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Population Health for Nurses

21.3 The Role of Culture in Shaping Health Beliefs and Practices

Population Health for Nurses21.3 The Role of Culture in Shaping Health Beliefs and Practices

Learning Outcomes

By the end of this section, you should be able to:

  • 21.3.1 Explain the cultural significance of health.
  • 21.3.2 Assess how culture influences health.
  • 21.3.3 Describe how the cultural environment informs cultural development.

The World Health Organization (WHO) introduced the modern understanding of health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” in its constitution in 1948 (Svalastog et al., 2017). In 1986, the Ottawa Charter, signed at the First International Conference on Health Promotion, proposed that health is created in the context of everyday life and environment, where people live, love, work, and play. Societies have historically recognized health as not just the absence of disease but a state of internal harmony. Beliefs about how harmony is created and maintained distinctly influence views on the causes and effects of illness, health-seeking behavior, healing practices, coping mechanisms, and treatment modalities. These views influence one’s sense of control over health, illness, and death.

Historical Views of Health Informing Health-Related Belief Systems

During the period known as ancient Greece, which spanned from the beginning of the Greek Dark Ages around 1200 BCE to the fall of the Western Roman Empire around 600 CE, health was viewed as a harmony between an individual and their surroundings, a unity of both body and soul. Greek philosophy placed great importance on maintaining a healthy body and mind. The Greeks viewed the origin of disease as connected with the geographical and atmospheric environment. In ancient Greece, treatment modalities focused on natural preparations, such as seawater, honey, vinegar, rainwater, and medicinal plants (Kleisiaris et al., 2014).

In East Asian traditions, health results from the unity of body, mind, and spirit, with disease resulting from being off balance. Yin and yang are the underlying principles of Chinese philosophy and medicine. Good health is believed to come from a balance of yin (negative, dark, and feminine) and yang (positive, bright, and masculine) (National Library of Medicine, 2023). The concept of harmony and unity of yin and yang is still practiced today. In some traditional African cultures, health is a balance between the mental, physical, spiritual, and emotional well-being of self, family, and community. Good health includes the ancestors’ health, as the ancestors are responsible for keeping the living healthy. Disease is viewed as the result of evil attacks (including spell casting and witchcraft), bad spirits, or punishment by ancestors. Therefore, health is achieved by balancing the visible and invisible worlds (White, 2015). Traditional African practices have influenced views of health and disease globally. For example, Indigenous African beliefs gave rise to the Vodun or Vodou religion (Auguste & Rasmussen, 2019).

Similarly, Native Americans have traditionally believed that physical and spiritual health are connected. To overcome illness, the body and the soul must heal together. Healing ceremonies include prayer, chants, drumming, storytelling, songs, and sacred objects. Concepts of the Spirit, the Creator, and the universe are central to Native beliefs (National Library of Medicine, n.d.-a). The medicine wheel, also called the sacred hoop, has been used by generations of Native American tribes (National Library of Medicine, n.d.-b). The medicine wheel is symbolic of health and the cycles of life. Each tribe has its own interpretation of the medicine wheel, and such wheels continue to be used today. For example, the Medicine Wheel and 12 Steps recovery program is a culturally appropriate 12-step recovery program for Native Americans and Alaska Natives, based on the cycle of life and the four laws of change depicted by the wheel.

Conversations About Culture

Medicine Wheel Teaching with Elder Elsey

In this video, Elder Elsey Gauthier speaks about the medicine wheel concept.

Watch the video, and then respond to the following questions.

  1. What do the four quadrants of the medicine wheel represent?
  2. What is the significance of ceremonies?
  3. Describe what it means to be part of the same circle.

The writings of Plato, Aristotle, and Hippocrates influenced the understanding of health in many societies. Plato (429–347 BCE) viewed health as internal harmony and harmony with the physical and social environment. Aristotle associated health with the four basic qualities: hot, cold, wet, and dry. These qualities characterize the four elements, four humors, and four temperaments and serve as the foundations for all notions of balance and homeostasis in ancient Greek medicine. Aristotle emphasized society’s role in achieving its harmonious functioning and preserving its members’ health (Svalastog et al., 2017). He associated health with the supreme good for humanity, or eudaimonia, a philosophical term utilized today as “human flourishing.” Hippocrates, widely recognized as the father of medicine, proposed that health depended on the human constitution, proper diet, and exercise. The concept of harmony between the individual, social, and natural environments informed the current holistic health view. Such concepts are reflected in the Hippocratic oath (Kleisiaris et al., 2014).

How people understand health and illness, their beliefs about disease causes, and their strategies to maintain health can vary greatly depending on cultural factors such as beliefs, values, and social norms. For example, in some cultures, physical and mental health are viewed as interconnected, and holistic approaches to health care are preferred, which may include traditional healing practices, meditation, or herbal remedies. In other cultures, medical treatments may be more focused on addressing specific symptoms, rather than considering the overall health and well-being of the individual.

The Cultural Environment

An individual’s cultural environment refers to the social, economic, political, and historical factors that shape their experiences and beliefs in a particular culture. This includes the language they speak, the values they hold, the traditions they follow, and the cultural practices they engage in. The cultural environment also includes a culture’s social and institutional structures, such as family dynamics, religious institutions, and political systems. The cultural environment can be defined as ecological systems at various levels: microsystems, mesosystems, exosystems, macrosystems, and chronosystems.

The microsystem level consists of the immediate environment in which an individual interacts, including family, friends, and other close relationships. Cultural factors at this level may include family traditions and beliefs, cultural values, and customs related to health and wellness.

The mesosystem level refers to the interactions between different microsystems. For example, at the micro level, family organization influences routine practices essential to psychological health and well-being. Family rituals foster a sense of belonging and personal identity (Fiese et al., 2002). Sharing meals can be an essential family ritual that helps create a sense of togetherness and belonging. Mealtime rituals such as saying grace or having a family member cook a particular dish can be meaningful and reinforce family traditions. Community-level networks promote an individual’s and family’s physical, psychological, social, and spiritual well-being (Figure 21.4).

Social organizations can affect how community members interrelate, cooperate, and support one another and influence expectations of support norms and social controls that regulate behavior and interaction patterns (Mancini & Bowen, 2013). Cultural factors at this level may include communication styles, expectations around health care, and cultural beliefs related to health and illness.

A roomful of diverse people sit at long tables, eating a meal together.
Figure 21.4 The mesosystem level includes community gatherings, such as this Thanksgiving dinner, which was shared by over 900 members of the Presidio of Monterey military community in California. (credit: “Thanksgiving 2015” by Catherine Caruso/Presidio of Monterey Public Affairs/Flickr, Public Domain)

The exosystem level refers to the external systems and institutions that influence an individual’s life, such as the health care system, educational system, and media. Cultural factors at this level may include access to culturally appropriate health care, cultural stereotypes, and media portrayals of health and wellness.

The macrosystem level refers to the broader cultural context in which an individual lives, including societal beliefs, values, and norms. Macrosystems can influence access to resources, including health care. For example, immigration policies may make it difficult for migrant workers and immigrants to seek care due to fear of deportation (Toney et al., 2022). In the United States, immigrants are only eligible to receive benefits or have coverage after being “qualified,” frequently termed a waiting period. In addition, to qualify for Medicaid and the Children’s Health Insurance Program (CHIP), a lawful permanent resident (LPR), also known as a green card holder, must have at least 5 years of residence in the United States (Turner, 2023). See Caring for Vulnerable Populations and Communities for more information. Cultural factors at this level may include cultural attitudes toward health and wellness, cultural norms related to health behaviors, and policies and laws related to health care access.

The chronosystem level refers to the influence of time and history on an individual’s cultural experiences, including generational and historical changes in cultural beliefs and practices related to health and wellness.

The cultural environment shapes an individual’s perception of the world and influences behavior, including health behavior. It influences perceptions of health, illness, and death; coping mechanisms; and the experience and expression of illness and pain (Agency for Healthcare Research and Quality, 2020).

Cultural Beliefs and Practices Related to Health and Illness

Different cultures have unique beliefs and practices regarding health, illness, and healing, which can influence how individuals approach and manage their health. Health beliefs influence how people think and feel about their health and health problems, when and from whom they seek health care, how they respond to health care interventions, and how well they adhere to treatment (Swihart et al., 2023). For example, in some cultures, people believe that talking about a possible poor health outcome will cause that outcome to occur.

Death and Dying

Different cultures have unique beliefs and practices regarding death, mourning, and the afterlife, which can influence how individuals approach the end of life. In some cultures, mourning may involve specific rituals or customs, such as wearing specific clothing, preparing the deceased, or observing specified periods of mourning. In other cultures, mourning may be less formalized or structured (Giger & Haddad, 2021).

Conversations About Culture

Death and Dying: Cultural and Religious Perspectives

This video delves into death, exploring the concept and how cultural and religious perspectives shape our understanding of it.

Watch the video, and then respond to the following questions.

  1. How do different cultures conceptualize death, and in what ways do these conceptualizations impact individuals’ views on end of life, readiness to die, and funeral rituals?
  2. How does death anxiety manifest across various cultures, and in your opinion, do cultural factors contribute to or alleviate this anxiety?
  3. How do different religious beliefs influence funeral practices and rituals in the context of death?
  4. Select an example of a funeral ritual from the video and describe how it reflects cultural values and beliefs.

Coping Mechanisms

Coping mechanisms are the strategies and behaviors that individuals use to manage stress and difficult situations. Various cultures have unique coping mechanisms that reflect their values, beliefs, and practices. For example, some cultures may use spiritual practices, such as prayer or meditation, to cope with stress or illness. Others may rely on social support networks like family or community members (Giger & Haddad, 2021).

Perception and Reporting of Illness

Culture can shape how individuals perceive and report symptoms. For example, some cultures may view mental health symptoms (such as depression) as a sign of weakness or moral failing and may be less likely to seek help or report these symptoms. In contrast, other cultures may prioritize mental health and view seeking help as a sign of strength. Differences also exist regarding the meaning of an illness and whether an illness is “real” or “imagined” (Giger & Haddad, 2021).

Pain and Discomfort

Many cultures have unique beliefs, values, and practices that shape their experiences of pain and discomfort. For example, in some cultures, it may be common to downplay or minimize symptoms of illness or pain. This may be due to a cultural belief that expressing vulnerability or weakness is undesirable or that complaining about pain is a sign of ingratitude. In contrast, other cultures may encourage individuals to be vocal about their pain and discomfort to seek help and support from others (Giger & Haddad, 2021).

Conversations About Culture

Cultural Influence: Perception of Pain

This video depicts the interaction between a health care provider and Carlos, a postoperative client. It addresses issues associated with making assumptions and emphasizes the importance of listening to the client.

Watch the video, and then respond to the following questions.

  1. How does culture influence pain response and expression?
  2. Could the physician have responded differently to Carlos’s request? If so, how?
  3. How do assumptions regarding drug-seeking behavior impact client care?
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