French adults
• Health an attribute of the individual - a state
  of harmony or balance
• includes physical well-being, plenty of
  physical
• resources, absence of fatigue, psychological
  well-being, eveness of temper, freedom of
  movement, effectiveness in action and good
  relations with other people

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Popular definitions of health

• Health as being not-ill the absence of physical
  symptoms
• despite diseasekeeping going in spite of..
• a reserve the presence of personal resources
• as behaviour
• as physical fitness
• as vitality
• psycho-social well-being
• social relationships
• as function
• Source Blaxter, 1990

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Social class differences

• 1. Physical aspects only (lower SES only)
• 2. Dualistic view combines physical and mental
• aspects, but not in an integrated way (lower and
  higher SES)
• 3.Complementary view integrates the mental with
  the physical
• 4.A multiple view that includes physical, mental,
  emotional, social and spiritual dimensions
• Source Chamberlain, 1997

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Popular explanations of health (Stainton-Rogers,
1991)

• Body as machine
• Body under siege
• Inequality of access
• Cultural critique
• Health promotion account
• Robust individualism account
• Gods power account
• Willpower account

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Chinese views of health

• H. is a balance between and within the various
  systems , internal and external to the person.
• Disease is a disharmony or lack of equilibrium.
• Reflects a worldview that emphasises
  interconnectedness and balance -
• Yang (male, positive energy) and yin (female,
  negative energy)

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Ayurvedic medicine

• Sanskrit words
• veda knowledge
• ayus longevity
• 70 of the Indian population practice this type
  of medicine
• Prakftibody (female component)
• Purusasoul (male component)

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African medical systems

• Herbal and physical remedies mixed with religious
  beliefs
• Sickness is caused by ill-will, spirits sorcery,
  witchcraft, and diabolical or divine intervention
• 2 key dimensions spiritual influences
• communal orientation

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The Health Beliefs of the Chinese Community in
England a qualitative Study
Marie-Claude Gervais and Sandra Jovchelovitch
(1998) London School of Economics
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Study was commissioned by HEA. There has been
increasing interest over the last decades in how
notions of health and illness are constructed by
different communities of people and how this
variation affects health-care delivery.
In multicultural societies, where different
ethnic communities live side by side with the
cultural system of the host society, cultural
backgrounds and the corresponding representations
they entail about health and illness emerge as
key factors in the planning of health-care
delivery.
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The Chinese in this sample do not generally
consider that their traditional medical knowledge
and beliefs clash with Western biomedicine.
I think most of us look at traditional Chinese
medicine and Western medicine as coexisting quite
nicely. I think on the whole most of us would
try anything as long as it works. Youll find
that sometimes (the Chinese) go to both. They
see the Western medical doctor and then toddle
off to a herbalist to get herbs and then theyll
use the two together. They wouldnt see the
conflict.
expert
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If you want to get well completely, to get rid
of the root of the illness as such, youll have
to take Chinese medicine because only Chinese
medicine could get rid of the root of your
illness. If you want just to relieve the symptom
for one day then you can take the Western
medicine. But if you want to get to the root,
you have to take the Chinese medicine.
Lay participant, male, 44 years
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Main Findings
Diversity and Unity in the Chinese
community. Chinese Values. The structure of
Chinese health beliefs. Health and Cultural
identity. The coexistence of Western and Chinese
notions of health and illness. The combination of
health practices. The transmission of
knowledge. Use of primary care services.
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George Orwell

• All animals are equal but some animals are more
  equal than others
• Animal Farm (1945) ch. 10

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Richest 20 to poorest 2044 richest countries

• Highest 5 Lowest 5
• UK 9.6 Slovakia 2.6
• Australia 9.6 Czech Rep3.6
• USA 8.9 Poland 3.9
• NZ 8.8 Japan 4.3
• Switzerland 8.6 Spain 4.4
• Source UN Human Dev. Report, 1999

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Where do the poorest people live?

• Africa and India
• 50 of population living on lt1 per day
• India 52.5, Nepal 53.1
• Lesotho 50.4, Kenya 50.2, Senegal
  54.0,Uganda 50.0,
• Madagascar 72.3, Zambia 84.6, Guinea-Bissau,
  87.0, Niger 61.5
• SourceUN Human Development Report, 1999

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Biopsychosocial translation

• Observation
• of social inequality Identity
• education
• culture/gender
• housing
• social acceptance Expectations
• job
• income
• Experience of inequality
  Reality
• Dissonance/Stress
• inequity Biological
• limited opportunity triggers Disease
  development
• employment instability
• social segregation

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Inequalities

• World, societal and individual health are
  determined more by the distribution of economic
  and educational opportunities and their
  psychosocial consequences than by genes, germs or
  health care.

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Health and wealth (1997)

• Life exp. Under-5 GDP
• at birth mort.rate US
• Zambia 40.1 20.2 960
• Madagascar 57.5 15.8 930
• India 62.6 10.8 1,670
• United States 76.7 0.8 29,010
• United Kingdom 77.2 0.7 20,730
• Canada 79.0 0.7 22,480
• SourceUN Human Development Report, 1999

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Summary

• 1.Health beliefs are part of a culture, a world
  view
• 2.Health as a quality of the body is peculiar to
  biomedicine.
• 3. Non-western societies prefer a more social
  definition of health.
• 4. All systems are not fixed, but constantly
  changing.

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Summary

• 1/ Health, wealth, education and social
  circumstances are strongly inter-related.
• 2/ Regional, societal and individual health
  differences are determined by common influences.
• 3/ Strong, reliable social gradients occur across
  time and place based on economic and educational
  mediators.
• 4/ Gradients of social position are translated
  through biopsychosocial mechanisms and pathways
  into wellness/illness conditions.
• 5/ We need to study these pathways and mechanisms
  to generate theories about how and why the health
  of the individual follows from his/her position
  within social structures.