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Health is generally defined as a state of well-being (physical and/or psychological), but sociological theories differ in their interpretation of the social meaning of illness. For example, as Gerhardt (1989) pointed out, structural-functionalism assigns responsibility for one’s health to the individual; symbolic interaction theory sees illness in terms of stigmatization and proposes that societal and cultural influences impinge upon individuals’ perception of health, self-determination, and ability to negotiate their situation; phenomenology sees the situation as ”trouble-trust dialectics”; and conflict theory addresses the questions of power and domination and associates illness with a surfacing of the everyday conflict that results from social, ”political, and economic inequity,” an argument also pursued by Marxist and neo-Marxist approaches. Of these theories, symbolic interaction incorporates culture most directly, mainly in the form of socially constructed and subjectively perceived meanings of illness, definitions of illness severity, and labeling. Health behavior studies using social psychology theories (such as the health belief model, protection motivation theory, self-efficacy theory, and the theory of reasoned action) and approaches on social networks and help-seeking behavior (e.g., Levy and Pescosolido 2002) are now paying more attention to the relevance of culture.
The inclusion of culture (subjects’ values, beliefs, and customs) in research designs means asking how culture impinges upon people’s subjective perception of health, illness, power, and stigma; upon the meaning they attach to illness and health; upon their sense of trust, normality, and deviance; and upon their health behavior. Increased interest in the cultural dimension of health has been prompted since the 1940s by socio-political upheavals; major movements of populations as the result of forced and free migration (leading to higher rates of ethnic minorities in the developed world); substantial changes in people’s lifestyle (such as diet, rate of physical activity, leisure activities, and high stress levels); demographic trends including the incidence of chronic diseases (e.g., cardiovascular diseases); and epidemics affecting a multitude of culturally diverse communities, for example HIV/AIDS and outbreaks of infectious diseases like SARS (severe acute respiratory syndrome).
Based on their principal unit of inquiry, studies of culture and health are of three types. The first type includes studies on the sources of illness as well as people’s health-related behavior, attitudes, and beliefs through the health—illness trajectory: preventive health behavior, illness behavior, and sick-role behavior. The second type includes studies on the sources of healing, addressing the role of healers, groups, networks, and organizations whose main objective is helping the sick or safeguarding the health of others. The third category includes studies using the comparative pragmatic acculturation perspective (the borrowing of ideas and procedures from other cultures to solve specific problems) whereby both the users and the providers of healing are the focus of analysis. Pragmatic acculturation studies (Quah 2003) suggest that comparative research can provide more effective understanding of the permeability of cultural boundaries and its effect on health; of the permanent or temporary transformation in belief systems; and of the ways in which cultural beliefs and norms influence accounts of disease incidence and prevalence across communities and countries.
- Gerhardt, U. (1989) Ideas about Illness: An Intellectual and Political History ofMedical Sociology. New York University Press, New York.
- Levy, J. & Pescosolido, B. (eds.) (2002) Social Networks and Health. JAI Press, New York.
- Quah, S. R. (2003) Traditional healing systems and the ethos of science. Social Science and Medicine 57: 1997—2012.
- Stone, J. & Dennis, R. (2003) Race and Ethnicity: Comparative and Theoretical Approaches. Blackwell, Oxford.