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Chapter 8

Cultural Conceptions of Health and Illness
by

Shanley Apele

on 7 March 2013

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Transcript of Chapter 8

Chapter 8 Cultural Conceptions
of Health and Illness Culture A Profile of Cultures The Nature of Health
and Illness Patient and Caregiver Roles Developing Cultural Competence Social Implications of Disease Social desirability and cultural modes of expression influence the way people think about health and illnesses. By becoming more culturally competent we increase our understanding and ability to help ourselves and others. -Beliefs, rules, and practices shaped by a group of people
-Suggests how we should behave:
-roles we play
-how actions/events are interpreted Tripping over cultural gaps can have harmful consequences - cultural assumptions guide interpretations of and the significance attached to events
- some cultures regard sick people as a threat to moral order
*behaviors associated with conditions are considered immoral and frightening - Role: expectations of people performing various functions in the culture
- Some behaviors are rewarded, others bring social penalties •Be careful about assuming cultural beliefs based on appearance or ancestry Why Culture? Cultural barriers limit our awareness Health threats don't perceive cultural and national boundaries Health is a global phenomenon requiring global efforts and interconnectedness Cultural norms and practices make us more / less susceptible to health concerns We need to recognize interdependency and look to each other for solutions -open communication
-learning
-understanding For example: In India: 10,700 children/year die of cancer
In the UK: 350 children/year die of cancer For example: In Africa: Malawian culture and customs put people at risk for STD's Asian and Pacific Hispanic Arab Organic Perspective
(biomedical perspective) Harmony Perspective
(biopsychosocial perspective) Health: presence (or absence) of physical indicators. Strength: Weakness: - emphasis on scientific
knowledge - does not account for conditions that cannot be verified
- definition of health is fairly low Evidence Based Medicine - making treatment decisions based
on results of scientific studies- Used in medical schools / hospitals as a strategy for avoiding medical waste and make effective decisions. - not just the absence of physical signs of disease
- overall well-being produces gradual and ambiguous results Drawback: - polar energies whose cyclical forces define all living things.
- human life and a common element uniting all forms of existence - concept lies at the origins of Asian science and philosophy
- primary guideline of traditional Asian medicine
- central principle of different forms of Asian martial arts and exercise Qi - one’s central life energy- life energy is sustained and balanced by awareness and meditation. Disease as a Curse Stigma of Disease Mortality of Prevention Victimization - result inflicted by God and witches when science explanatory models fail - Stigma: type of social rejection where a person is treated as dishonorable or ignored
- people are lead to avoid medical evaluation - Sick people are considered lazy and ignorant in western society judgment
- Criticism: people fall ill for reasons hard to explain - Survivors are still described as victims of their past diseases Caregivers =
Mechanics
Patients =
Machines - Doesn't encourage emotional communication
- Identify and fix
-Objective, neutral Advantages: Disadvantages: - Reduces emotional drain on caregivers.
- Confidence that people can be helped is comforting - Patients don’t appreciate being treated like machines.
- Ignoring patient’s description / concern is considered passive. Paternalism Caregivers = Parents
Patients = Children - Doctors give orders, patients expected to obey
- Doctors expected to know what's best for the patients South Africans and Asians:
Agree with anything their doctor’s say, even when they don't understand or have reservations Case:
14 year old Asian immigrant died of liver cancer when her doctor thought it was menstrual cramps* Assumptions are RISKY because patients may have many feelings and desires unknown to their doctors. Native American Cultures Christian Science Church Faith Healers Glossolalia Evidence Supported Through Placebos Spiritualists and Believers - Spiritualists used their powers on behalf of faithful patients
- Jesus = great physician
- Anthropologists compared doctor's role to that of a priest Shaman:
- coaxes patient's disease into his/her own body and expels it through strength of will
- communicates with beings beyond the physical world
* magical abilities & healing powers - Conventional science medicine = anti-Christian
- Illness = illusion, medicine makes it worse
- No drugs, surgery, home treatments
- CONTROVERSY: denying children medical care
* CHILD ABUSE? - Channel curative power of Holy Spirit, pass on to believers
* Laying on of hands: ceremony - Trance-like state: worshiper speaks a foreign language
- The language is known only to God or it is a foreign tongue unknown to the worshiper expect through divine inspiration Placebo: Inactive “treatments” - Scientist acknowledge the power of faith, but do not regard it as the central power of work
- Researchers give some patients real medicine and others get placebos Providers and Consumers - Patients regarded as shoppers / clients
- Consumerism fueled by internet resources
* People look up health information
* Websites offer reviews of hospitals
- Competitiveness makes caregivers mindful of patient satisfaction Partners - Collaborative medical talk
* Respectful listener = trust and partnership
- Doctors guide discussions and patients are passive To recognize cultural and individual differences ask or try to answer these questions How do they identify themselves? Are questions answered by the client or family members? What language do they speak to you?

Their family members? How is respect shown?

What role are you expected to play? Who makes the decisions? - More than 1/2 the population
- Mind & Body = interwoven whole
- Traditional holistic healing methods
* Seek Western Medicine only when their methods don't work
- Prefer quiet, unhurried demeanor Age is sometimes calculated differently Don't openly contradict / question them
* Seen as criticism High regard for status
* May decline to take part in decision - making Physical touch and eye contact = overly personal Not emotionally expressive Different meanings of emotional displays Believe that dead continue to have influence & relationships with the living Health history = PRIVATE information Autopsies & organ donation = Distasteful Eastern and Western
Perspectives West: East: - Illness is a foe
- Body is unpredictable and mysterious
- Word choices:
* Depict human body as being on the verge of war / disaster
* We need to engage in combat
* Body = Bad, Medicine = Good
- - Idea of strength
* Being supple and flowing
- Prevention vs. Treatment
- Body = Natural place of harmony and well-being
- Good Health = Balance + Harmony + Flexibility
- Honor body and follow its rhythms, be aware of patterns
- Aggressive interventions interfere with body's rhythm Latin America, South America, Spain, & some African Nations Personalismo Respeto Confianza Susto Preference for warm, friendly relationships vs. impersonal, institutional scenarios Respectful / differential behavior toward people of greater age / social status Openness / trust among members of one's intimate circle Conviction that a shocking, unpleasant, or frightening experience may cause illness Recommendations for situations involving Susto Conduct cultural awareness assessment Assess family beliefs Negotiate cultural conflicts - incorporate into assessment, diagnosis, and treatment - Each family has its own blend of beliefs and values - Try to satisfy both cultural expectations AND rigors of medical care - Underutilize health services
* Language, citizenship, and cultural misunderstandings
- Find mainstream health messages culturally unappealing
* Assume it doesn't pertain to
them Suggestions: - Learn some Spanish
- Be warm and friendly
- Build a trusting relationship
- Show respect and use honorific titles
- Acknowledge and include family members
* Non- relatives may be included in self-identified family - Religion is likely to be of great value
* May think health measures are unnecessary since everything is in God's hands
- Statements related to time may differ from typical American expressions
- Patients may be involved with folk treatments 22 countries exist in the Middle East and North Africa - Elders deeply revered
- Traditional gender roles
- Many migrate due to war / violence
* Susceptible to depression, anxiety, and suicide
- Emotionally expressive & dedicated to being polite Religion - Islam is the 2nd largest religion in the world
- Muslims make up 1/5 of the world's population
- Synthesis of Christianity and Judaism
- Qur'an: set of universal, divine laws for human behavior
- May refuse therapies during Ramadan
- Pray for good health: Allah controls ultimate destiny Halah Muslim diet forbids pork & alcohol - Hospital foods and medication may be an issue
- Fasting may dissuade them from taking oral / intravenous medications * Insulin from pigs * Cough syrup with alcohol - Left hand used for personal hygiene
- Right hand saved for eating and drinking
* don't put food, drinks, or pills in your left hand
- Separation of men and women
* same sex doctors are prefered
- Muslims can't accept death without Islamic explanation as Allah's will
* dead are buried quickly
* believe body feels pain until it's buried Collectivist Culture - A dishonorable action by one = FAMILY SHAME
- Health conditions have powerful implications for the whole family
- Direct knowledge about illness given to a person’s male head-of-family first
- Mental illness is prevalent in a lot of Arab Americans because it is shameful to seek help - It is often difficult to make sense of disease
- Some cultures honor scientific explanations but sometimes those explanations don't make sense of the diseases. - People with diseases such as cancer, tuberculosis, mental illness,
AIDs, etc. have been viewed negatively
- People with these conditions were shunned or imprisoned Effect of social stigma:
People’s individuality and humanity is overshadowed by the discrediting characteristic of their disease Take care of yourself and there is no reason you should become ill
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