Culture and Public Health
- LAST REVIEWED: 05 May 2017
- LAST MODIFIED: 24 May 2018
- DOI: 10.1093/obo/9780199756797-0009
- LAST REVIEWED: 05 May 2017
- LAST MODIFIED: 24 May 2018
- DOI: 10.1093/obo/9780199756797-0009
The concept of culture has been used as a descriptive and explanatory concept in public health efforts to understand human action and knowledge about health, illness, medicine, and health-seeking practices of individuals and groups. Increased global connections and medical intervention, along with a renewed attention to health disparities and issues of cultural competence, have lead to the ubiquity of culture as an explanatory concept for health behaviors. Early definitions of culture viewed it as a holistic system that humans acquired through their interactions in society. While this definition recognized that culture is relational, occurring in human interaction, and pervades most facets of daily life, it also constructed culture as static and as an object or a thing that people have. Most researchers reject the latter half of this formulation. Current formations of the culture concept understand culture as a complex system of meanings. Culture is relational and learned; it is a dynamic process of meaning making that is informed and constrained by social contexts. This predominant view of culture consists of a shared system of meaning that is adaptive and always changing. As a shared meaning system, culture includes conscious and unconscious assumptions; it assists in the interpretation of individual experience and guides future expectations and actions. This fluid process allows people to move between meaning systems, such as dominant social values and their own local values, which at times overlap or even contradict each other. The more complex definition of culture involves debate and struggle over the exercise of power (who decides and what institutions enforce the meaning of a symbol or action). This recognition of the exercise of power in meaning making is most clearly seen in the recognition of biomedicine as a cultural system, efforts to understand the influence of culture on health professionals and policymakers, and the focus on issues of cultural competence. Although the culture concept is used by many disciplines to understand many human practices, the methodological tracing of cultural influences on health remains relatively unspecified in the literature. This lack of specificity facilitates a return to the use of culture as static, as a barrier to health improvement, and for a conflation of culture with race, ethnicity, socioeconomic characteristics, non-normative behavior, and even nationality. In the effort to improve the measurement of culture and the influence of culture on health, many authors caution against treating culture as a simple, fixed categorization variable. Because culture informs and is also influenced by social contexts (historical, economic, political, and geographic), the two must be examined and accounted for together.
The culture concept is used across multiple disciplines and across a variety of questions within public health and health research. What is apparent from a review of the literature is that differences in the health of populations are inextricably entwined with cultural processes that can improve or hinder physical and psychological well-being. Consequently, public health has recognized that for interventions and campaigns to be increasingly effective, cultural processes and values that lead to different health statuses must be integrated into their work. The guiding approach for this overview is to provide the reader with publications that define, examine, and make suggestions for approaches to the study of culture and health so that cultural processes can be identified and effectively integrated into public interventions and campaigns. Helman 2007 provides a clear and working description of the intersections between culture and illness that attends to international, multidisciplinary, and multiple-topic issues. Edberg 2013 addresses the use of culture within public health and how understanding cultural processes elucidates the intersection and relationship of culture and health, to the benefit of public health practices. Nichter 2008 focuses on the importance of understanding cultural perceptions and local and global contexts in public health interventions. Kreuter and McClure 2004 reviews the multiple uses of the culture concept in health communications research. Hruschka and Hadley 2008 details key issues in the use of the culture concept. The greater specificity of culture allows an elaboration of ways in which to integrate the concept into public health programs. Kagawa-Singer, et al. 2010 examines and critiques the interchangeable use of culture, race, and ethnicity. Disentangling these terms allows greater methodological efficacy for understanding the influence of culture on health and health disparities. Taylor 2007 examines the use of the culture concept in HIV/AIDS research, arguing that greater attention to social science debates about the concept in a historical and global context may lead to the development of more effective interventions.
Edberg, Mark C. 2013. Essentials of health, culture, and diversity: Understanding people, reducing disparities. Burlington, MA: Jones & Bartlett.
As part of the Essential Public Health series, co-published with the America Public Health Association, Edberg examines the term culture, what it means, and its use within public health. The author discusses culture in relation of health disparities and develops and implements culturally cognizant public health programs; provides some practical tools for applying cultural processes for effective programing.
Helman, Cecil G. 2007. Culture, health, and illness. 5th ed. London: Hodder Arnold.
Provides a detailed definition and examination of the culture concept, contextual social factors, and how they are related to and influence health, illness, and medical care. The text includes international examples and case studies ranging from poverty and medical technologies to HIV/AIDS and genetics.
Hruschka, Daniel J., and C. Hadley. 2008. A glossary of culture in epidemiology. Journal of Epidemiology and Community Health 62.11: 947–951.
Examines definitions, theories, and methodologies used to understand the culture concept. This article is useful for acquiring an understanding of basic issues and for considering how to approach effective integration of cultural processes into public health programs.
Kagawa-Singer, Marjorie, Annalyn Valdez Dadia, Mimi C. Yu, and Antonella Surbone. 2010. Cancer, culture, and health disparities: Time to chart a new course? CA: A Cancer Journal for Clinicians 60.1: 12–39.
Examines use of the culture concept in cancer research. Argues that a key factor in the persistence of health disparities is a lack of clarity and willingness to account for cultural processes. Provides a framework for researching the role of culture in health disparities and the need to account for these processes in community-based participatory research.
Kreuter, Matthew W., and Stephanie M. McClure. 2004. The role of culture in health communication. Annual Review of Public Health 25:439–455.
Reviews diverse uses of the culture concept and how it influences health communication, particularly in the area of audience segmentation. Drawing on the Institute of Medicine’s 2002 report that stated that greater similarity between cultural characteristics and public health approaches may enhance health communication programs, the authors argue that better specificity regarding the culture concept should guide future research.
Nichter, Mark. 2008. Global health: Why cultural perceptions, social representations, and biopolitics matter. Tucson: Univ. of Arizona Press.
Examines the intersections between social contexts and cultural understandings of infectious diseases. Demonstrates through case studies, theory, and method the importance of integrating local understandings of health, illness, and medical care in public health interventions. This work provides examples and insights useful for community-based participatory research.
Taylor, Julie J. 2007. Assisting or compromising intervention? The concept of “culture” in biomedical and social research on HIV/AIDS. Social Science and Medicine 64.4: 965–975.
Examines the use of the culture concept in HIV/AIDS interventions in sub-Saharan Africa. Traces the debates between a static and a dynamic view of culture. Argues that the culture concept has value for public health interventions when greater attention is paid to larger debates about the use and abuse of the concept.
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