as “a map” or “abstract representation” of the distinctive features of a community’s way of life. This method is akin to the ideal type, the analytical tool introduced by Weber (1946) to identify general characteristics, patterns, and regularities in social behavior.
A direct connection between culture and health was articulated by Bronislaw Malinowski (1944: 37), who considered culture as a functional response to satisfy “the organic and basic needs of man and of the race.” He defined culture as “the integral whole” encompassing “human ideas and crafts, beliefs and customs … A vast apparatus, partly material, partly human and partly spiritual, by which man is able to cope with the concrete, specific problems that face him” (Malinowski 1944: 36). Malinowski saw those problems as human “needs” that prompted “cultural responses.” These needs were metabolism, reproduction, bodily comforts, safety, movement, growth, and health. However, in his view, health is implied in all the other six human basic needs, in addition to the explicit need for “relief or removal of sickness or of pathological conditions” (1944: 93). The “cultural response” which addresses the problem of health is “hygiene”, defined as all “sanitary arrangements” in a community, “native beliefs as to health and magical dangers,” “rules about exposure, extreme fatigue, the avoidance of dangers or accidents,” and the “never absent range of household remedies” (Malinowski 1944: 91, 108).
Another valuable contribution to the understanding of culture was provided by sociologist Talcott Parsons. Parsons was greatly influenced as a student by Durkheim and Weber. Among his colleagues, he acknowledged the influence of Kluckhohn concerning the problems of culture and its relation to society (Parsons 1970). He conceptualized social action as taking place within a three-dimensional context comprising personality, culture, and the social system. Parsons (1951: 327) defined culture as “ordered systems of symbols” that guide social action and are “internalized components of the personalities of individual actors and institutionalized patterns of social systems.” For Parsons (1951: 11), the shared symbolic systems are fundamental for the functioning of the social system and they represent “a cultural tradition.” Parsons (1951: 326–7) argued that a cultural tradition has three principal components or systems: value-orientations, beliefs, and expressive symbols.
His preoccupation with a balanced analysis of values and motives that would prevent us from falling into the extremes of “psychological” or “cultural” determinism, led him to invest considerable effort into the discussion of culture. Parsons (1951: 15) identified three main features:
First, that culture is transmitted, it constitutes a heritage or a social tradition; secondly, that it is learned, it is not a manifestation, in particular content, of man’s genetic constitution; and third, that it is shared. Culture, that is, is on the one hand the product of, on the other hand a determinant of, systems of human interaction.
Parsons’ concepts of culture and cultural traditions and his identification of culture as transmitted, learned, and shared, together with the contributions from Durkheim, Weber, Kluckhohn, and Malinowski form the classical foundation for the study of culture. An additional heritage of the study of culture is the cross-fertilization of insights and research between sociology and anthropology. Most current studies on culture and on the link between culture and health have developed from this rich foundation.
By identifying the fundamental components of culture, the collective wisdom inherited from the classics permit us to consider culture and ethnicity as the same phenomenon. Although Margaret Mead (1956) and Benjamin Paul (1963) proposed that cultural differences cut across racial and religious lines, these two factors are very much part of the cultural landscape within which individuals and groups operate. This idea is captured by Stanley King (1962: 79), who proposed that what constitutes an ethnic group is the combination of “common backgrounds in language, customs, beliefs, habits and traditions, frequently in racial stock or country of origin” and, more importantly, “a consciousness of kind.” Note that, from the perspective of individuals and collectivities, these ethnic similarities may be factual or perceived and may include a formal religion. The sharing of the same geographical settlement is not as important as it was once thought, mainly because large migrations (voluntary or not) of people from different ethnic groups have resulted in the formation of diaspora beyond their ancestral lands and the subsequent increase of multiethnic settlements. The process of assimilation (becoming a member of the host culture) is common when individuals settle in a new country. Living in close proximity to each other leads individuals from different ethnic groups into another process, pragmatic acculturation, that is, the process of culture borrowing motivated by the desire to satisfy specific needs (Quah 1989a: 181). Assimilation and pragmatic acculturation have been found to influence health behavior significantly, as discussed later. But first, let us review some of the contemporary leading ideas on culture and health.
Main Contemporary Research Trends
The contributions of the classics are the foundation of our understanding of culture and of its impact on behavior. Research over the past six decades support their interpretation of culture. The corpus of contemporary sociological and anthropological research on culture is expanding rapidly and in different directions. “Neoclassical” approaches emerged from the work of Weber, Durkheim, and Marx but have taken a life of their own as seen, for example, in interpretations of religion, studies of social control, and feminist perspectives of the body and gender (Alexander 1990). Research is also advancing on multiple aspects of the impact of culture and ethnicity on health status (e.g. Fox et al. 2017; Gage-Bouchard 2017; Nelson and Wilson 2017; Versey et al. 2019); on utilization of healthcare services (e.g. Galbraith et al. 2016; Kikuzawa et al. 2019; Korous et al. 2017; Miller et al. 2019); and on the link of socioeconomic inequalities and health (e.g. Downing 2016; Lane et al. 2017), including the differential impact of the COVID-19 pandemic among ethnic minorities in the US (Borjas 2020), among other aspects.
Attention to the body as an important subject of social analysis was brought up by Michael Foucault’s work on The Order of Things (1970), The Birth of the Clinic (1973), and Discipline and Punish (1977). He eschewed research in favor of formulating assumptions, but his effort at awakening alertness to the symbolic and perceived meaning of the body is, to me, his vital contribution. Research findings over the past two decades show that the symbolic meaning of the body in relation to health and illness, manipulation and completeness, varies across cultures. A dramatic illustration is the cultural interpretation of female genital mutilation/cutting (FGMC) by Western groups advocating the eradication of FGMC as opposed to the symbolic meaning of FGMC held by some African communities that are struggling to preserve it (e.g. Fox and Johnson-Agbakwu 2020; Greer 1999; Grose et al. 2020).
On the effort to elucidate how culture affects the individual’s behavior, the work of Erving Goffman (1968a, 1968b) using the symbolic-interaction perspective is important. Goffman focuses on the person’s subjective definition of the situation and the concept of stigma. He proposes a three-stage stigmatization process (1968b): the person’s initial or “primary” deviation from a normative framework; the negative societal reaction; and the person’s “secondary” reaction or response to the negative reaction that becomes the person’s “master-status.” Goffman’s “normative framework” is socially constructed based on the community’s predominant culture. Disability and disease, particularly mental illness (Goffman 1968a), are typically perceived as stigma and trigger the stigmatization process. Unfortunately, Goffman and many of his followers have neglected to apply his conceptual approach fully to their own studies: they overlook cross-cultural comparisons (e.g. Locker 1983; Scambler 1984; Strauss 1975).
The preceding discussion might suggest there is consensus on what culture is and how to study it. Jeffrey Alexander (1990: 25–6) suggests that while contemporary researchers agree on “the autonomy of culture from social structure,” he finds “extraordinary disagreement over what is actually inside the cultural system itself.” Is it symbols, or values, or feelings, or metaphysical ideas? He proposes that culture might embrace
