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4
Health and Culture in the Global Context
STELLA QUAH
Is culture relevant to the study of health and illness? Yes. Culture is not just one of many factors associated with health but is the context within which health-related behavior unfolds. Over the past few decades the consensus among sociologists and anthropologists has been strengthened by increasing evidence-based research. Both disciplines produce the bulk of systematic research on health-related behavior by applying a wide range of conceptual perspectives and methodological approaches; and relevant psychology research contribute pertinent information. This analysis proposes and explains why the inclusion of the cultural context is central to our understanding of health, illness, and health-related behavior. The analysis unfolds in three steps: the definition of culture; the link between culture and health behavior; and the link between culture and healing systems.
DEFINING CULTURE
The meaning of the term “culture” varies widely across disciplines and conceptual perspectives. Let us begin with an historical glance at the efforts made in sociology and anthropology to define and understand “culture”.
The Classics
One enduring contribution comes from Emile Durkheim, a pioneer of the discipline of sociology. In his Rules of Sociological Method, first published in 1895, Durkheim (1938) proposed guidelines for the study of social phenomena as social facts. He argued that social facts are “representations” of society in the mind of the individual. They are ways of thinking, feeling, and acting external to the person. Such “facts” include myths, popular legends, religious conceptions, moral beliefs, and social beliefs and practices in general. By treating social values, beliefs, and customs as social facts, Durkheim promoted the systematic study of culture. He introduced his concepts of social solidarity and, particularly, a collective consciousness, as reflective of culture and concurrently present within and external to the individual. Taylor and Ashworth (1987: 43) propose that these concepts are applicable to the study of medical sociology phenomena, such as attitudes toward death and the link between “changing forms of social solidarity and changing perceptions of health, disease, and medicine.”
Another key pioneer in the study of culture was Max Weber. His research during the first two decades of the twentieth century brilliantly marked the initiation of the sociological analysis of culture. Among his voluminous work, two studies are particularly relevant: The Protestant Ethic and the Spirit of Capitalism (1904–5) and Economy and Society (first published in English in 1968). Weber highlighted the importance of culture as values and beliefs coexisting and shaping social action within the micro-cosmos of the individual actor as well as at the level of collectivities, institutions, and the larger society. Weber’s conceptualizations of ethnic group and traditional action offer the most relevant insights to the study of culture.
Weber defined ethnic groups as human groups characterized by a “subjective belief in their common descent” given their real or perceived similarities in one or more characteristics (physical types or race, customs, language, religion), and in “perceptible differences in the conduct of everyday life” (Weber 1978: 389–390). The impact of these subjectively perceived similarities on social action is heightened by yet another essential feature of ethnicity: “the belief in a specific honor of their members, not shared by outsiders, that is, the sense of ethnic honor” Weber 1978: 391) explained:
palpable differences in dialect and differences of religion in themselves do not exclude sentiments of common ethnicity… The conviction of the excellence of one’s own customs and the inferiority of alien ones, a conviction which sustains the sense of ethnic honor, is actually quite analogous to the sense of honor of distinctive status groups.
Weber’s concept of traditional action (one of four in his typology of social action) is also relevant to the link between culture and health. Weber defines traditional action as social action “determined by ingrained habituation.” Traditional action, he wrote, “is very often a matter of almost automatic reaction to habitual stimuli that guide behavior in a course which has been repeatedly followed. The great bulk of all everyday action to which people have become habitually accustomed approaches this type” (Weber 1978: 4). The concepts of ethnicity and traditional action, as defined by Weber, elucidate the pervasiveness of customs, beliefs, and practices of different ethnic or cultural communities upon their health-related behavior. Weber’s analyses have inspired subsequent research and contributed to the understanding of the pervasiveness of culturally inspired and culturally sustained health practices. Probably because of the profound influence and widespread incorporation of his conceptual insights into the body of general knowledge of sociology, these Weberian contributions are seldom cited directly in current medical sociology research. Two notable exceptions are the analysis of Weber’s legacy in medical sociology (Gerhardt 1989) and his concept of lifestyles (Cockerham 2021a, 2021b).
This interest in culture continues among subsequent generations of social scientists. By 1951, Clyde Kluckhohn reported many different definitions of culture and many more have appeared since. Yet, in spite of the plurality of definitions, some common strands that make up the fundamental fabric of this important concept are found in the cumulative work of anthropologists and sociologists. Kluckhohn (1951: 86) defined “culture” in the widest sense, as a community’s “design for living.” He pointed out that despite the wide variety of definitions he and A. L. Kroeber (Kroeber and Kluckhohn 1952) found, an “approximate consensus” could be developed, in which:
Culture consists in patterned ways of thinking, feeling, and reacting, acquired and transmitted mainly by symbols, constituting the distinctive achievements of human groups, including their embodiments in artifacts; … traditional (i.e., historically derived and selected) ideas and especially their attached values. (Kluckhohn
