Question

In what ways do cultural care expressions, patterns, and practices influence an individual’s health and well-being?

Answer 1

HEALTH

According to Who ‘ health a complete state of physical, mental and social wellbeing, and not merely the absence of disease or infirmity

Factors affecting health and well-being

• A range of different types of factors affect the health and well-being of individuals.
• These include socio-economic, physical, environmental and behavioural factors.
• The three aspects of health and well-being that can be affected by any of these factors are physical health and well-being, social health and well-being and psychological health and well-being.

Culture

Culture refers to the practices, beliefs, traditions and customs of a particular group of people. This is often linked to ethnicity but can also be applied to other groups of people in society. A person’s ethnicity refers to his belonging to a group of people of similar origin and culture and the adjective ethnic is often used to refer the culture a minority group within the wider population

• It is a Product of human societies, and man is largely a product of his cultural environment.
• Lays down norms of behavior and provides mechanisms which secure an individual in his personal and social survival.
• Culture stands for the customs, beliefs, laws, religion and moral percept, arts & other capabilities, skills acquired by man as a member of society.
• People of diverse cultural backgrounds often make different attributions of illness, health, disease, symptoms and treatment.
• Cultural differences in health attributions have major implications for medical professionals because over time, attributions play an essential role in the formation of beliefs concerning health and illness

Example,

• With regard to health beliefs in the U.S., African Americans may be likely to attribute illness externally to destiny or the will of God (equity attributions) and believe in the healing power of prayer
• As compared to ethnic minorities in the U.S., Anglo Americans are likely to hold more traditional Western health beliefs such as individual responsibility for health and illness and more “empirical” explanations of illness
• Because of the emphasis on micro-level and natural causes of illness, many White Americans believe that illness can be treated without reference to family, community or deities.
• Although very diverse, Latino populations as a whole are likely to believe in attributional equity as the cause of illness (e.g., God is punishing me for bad behavior and making me ill) and utilize ethnomedical approaches to healthcare
• Among the U.S. Latino populations, Murguía and colleagues found that U.S. acculturated Latino adults were less likely to make equity attributions about illness, and those Latinos who made equity attributions were more likely to delay seeking healthcare when sick.
• African patients are more likely to expect health practitioners to provide an experiential and a spiritual reason why they have been afflicted with illness

CULTURAL BELIEFS AND HEALTH

Different cultural groups have diverse belief systems with regard to health and healing in comparison to the Western biomedical model of medicine.Helman suggests that people attribute causes of illness to:

1) factors within individuals themselves (e.g., bad habits or negative emotional states);

2) factors within the natural environment (e.g., pollution and germs);

3) factors associated with others or the social world (e.g., interpersonal stress, medical facilities, and actions of others);

and 4) supernatural factors including God, destiny, and indigenous beliefs such as witchcraft )

CULTURAL PRACTICES OF HEALTH AND HEALING

Naturalistic disease theories explain disease in objective, scientific terms and have the core concept that illness occurs when the body is out of balance

In the traditional biomedical model, the pathogens need to be eradicated so that the person is without disease and only then are they considered healthy

The humoral system is another naturalistic disease theory originating from Greek and Roman philosophers and popularized by Hippocrates. According to Hippocrates, the body contains four elements (humors): blood, phlegm, yellow bile and black bile and health comes from an equal balance of the four humors. In this theory, healing occurs by restoring the proper balance of humors through removal (bleeding, starvation) or replacing (special diets, medicine) the deficiency

Personalistic disease theory attributes illness to intervention by an agent such as another human, witch, sorcerer, non-human, or supernatural force.

Emotionalistic disease theories explain illness as caused by strong emotional states (e.g., intense anger, jealousy, shame, grief or fright).

Two well known cultural systems of medicine and healing considered to be alternative by Western standards of medicine are Chinese Medicine and Ayurvedic Medicine.

1. Traditional chinese medicine

Traditional Chinese Medicine (TCM) is based on the concept that the human body has interconnected systems/channels (meridians) that need to stay balanced in order to maintain health. TCM healing practices include herbal medicine, acupuncture, dietary therapy, and Shiatsu massage. Qigong (breathing and meditation practice) is also closely associated with TCM

2.Ayurvedic medicine

Ayurvedic Medicine is native to India. The Ayurvedic system is based on the idea that every human contains a unique combination of Doshas (the three substances of wind/spirit/air, bile, and phlegm) that must be balanced for health. In addition, healthy metabolism, digestion, and excretion are thought to be vital functions of the body.

CULTURE-BOUND SYNDROMES

In 1994, the DSM (Diagnostic and Statistical Manual of the American Psychiatric Association) added culture-bound syndromes (i.e., troubling patterns of behavior/ experience that may not fall into one of the traditional Western DSM diagnostic categories)

Culture-bound syndromes are considered within the specific culture to be illnesses or at a minimum afflictions

Eating disorders span both physical and mental boundaries of cultural health. Eating disorders especially in highly industrialized societies continue to rise

Somatization, or physical ailments due to stress or emotional distress, is common especially in collectivistic societies perhaps because people avoid expressing psychological complaints to families and friends

Recognizing that there are culture-bound syndromes and that the expression and formation differs culturally paves the way for practicing culturally sensitive medicine and psychotherapy.

CULTURAL CONSIDERATIONS IN TREATMENT AND THERAPY

1. Listening to History- provide the opportunity for client to safely communicate their story; compassionate connection necessary keeping in mind the honor of a survivor’s willingness to relay their story to you E (Focus on Emotions and Reactions)
2. Focus on the emotions experienced throughout their experience; allowing survivor to put words to his/her feelings about what took place; increasing “feeling vocabulary” A (Asking Questions about Symptoms)
3. Discuss behaviors and physical symptoms R (Explaining the Reasons for Symptoms)
4. Help survivor make sense of symptoms; discussing physical and psychological symptoms as related to experience of trauma; normalizing; helping establish sense of control; symptoms as method employed by body for protection T (Teaching Relaxation and Coping Strategies)
5. Increse sense of mastery and reducing symptoms; imagery and focused breathing; identifying coping skills used during times of trauma, stress S (Helping with Self-Change)
6. identify ways in which survivor is the same and different after trauma; positive changes

CULTURAL CONSIDERATIONS IN MEDICAL EDUCATION

Medical educators should modify their teaching and learning approaches and philosophies in order to take into account cultural health attributions, beliefs, and practices of patients who medical learners will encounter.

• Training in medical education must incorporate the changing demographics, globalization, and technology as sociocultural conditions that shape the learning needs in today’s world
• the educational situation is marked by posing problems that relate to the real world which encourages critical reflection about these problems resulting in a continual creating and recreating of knowledge by both teachers and students.
• The strength of such approaches is that they challenge the existing hegemony in hopes of transforming society for the better for all people even the disenfranchised or marginalized