Culture and International Health

            Culture is an ambiguous term. It can be, and is, operationalized differently depending on the agenda of the researcher, the topic of research, or the outcome that one is looking for. It can be observed in different levels, whether it be the culture of a country (macro), a state/territory/province (mid-range), or of a village (micro), and often times is evaluated based on the different cultural values that the researcher, knowingly or unknowingly, bring from his/her own point of view. When I say culture, I am referring to the meaning-making processes, point-of-views, and framework of a group that guides the actions and problem-solving processes of the individuals within that group (Kao et al., 2004; Swindler; 1986). Common characteristics that are threaded throughout culture are:

 1) learned from birth through the processes of language acquisition and socialization, 2) shared by all members of the same cultural group, 3) an adaptation to specific environmental and technical conditions, and therefore 4) a dynamic, ever-changing process (Kagawa-Singer 2012:357; Leininger, 1995).

                  The above characteristics illustrate the reciprocal nature of culture.  #3 in particular, “an adaptation to specific environmental and technical conditions”, brings to the forefront that culture is, in part, a result of the conditions that a community experiences as a way to not only make sense of life, but to survive.  #4 goes further to explain that culture is dynamic, not static, and will continue to change as life changes.

When I look at this definition, it makes me realize a more careful consideration of culture in developing and implementing health interventions should be a priority. It is important to ask ourselves, as researchers, not just what problem we are trying to address, but also what is creating the problem, and how culture interacts with the problem. We must take into account the size of the group we are trying to generalize about. If we are trying to create and implement a national scale intervention, we must recognize that there will be within level differences of culture that makes the applicability of that intervention vary depending on the cultural clashes within a country.  Further, recognize that culture clashes that seem to be between what we deem the “civilized” majority and the “uncivilized” minority may speak about the inequalities embedded within the social structure of that country. There are different levels of culture that need to be taken into consideration:

-Macro: national culture (values, behavior, environment)

            -Middle-Range: States/territories/Provinces

-Micro: Villages (taking into special consideration the marginalized and poorer populations that are usually silenced, and victims of social inequality)

            Without knowing who you are trying to target with your intervention, and what possible cultural differences lies between and within these different levels of organization, the effectiveness of the intervention can be entirely compromised. For example, in Dutta-Bergman’s article on the Santali (2004), trying to promote national family planning to a village whose culture revolves around large families not because they are primitive, but because the culture of their village promotes many children to bring in money and labor into their family’s income due to their marginalized status, the intervention is not going to be successful. This also points to structural violence’s role in causing harm to certain populations. Culture has become a scapegoat of failed public health interventions, but there needs to be a deeper look at how culture has arisen in populations.

References:

            Dutta-Bergman, Mohan J. 2004. “Poverty, Structural Barriers, and Health: A Santali narrative of Health Communication.” Qualitative Health Research 14(8): 1107-1122.

Kagawa-Singer, M. 2012.”Applying the concept of culture to reduce health disparities through health behavior research.” Preventative Medicine 555(5):356-361.

Kao, H.F., M.T. Hsu, & L. Clark. 2004. “Conceptualizing and critiquing culture in health research.” Journal of transcultural nursing 15:269-277.

Leininger, M. 1995. Trancultural Nursing: Concepts, Theories, Research, and Practice. McGraw Hill: New York.                                   

Swidler, A. 1986. “Culture in Action: Symbols and Strategies.” American Sociological Review 51:273-286.