Because every culture is complex, it can be difficult to determine whether health and illness are the result of cultural or of other factors, such as physiological or psychological factors. However, there are numerous accounts of the presence or absence of certain diseases in certain cultural groups and reactions to illness that are culturally determined. Cultural influences may include food availability, dietary taboos, methods of hygiene, and effects of climate-all factors related to culture. Several examples of the influences of culture on health and illness follow. Of necessity, the examples are limited.
Three cultures have been studied by Leaf in which many of the people live to be very old, often well over 100 years. These people live in Vilcabamba, Ecuador; in Hunza, located in Pakistani-controlled Kashmir; and in Abkhazia in the Caucasus Mountain region of the Soviet Union. In each of these cultures the old people, even centenarians, share in a great deal of the hard labor and are physically active at levels that fatigue the average Westerner. Exercise appears to be a major factor in their longevity, in that constant physical activity improves cardiopulmonary functions so that the oxygen supply to the heart is superior to that of sedentary or urban people. A caronary attack (without overt symptoms) may have occurred when the person was 60 or 70 without having interfered with his activity or life. The body apparently compensated without difficulty.
In each of the cultures the aged are accorded high social status. They occupy a central and privileged position in the extended family. They live with close relatives, are given useful roles, continue daily to perform useful tasks, contribute to the economy of the community, and are sought for counsel and for their wisdom. Sense of family continuity is strong. Marriage and a regular, prolonged sex life seem important to longevity. Centenarians admit that a spouse who made them unhappy aged them, meaning they felt old in earlier life. Women who have borne children often live longer; some centenarian women have more than 20 children. The elderly are not shunted aside as in Western industrial societis, nor are they forced to retire; instead, they remain independent and expect great longevity. Once they lose their useful roles in the community, however, they die quickly.
Cultural dietary habits may also influence these people`s health and longevity. In Abkhazia many of the elderly people ate primarily beans and other vegetables in early life, and while their present diet is more varied, they still do not overeat. In Vilcabamba and in Hunza, the diet is low in calories, protein, fat, and carbohydrate and would be considered deficient by Western standards.
The geographical and cultural isolation of the people in Hunza and Vilcabamba may have resulted in generations of people with an absence of genes that would contribute to disease. However, in Abkhazia there are centenarians from many different ethnic groups. One common factor for centenarians in all three cultures is that their parents were also longlived.
The influence of other cultural folkways on health was studied by Graham. Using groups with low and high incidence of illness, he studied the influence of race, social class, ethnic group, and religion on distribution of disease. His epidemiological findings suggest thet Jewish women have less cancer of the cervix than non-Jewish women and that these results can be related ti circumcision of the Jewish male or to abstinence from intercourse as prescribed by Jewish law for a certain period after the menses. Nuns also have low risk for cancer of the cervix. Lower-class and Black women generally in the United States, with earlier sexual intercourse and early and more frequent childbirth, run a higher risk than the rest of the population in general and than Jews in particular. Prostitutes also have a higher incidence of cancer of the cervix, possibly because of multiple sex partners. Graham was influenced by the etiological theory proposed byy Martin that the uncircumcised non-Jewish male is more likely to harbor a carcinogenic virus, although only certain men carry it. Therefore, a woman who has sexual intercourse with a greater number of men during her life has a greater chance of being exposed to the virus and hence runs a greater risk of cervical cancer.
Culturally induced belief in magic can cause illness and death. The profound physiological consequences of intense fear, including inability to eat or drink, may be resposible. However, there may be no physiological changes except in the terminal moments. If the behavior of friends and relatives-what they say or do-strongly reinforces the person`s conviction of his imminent death, the victim becomes resigned to his fate and soon meets it.
A culture`s favored drink may have implications for health. For example, in a remote Mexican village, health workers found that the only available beverage was an alcoholic drink made from the juice of the a local plant. A safe water supply was brought in, but the people dit not fare well on it. The local drink was a rich source of essential vitamins and minerals not otherwise present in the local diet. Thus, although is may have appeared desirable to change a cultural pattern for certain health reasons, the unanticipated consequences proved detrimental to health in another way.
References :
Murray, RB and Zentner JP., Nursing Concepts for Health Promotion, Second Edtion, Prentice-Hall, Inc, Englewood Cliffs, N.J, 1979.
Graham, Saxon, “Cancer, Culture, and Social Structure”, in Patients, Physicians, and Ilness (2nd ed.). ed. E. Gartly Jaco. New York : The Free Press, 1972.
Martin, C., “Marital and Coital Factors in Cervical Cancer”, American Journal of Public Health, 1967.
MacLachlan, J., “ Cultural Factors in Health and Disease”, in Patients, Physicians, and Ilness : Behavioral Science and Medicine, ed. E. Gartly Jaco. Glencoe, III .: Free Press of Glencoe, 1958.
Fuerst, Elinor, and LuVerne, Wolff, Fundamentals of Nursing (4th ed.). Philadelphia: J. B. Lippincott Company, 19669.
