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Introduction to Medical Anthropology

MEDICAL ANTHROPOLOGY LECTURE

by Dr PHUA Kai Lit
School of Medicine and Health Sciences
Monash University Sunway Campus
Bandar Sunway, Malaysia


CULTURE, HEALTH AND DISEASE

WHAT IS "CULTURE"?: "Culture" refers to an ethnic group's system of values, beliefs and customs etc which guide and influence everyday behaviour. "Culture" is passed on from generation to generation and can change significantly over time. A "sub-culture" can also exist e.g. teenage subculture in the USA

ELEMENTS OF CULTURE
Language and other systems of communication (such as an alphabet & symbols which stand for other things)
Beliefs (including religion)
Rules of etiquette ("proper"behaviour) - this may vary by sub-group within that particular ethnic group
Material artifacts e.g. dress, tools
Food, music, law, customs and traditions etc

HOW CAN CULTURE AFFECT HEALTH AND DISEASE?
1. By defining certain signs and symptoms as "sick" versus other signs and symptoms as "not sick".
Example: in the case of mental health, is a particular behaviour considered normal ("not sick") or abnormal ("sick") in that culture?
2. By influencing theories of disease causation.
Is sickness due to evil spirits, spells
cast by others, punishment by God, bad air, humoral imbalance, germs etc?
3. Presence of "culture-bound illnesses"
Note the difference between "disease" and "illness". "Disease" is physical malfunctioning of the body. "Illness" is subjective perception of whether one is sick or not. Possible to have a disease and not feel sick, e.g., undetected diabetes. Also possible to feel sick without any detectable disease, e.g., hypochondriasis.

Culture-bound illnesses: Illnesses found in some cultures but not in others, e.g., anorexia nervosa (not found in poor countries where people may not even have enough to eat!), Chinese restaurant syndrome, latah, koro.

4. Impact of cultural practices on health
Nutrition (including food taboos)
Personal hygiene and grooming
Sexual and contraceptive behaviour
Gender roles
Pregnancy and childbirth practices
Child-rearing practices (including breast-feeding)
Indigeneous health technology e.g. traditional medicine/drugs
Material culture e.g. house design
Organisation of work/division of labour
e.g. what jobs do people do and how does this affect their health?

NUTRITION: "Food" versus "non-food" -- do these beliefs increase the risk
of nutritional deficiency at different stages of the life cycle?
Religious beliefs and food e.g. prohibition of alcohol consumption in Islam.
Dietary changes and health e.g. introduction of the "Western" diet and its
impact on health.

PERSONAL HYGIENE AND GROOMING: Personal hygiene practices in that particular
culture. Scarification and body alterations e.g. tattoos, circumcision, artificial "beauty marks"
such as teeth filing, cosmetic surgery etc.

SEXUAL AND CONTRACEPTIVE BEHAVIOUR: Do females enter into sexual relationships
when they are very young e.g. teenage marriage? Does the culture discourage multiple sex
partners? Is prostitution common in that culture? Are there different standards of
sexual behaviour for men and women? Is contraception used to reduce frequency of
child-bearing?

GENDER ROLES: Gender roles and male-female relations e.g.
Are females treated very differently from males in that culture?
Are strong negative attitudes toward women common among the men?
Is violence within marriage tolerated in that culture?
Is it considered acceptable for women to smoke tobacco and drink alcohol?
Are females pressured to conform to cultural practices that harm them?
Examples include female genital mutilation; harmful fashions (corsets, high heeled shoes),
harmful body images (leading to plastic surgery, eating disorders etc). These can be
imported from Western countries via the mass media such as the TV

PREGNANCY AND CHILDBIRTH PRACTICES:
Are there any dangerous practices during childbirth e.g. applying mud
or dung to the newly-cut umbilical cord?
Are pregnant women forbidden to eat certain foods?

CHILD-REARING PRACTICES: Are child-rearing practices harsh in that culture?
Is it considered acceptable to discipline children by beating them harshly?

INDIGENEOUS HEALTH TECHNOLOGY: Are the traditional drugs effective against particular diseases? Are the traditional drugs actually harmful e.g. traditional Chinese medicine contaminated by mercury.

MATERIAL CULTURE AND IMPACT ON HEALTH:
Traditional house design -- if ventilation is poor, there will be high
exposure to indoor air pollutants such as smoke from indoor cooking or indoor heating
Dress and health e.g. corsets leading to fainting spells in women in Europe in the past.
Today, wearing of high-heeled shoes and injuries to the foot.

ORGANISATION OF WORK/DIVISION OF LABOUR AND HEALTH
What work do people from that ethnic group/sub-group do and how would this affect their health?
Hunter-gatherer society e.g. injuries
Animal herders e.g. zoonoses
Fishers e.g. weather-related, drownings
Agricultural workers e.g. pesticide poisonings
Industrial workers e.g. occupational diseases
Office workers e.g. ergonomic injuries
Other workers e.g. those who do 3D jobs (dirty, dangerous, degrading)
such as Indian Outcastes, Roma (Gypsies), garbage sorters
Migrant workers, especially those who work illegally in foreign
countries are at higher risk of ill health

"CULTURAL SENSITIVITY"
Being aware of how culture can affect behaviour (including health-related behaviour)
Respecting beliefs of others and taking care not to offend them (even if you disagree
with the beliefs)
Avoiding ethnocentrism

HOW TO HANDLE "CULTURE AND HEALTH" ISSUES (IMPORTANT!)
1. Encourage those behaviours which are good for health
2. Ignore those which are known to be harmless
3. Discourage those which are harmful
e.g. food taboos which lead to nutritional
deficiency during pregnancy, lactation,
menstruation or sickness.
4. Find out more or do research on those which you are unsure of.

FINALLY, think about how your being a Malay/Chinese/Indian/Muslim/Christian etc.
affects your behaviour and lifestyle and how these, in turn, can affect your health.


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