Culture and Disability Behavior

A substantial amount of literature suggests that illness behavior in the United States is a product of a patient''s core culture; equally credible findings do not support this contention. Most students and graduates in the health care professions believe that illness and disability behavior are affected by a patient''s culture, but they are hard put to find convincing examples of that relationship. In experience with medical students studying the social and cultural bases of illness behavior, with patients who are disabled and with persons who claim disability in the absence of physical disease or disabling psychopathology, I observed no deviant disability behavior that was typical for the members of any cultural group, and no behavior was displayed by the members of one cultural group that was not seen in members of other cultural groups. No cultural stereotypes were upheld. I did find evidence that disability behavior is influenced by personality factors, social situations and the gains derived from the disability status. Evolving concepts of “entitlement,” which are closely related to socioeconomic status, also have a significant influence. The impact of feedback from others in a person''s many social and medical subcultures is a more crucial determinant of illness and disability behavior, except in those for whom illness and disability behavior is determined by the limitations imposed by the disease or by a personality structure resistant to cultural expectations and social feedback.     

Use of traditional and modern health services by Laotian refugees.

Although refugee health care emerged as a special interest in the United States following the influx of almost a million Southeast Asians since 1975, few studies have been done of the influence of refugee traditions on the use of Western medical services. The illness patterns, medical beliefs, and health care behavior of a Southeast Asian refugee group, the Mien from Laos are described in this study. A cohort of 119 Mien refugees living in Richmond, California, was observed for a 6-month period. In-home interviews were undertaken about all episodes of ill health, including treatment and health care decisions. This study shows that the Mien integrate traditional healing beliefs and practices with the use of American health services. Such findings are important because the increasing cultural diversity in the United States, particularly in Western states, necessitates that health care professionals understand the importance of cultural factors for access to and the use of health care by all patients including refugees and other immigrant groups.     

The Zone of Social Abandonment in Cultural Geography: On the Street in the United States, Inside the Family in India

This essay examines the spaces across societies in which persons with severe mental illness lose meaningful social roles and are reduced to "bare life." Comparing ethnographic and interview data from the United States and India, we suggest that these processes of exclusion take place differently: on the street in the United States, and in the family household in India. We argue that cultural, historical, and economic factors determine which spaces become zones of social abandonment across societies. We compare strategies for managing and treating persons with psychosis across the United States and India, and demonstrate that the relative efficiency of state surveillance of populations and availability of public social and psychiatric services, the relative importance of family honor, the extent to which a culture of psychopharmaceutical use has penetrated social life, and other historical features, contribute to circumstances in which disordered Indian persons are more likely to be forcefully "hidden" in domestic space, whereas mentally ill persons in the United States are more likely to be expelled to the street. However, in all locations, social marginalization takes place by stripping away the subject's efficacy in social communication. That is, the socially "dead" lose communicative efficacy, a predicament, following Agamben, we describe as "bare voice."     

Well-Being: A Theoretical Program

A theoretical program of anthropological well-being is described and a special theory linking adaptive potential to biocultural success, longevity, and physical health is tested with a multicultural sample of 133 college students born outside, the United States. Those students who scored high in adaptive potential reported fewer symptoms of physical illness. The implications of the theory for a better understanding of cultural dynamics are discussed.     

The Health Consequences of Cultural Consonance: Cultural Dimensions of Lifestyle, Social Support, and Arterial Blood Pressure in an African American Community

Cultural dimensions of health and behavior have been difficult to study because of limited theoretical and methodological models linking the cultural, the individual, and the biological. We employ a cognitive theory of culture to understand culture and health in an African American community in the southern United States. First, cultural consensus analysis is used to test for shared cultural models of lifestyles and social supports within the community. Then, the theoretical and operational construct of "cultural consonance" is used to assess the degree to which individuals behave in a way consistent with cultural models. Findings indicate that cultural consonance in lifestyle and social support combine synergistically in association with blood pressure. These associations of cultural consonance and health are not altered by taking into account a variety of other variables, indicating an independent association of cultural dimensions of behavior with health status. Implications of these results for culture theory are discussed, [culture theory, culture consensus analysis, cultural consonance, African American community, arterial blood pressure]     

Toward a Puerto Rican Popular Nosology: Nervios and Ataque de Nervios

This paper is about naming illnesses—about who determines what categories are used and the implications of these determinations. The central concerns of medical/psychiatric anthropology have been to understand popular categories of and systems for classification of illness, to examine the relationship of illness categories to cultural understandings of the body, and to interpret the role of categories of illness in mediating between the personal and social spheres. At the same time, the paper also discusses the interplay of popular categories and psychiatric diagnoses. This paper examines the multiple experiences of nervios among Puerto Ricans in Puerto Rico and New York City. Our contention is that nervios is more than a diffuse idiom of distress, and that there are different categories and experiences of nervios which provide insights into how distress is experienced and expressed by Puerto Ricans and point to different social sources of suffering. The data in this paper come from the responses to a series of open-ended questions which tapped into people's general conceptions of nervios and ataques de nervios. These questions were incorporated into follow-up interviews to an epidemiological study of the mental health of adults in Puerto Rico. The results suggest ways to incorporate these different categories of nervios into future research and clinical work with different Latino groups in the United States and in their home countries.     

Science, religion, and society: the problem of evolution in america

American resistance to accepting evolution is uniquely high among First World countries. This is due largely to the extreme religiosity of the United States, which is much higher than that of comparably advanced nations, and to the resistance of many religious people to the facts and supposed implications of evolution. The prevalence of religious belief in the United States suggests that outreach by scientists alone will not have a huge effect in increasing the acceptance of evolution, nor will the strategy of trying to convince the faithful that evolution is compatible with their religion. Because creationism is a symptom of religion, another strategy to promote evolution involves loosening the grip of faith on America. This is easier said than done, for recent sociological surveys show that religion is highly correlated with the dysfunctionality of a society, and various measures of societal health show that the United States is one of the most socially dysfunctional First World countries. Widespread acceptance of evolution in America, then, may have to await profound social change.     

Biohistorical approaches to “race” in the United States: Biological distances among African Americans,European Americans,and their ancestors

Folk taxonomies of race are the categorizations used by people in their everyday judgments concerning the persons around them. As cultural traditions, folk taxonomies may shape gene flow so that it is unequal among groups sharing geography. The history of the United States is one of disparate people being brought together from around the globe, and provides a natural experiment for exploring the relationship between culture and gene flow. The biohistories of African Americans and European Americans were compared to examine whether population histories are shaped by culture when geography and language are shared. Dental morphological data were used to indicate phenotypic similarity, allowing diachronic change through United States history to be considered. Samples represented contemporary and historic African Americans and European Americans and their West African and European ancestral populations (N = 1445). Modified Mahalanobis' D² and Mean Measure of Divergence statistics examined how biological distances change through time among the samples. Results suggest the social acceptance for mating between descendents of Western Europeans and Eastern and Southern European migrants to the United States produced relatively rapid gene flow between the groups. Although African Americans have been in the United States much longer than most Eastern and Southern Europeans, social barriers have been historically stronger between them and European Americans. These results indicate that gene flow is in part shaped by cultural factors such as folk taxonomies of race, and have implications for understanding contemporary human variation, relationships among prehistoric populations, and forensic anthropology. Am J Phys Anthropol 2009. © 2009 Wiley-Liss, Inc.     

The Difference that Diaspora Makes: Thinking through the Anthropology of Immigrant Education in the United States

In this article, I examine the possibility of a productive dialogue between diaspora studies and the anthropology of immigrant education in the United States. Arguing that their respective views on the nation-state is a key source for their different orientations toward migrant social and cultural worlds, I nevertheless argue that an engagement between these two fields of study will yield more critical understandings of nationalism, the category of the "immigrant," and multiculturalism within both these areas of scholarship.     

Health issues of Afghan refugees in California.

Since the 1979 Soviet invasion of Afghanistan, more than 6 million Afghan refugees have become the world''s largest refugee population. Although refugees in Pakistan and Iran are now beginning to repatriate, continuing political turmoil in Afghanistan and children''s acculturation and educational opportunities will keep many Afghans in the United States permanently. Although there are no accurate statistics, local resettlement agencies and Afghan community leaders estimate that there are 10,000 to 35,000 Afghans in northern California. They suffer from a variety of problems common to refugees: language, economic and occupational problems, and substantial challenges in psychological, family, social, and cultural adjustment to the United States. Although many Afghans are doing well, many others have depression, psychosomatic symptoms, and posttraumatic stress disorder.     

Health policy and ethnic diversity in older Americans. Dissonance or harmony?

The rapid growth and diversity of the older population have long-term implications for health care policies in the United States. Current policies designed for a homogeneous population are increasingly obsolete. To ameliorate obstacles that handicap many ethnic minority elders and to provide equal access to adequate and acceptable health care, several factors need to be considered. Enhanced data collection and analytic techniques are needed. The effects of race or ethnicity must be separated from other biologic, environmental, socioeconomic, cultural, and temporal factors on health status and behavior. Health care professionals and organizations serving minority elders must continue to expand their advocacy efforts to articulate the findings and their concerns to policymakers. Policymakers must understand and acknowledge the implications of an increasingly diverse society and determine what will constitute adequate, accessible, and acceptable health care within continuing fiscal constrains. Program planning, implementation, and evaluation methods must be revised to meet future health care needs effectively and efficiently.     

Need for Legal Protection Against Weight Discrimination in the United States

The steady rise in the prevalence of obesity has had a negative impact for people living with obesity. This includes health care and social disparities that lead to diminished quality of life and social prosperity. Even though discrimination based on weight has a negative impact on people’s health and wellness, there is only one state in the United States, Michigan, that has an antiweight discrimination law. Massachusetts and some cities in the United States have been working to ensure that weight is added as a civil protection over the years. This perspective describes the importance of a weight discrimination law in the United States as well as summarizes the currently existing protections in the country.     

Cultural assessment in bioethical advocacy--toward cultural competency in bioethical practice

The continued diversification of the U.S. population poses increasing challenges for bioethical advocates (e.g., ethicists, physicians, nurses, social workers, psychologists, surrogates, researchers, and lawyers), especially those serving rapidly expanding and culturally varied populations. The issue from the bioethics perspective is that the members of ethnically diverse groups often bring different normative expectations and their own preferred decision-making formats to the bioethics table. For example, some advocates will encounter a "collectivity," or the family-as-a-whole rather than the individual, as a decision maker. In other instances, they may encounter cultural groups whose members (or some of whose members) will value the principle of beneficence more than personal autonomy. Moreover, such value-based challenges are likely to continue since forecasters predict that diversification will actually quicken in the United States throughout the next five decades. In the face of these changes in the bioethical climate, advocates must be prepared to strengthen their cultural assessment skills. Taking a multidimensional approach to the problem yields a four-point cultural assessment model to help advocates handle the great diversity of outlook and orientation among their culturally diverse clientele.     

Gypsies and health care.

Gypsies in the United States are not a healthy group. They have a high incidence of heart disease, diabetes mellitus, and hypertension. When they seek medical care, Gypsies often come into conflict with medical personnel who find their behavior confusing, demanding, and chaotic. For their part, Gypsies are often suspicious of non-Gypsy people and institutions, viewing them as a source of disease and uncleanliness. Gypsy ideas about health and illness are closely related to notions of good and bad fortune, purity and impurity, and inclusion and exclusion from the group. These basic concepts affect everyday life, including the way Gypsies deal with eating and washing, physicians and hospitals, the diagnosis of illness, shopping around for cures, and coping with birth and death.     

Gender differences in the diagnosis and treatment of HIV

Many cases of HIV infection in women in the United States are diagnosed very late in the course of their illness. HIV testing should be routinely recommended if a woman presents with certain gynecologic conditions or sexually transmitted diseases. Lack of awareness of HIV status leads to the majority of new sexually transmitted HIV infections. In the United States, most AIDS cases diagnosed among females in 2004 were attributable to high-risk heterosexual contact, disproportionately affecting black and Hispanic women. Depending on the racial/ethnic community being served, obstacles to access to care, including poverty, transportation issues, and cultural and language barriers, must be overcome. The full implications of gender differences in viral load and CD4 count in the treatment of women with HIV are not yet known. Clinical trial data on HIV therapies in women are limited, and most studies that have included women have not been powered to detect gender differences in virologic and immunologic success rates. Timing and choice of treatment are affected by the pharmacokinetics of antiretroviral drugs and the long-term complications of treatment, both of which may be different for men and women with HIV infection.     

Social linkages to biological markers of health among the elderly

The social environment and exposure to life challenge affect a person's physical and emotional well-being. The present research uses a population-based study of the elderly in Taiwan to elaborate the cumulative physiological costs--as reflected in biological markers of risk factors known to have adverse consequences for health--of challenge and unfavourable position in social hierarchies and networks. Overall, biological markers of risk among the elderly are similar in Taiwan and the United States. However, male and female Taiwanese elderly are at lower risk for illness associated with indicators of DHEA-S, while women are at higher risk for illness associated with elevated blood pressure, and men at lower risk for illness associated with total/HDL cholesterol, and glycosylated haemoglobin. There are strong and statistically significant effects of position in social hierarchy (education) and challenge (recent widowhood and a perception of high demands) on an index of cumulative risk (allostatic load). Membership in social networks and participation in social activities have expected, but not statistically discernible, effects.     

Becoming American,Constructing Ethnicity: Immigrant Youth and Civic Engagement

After presenting demographic data to demonstrate why immigrant youth are and will be important, this article addresses the limited literature on immigrant youth civic engagement. It also examines the historical literature of immigrant youth in the United States, specifically that of the last great wave of immigration approximately 100 years ago, along with the literature on contemporary adult immigrant civic engagement. It concludes that today's immigrant youth are Americanizing. Nevertheless, when U.S. society and particularly the U.S. state treats immigrant youth as different, the immigrant youth respond with pride by defending their cultural integrity, their right to be different. Contemporary immigrant youth also have the opportunity to maintain transnational ties with their homeland. In response to these forces and opportunities, immigrant youth maintain multiple identities, sometimes identifying with their homeland culture at other times with the United States. The unanswered question is what difference these multiple ties may make for civic engagement.     

Lifetime Risk of Fatal Occupational Injuries within Industries,by Occupation,Gender, and Race

Estimates of risk accumulated over a working lifetime are used to assess the significance of many workplace health hazards. Most studies which have estimated this risk have focused on a worker's lifetime risk of dying of a stated illness based on exposure to a hazard in a specific job. The concept, however, has not been widely applied to occupational injury deaths. This study examines the use of lifetime risk based on national fatal injury data from the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI). Lifetime risks are defined by specific causal events for those groups identified as having the highest general lifetime risks. The lifetime risk model for injury used in this work can be compared with risk assessments for occupational illnesses. Fatal injury lifetime risk estimates will be useful in defining traumatic injury exposures that are appropriate for targeting research and prevention efforts needed to reduce the burden of work-related death within the United States. These estimates also provide a means of prioritizing traumatic injury research with fatal illness research, while providing the additional benefit of providing a means of informing workers of their fatal injury risks.     

Medical disclosure and refugees. Telling bad news to Ethiopian patients.

The strong value in American medical practice placed on the disclosure of terminal illness conflicts with the cultural beliefs of many recent refugees and immigrants to the United States, who often consider frank disclosure inappropriate and insensitive. What a terminally ill person wants to hear and how it is told are embedded in culture. For Ethiopians, "bad news" should be told to a family member or close friend of the patient who will divulge information to the patient at appropriate times and places and in a culturally approved and recognized manner. Being sensitive to patients'' worldviews may reduce the frustration and conflict experienced by both refugees and American physicians.