1 sociocultural context of health and health care delivery

By C. Settley

2016

Culture

In sociological sense: Includes the total way of life of a group of

people. This way of life is shared, it comprises some

learning/teaching, and is based on symbols.

The social grouping sharing a way of life can be a nation, a region or

even an occupation.

Within a group in which most members share what we call the

dominant culture- these being subcultures

We are all born cultureless- and have to be taught our culture by

various individuals, such as our parents

This process is called socialisation

All new parents are actively involved in socialisation when they teach

their children to talk, walk and behave

Culture

Culture is an element of society- the most extensive element

It can be described as society’s ‘personality’ and comprises the

following aspects of social life: behaviors, norms, values, beliefs and

the physical artefacts, i.e. all the objects made by the members of a

society.

The latter, tangible products of human society are what we call

material culture e.g. cars, televisions, beds, homes, churches,

technology, paintings, etc.

Intangible creations or objects of human society (non-material

culture), includes knowledge, beliefs, norms, values, symbols and

language.

Material Culture and

Non-material Culture

Material culture

Physical features that define a

particular culture, society, or

group, such as jewelry, art,

buildings, weapons, machines,

clothing, hairstyles, etc.

Non-material Culture

Non-physical aspects like a group’s

ways of thinking (beliefs, values,

and assumptions) and common

patterns of behavior (language,

gestures, and other forms of

interaction).

Components of Culture

1) Knowledge and beliefs- the

Cognitive Component

2) Value and Norms- the Normative

Component

3) Symbols and Language- the

Symbolic Component


The Cognitive Component:

Knowledge & Beliefs Knowledge forms the foundation for social behaviour

Knowledge is a collection of relatively objective ideas and

facts about our physical and social worlds

Beliefs are ideas that are relatively subjective, unreliable

or not linked to evidence

We acquire our beliefs through the process of

socialisation; they help shape how we perceive our

surroundings and our personality development

Knowledge now is considered as a storage of information fact or assumption, and

these knowledge can be passed down from one generation to another.

Every culture has beliefs about health, disease, treatment, and health care providers. Not scientifically based. FILLIPINOS: Children sometimes use the words "mama," "opo," "po" and "papa"

to show respect to their elders, and they may often take care of their parents when they age. Some other folk beliefs are that paying debts at night will lead to poverty, having an itchy palm means money is coming and using a coin found on the road leads to a shortage of money. It's also common for women to not use medications during childbirth due to a belief that pain comes from

god, and for the father to take care of both mother and child for a month after delivery.&

Seeing a black cat will bring bad luck Avoid joining a meal of 13 people In Friday, do not clip your nails Cry on night and tomorrow you will be happy

&Roman Catholics belief that God’s Ten Commandments provide a moral compass — an ethical standard to live by.


The Normative Component:

Values, Norms and sanctions

Comprises elements necessary for the maintenance of integration and

conformity in society

This component specifies the correct ways of thinking and behaving

and of defining morality

Values are defined as socially shared ideas or standards about what is

good, desirable or important

They represent general criteria for evaluating our own views and

actions or those of others

The social rules that determine how we ought to behave arise from

the values

Thus, laws against murder clearly reflect the value we place on

human life.



Value, Norms and Sanctions (continued)

Sometimes the values within a society conflict

Most human populations, no matter how diverse, share at least some

consensus over values such as what is good or bad, appropriate or

inappropriate

The consensus is often not perfect, but without some degree of value

consensus, societies will be characterized by conflict and tension. Some

general values respected by most globally:

Values are defined as culturally defined standards of desirability, goodness and

beauty, which serve as broad guidelines for social living.

American values Japanese values European values

• Equality

• Individuality

• work hard, play hard

= success

• the sky is the limit

• Freedom

• Mobility

• Safety

• Competition

• efficiency

• obligation to the

group

• behaving according

to status

• Harmony

• Effort

• self-improvement

• self-criticism

• Aesthetics

• Intellectualism

• Socialism

• Tradition

• Leisure

• Sensuality

• Family and friendship




Norms are the social rules that specify how people should behave

They serve to guide people’s actions in particular situations and within particular roles, groups, organizations and institutions

Eg tell us how to act in elevators, how to address our parents, teachers and how to greet people

Norms can be prescriptive: defining how one ought to behave in given situations OR

Norms can be proscriptive: defining how one ought not to behave.

Cultural norms are the standards we live by. They are the shared expectations and rules

that guide behavior of people within social groups. Cultural norms are learned and

reinforced from parents, friends, teachers and others while growing up in a society. Norms

often differ across cultures. Eg: values regarding public behavior:

- Shake hands when you meet someone.

- Have direct eye contact with the person you are speaking with.

- Consume alcohol in moderation.

- Do not pick your nose.

- Say please and thank you.

- Be kind to the elderly, like opening a door or giving up your seat.

- When at someone’s home, ask permission, such as turning on the television or using the

bathroom.

- Stop at a red light.

- Go at a green light.

- Pull over for emergency vehicles.

- Drive on the right side of the road in the United States.

- Try to avoid burping or farting in public.

- Flush the toilet.

- Say "please" when asking for something.

- Say "thank you" when someone does something for you.

- Call to let someone know you will be late.




Folkways are norms that designate a society’s customs for routine and casual interaction and for distinguishing between right and rude.

They are weak norms that specify expectations about proper behaviour

Violating folkways are not considered serious-may be considered impolite and inappropriate

Will not be arrested for it

A Folkway is the traditional behaviour or way of life of a particular community or

group of people. Eg:

In Ghana, don't hand things with your left hand, eat, etc. This is the unclean

hand (used for wiping).

For example, the practice of waiting in (or on) line in many societies is an

example of a folkway. This practice creates order in the process of buying things

or receiving services, which smooths and expedites the tasks of our daily lives.




Mores (pronounced mo-rays)

Refers to strongly held norms that specify normal behavior and constitute

demands, not just expectations

Violation of mores involves a strong negative societal reaction

In many societies, some such norms are considered so important that they are

called laws

Some categories of people are put in charge of enforcing such laws and

specific punishment is imposed on violators

E.g. committing murder- brought to justice by laws and police, severely

punished by a judge

The term "mores" refers to the norms set by society, largely for behavior and

appearance. Individuals who do not follow social mores are often considered

social deviants. EG:

- It is not considered acceptable or mainstream to abuse drugs, particularly those

such as heroine and cocaine.

- It is expected that one would hold the door for a person behind him or her

when entering a building.

- It is expected that alcohol consumption in public will be in moderation.

- Talking to oneself in public is not considered a normal behavior.

- Adults are expected to work in order to support themselves.

- People are expected to be honest.

- If a promise is made, it is expected it will be kept.

Chewing with one's mouth closed is expected.




Norms guide behavior

How does society force people to obey the norms of a society?

Via Sanctions:

Can be positive (reward) or negative (punishment)

Can be informal (enacted by friends/family) or formal (enacted by formal institution)

The process by which are used to make people conform is called social control

Socialization causes us to internalize cultural norms and impose constraints on our own behavior

When we disregard an internalized norm, it results in our experiencing guilt and shame

Sanctions are mechanisms of social control. Sanctions can either be positive

(rewards) or negative (punishment), and can arise from either formal or informal

control.

Positive sanctions:– an action that rewards a

particular kind of behavior!

Eg: Teachers give good grades for good work

Negative Sanctions – punishment or threat of

punishment to enforce conformity.

Eg: Traffic fine when ignoring red light


The Symbolic Component:

Symbols and Language

A symbol is used to represent or stand for something. Can take various forms

Key example: Language. It differs across different cultures. It does more than enable us to communicate. It can determine or influence how we think and it can be a source of thought.

It can be a physical object such as a wedding ring standing for a promise between two people

It can also be a characteristic of an object, like the Aids- awareness ribbon

Or a gesture: a fist raised in the air

Analyzing Culture

Due to different theories on the social phenomena, culture is also being seen through different lenses

The theories help us to understand

Assists us to view our own culture more objectively/scientifically

Malinowski (anthropologist in branch of functionalism): he maintains that cultural phenomena do not develop because people accidently or unintentionally invent them or simply borrow them from others. Rather, they are determined by basic needs and the possibilities of satisfying these. 3 kinds of needs:

Analyzing Culture

Structural Functionalism

Biological needs: food, shelter, reproduction

Instrumental needs: social control, education, political

organization, economics

Integrative/symbolic needs: knowledge, religion, art

Stable orderly system with interrelated parts that serve

functions

Core values

Cultural universals: values found in every culture in the world

Analyzing Culture


(continued)

Culture functions: to meet the needs of individuals rather than society as a whole

When the needs of individuals- who comprise society are met, the needs of society are also met

The way in which individuals’ needs are served, is that society provides institutions, customary practices and beliefs

Eg for the need of production- the institution of marriage and family has been provided

Eg to ensure order and stability- society has developed laws

Eg as means of intellectual, emotional and pragmatic control of destiny and chance- society has developed magic and religion

Analyzing Culture


(continued)

Strengths of the functionalist approach:

that it can help explain puzzling cultural practices like magic rituals that

are ridiculed as being both ignorant and irrational

Malinowski’s viewpoint: rituals are highly sensible and effective

study on Trobraid Islanders)

Superstitiousness ….Scientific grounds

Major weakness of the functionalist approach: it overemphasises harmony

and cooperation, resulting in cultural conflict being underestimated and

the extend of cultural change in society being downplayed

Analyzing Culture

The Conflict perspective Based on the assumption that social life is about competition and struggle

With members of powerful groups seeking to control scarce resources

Acc to this perspective of culture, values and norms help sustain the privileged position of the powerful

Culture thus reflects the interest of the rich and powerful in this perspective

Certain values- such as competitiveness- benefit the powerful like stimulating worker productivity,

enabling obtaining larger profits

By believing in competition, the powerless will feel that the powerful are entitled to their riches and

privileges

This illustrates the way in which certain ideas are cultural creations are used

A system of ideas that guides the way in which people think and act accordingly, is called ideology

(capitalism, communism and apartheid)

A strength of the conflict theory is that it stresses how cultural values and norms may perpetuate social

inequalities.

A limitation of the perspective is that it underestimates the extent of integration in society in that it

focuses on societal discord and the divisiveness of culture

Analyzing Culture

Symbolic Interaction

Describes people as active in that they create, maintain and

modify culture during their numerous daily symbolic interactions

This means that one’s culture does not determine one’s behavior;

neither are the norms and values static-but dynamic in that we are

constantly interpreting and re- them, thus changing them

The strength of the Symbolic Interaction is that it reminds us that

despite its structural elements, society consists of people

interacting with one another. Alters us to the fact that people who

maintain and change culture by means of interaction with others

The aspect is also a point of criticism, because it fails to take into

account the larger, macro-level social structures, such as social

class- aspects considered by the structural-functionalist and

conflict perspective

Concepts related to Culture

Cultural Universals &

Cultural Diversity

Cultural Universals – the commonalities that cultures share. Language, marriages, health systems, religion, economic system, recreation

Cultural Diversity- the differences that cultures share. different ways of looking at things, different ways of dressing, different ways of expressing personality/goodness

Cultural Relativity &

Ethnocentrism

Culture: language, values, beliefs, rules,

behaviors, artefacts and other

characteristics common to or shared by the

members of a particular group.

Race: biological term(genetic- hair, etc)

ethnicity: non-biological characteristics

that provide members of a group with a

sense of common identity such as ancestry,

culture, history etc

Ethnocentrism: the practice of judging

another culture by the standards of one’s

own culture and regarding one’s own as

superior.

Cultural relativism: the practice of judging

another culture by its own standards

Subcultures

Groups within a group

They develop their own unique symbols, norms and values.

Can be formed around many aspects such as age, occupation, ethnic group and sport interests

A person can belong to various subcultures simultaneously

Have unique traits

Do not oppose the dominate culture of a society (opposite of counterculture)

Members of counterculture are likely to question the morality of the majority group and engage in some or other form of protest activities

Subcultures:

Alcoholics Anonymous - a group for recovering alcoholics

Bikers - people interested in motorcycles and often form groups that travel

together

Bodybuilding - using certain exercises to build muscle

Emo - started with the hardcore punk movement, attitudes and dress are

melodramatic

Goth - characterized with dark hair, eyeliner, nail polish and clothes

Hip hop - started in South Bronx in the 70s, includes break dancing, graffiti, DJs

combining two songs and rap music

Cultural Change

Culture is not static, but changes over time

Something considered unacceptable

behavior years ago, may be acceptable now

Change is inevitable, people resist change

often

Cultural change: EXAMPLE

An invention that substantially changed culture was the development of the

birth control pill, which changed women's attitudes toward sex. Prior to the

introduction of the birth control pill, women were at a high risk of pregnancy

as a result of sex. After the introduction of the pill, their risk of pregnancy

was substantially reduced, increasing their willingness to engage in sexual

activity outside of wedlock.

Cultural lag

The term cultural lag refers to the notion that culture takes time to catch up

with technological innovations, and that social problems and conflicts are

caused by this lag.

Example: Medical technology is being used to keep people’s bodies

functioning long after they would otherwise have been considered dead. This

raises cultural questions about when life ends, who has the right to end

artificial life support, etc.

Needle-Free Diabetes Care

Cultural diffusion

Cultural diffusion is the spread of cultural beliefs and social activities from one group to another. The mixing of world cultures through different ethnicities, religions and nationalities has increased with advanced communication, transportation and technology.

Example1: Some people in the United States play hockey, which is played in Canada.

Example 2:The spread of music throughout the world shows cultural diffusion. For example, jazz started as a blend of the music of Africa and the Caribbean.

Cultural Change- PG 44 in Pretoruis

3 main sources of influence responsible for change,

but also for resistance to change:

1) Forces within a society:

Invention: a key process of cultural change e.g. cellphones, electronic money

Culture loss

2) Habit

3) Contact between societies:

When societies come into contact with one another; it leads to change

Diffusion- the movement of cultural aspects from one culture to another

Acculturation- when traits replace traditional cultural patterns

Cultural contact & culture and health

Cultural Contact : occurs between cultural groups in the society

Culture and health:

- influences of culture on health and rehabilitation is important

- a good healthcare provider( able to recognize, learn about cultures of

his/her patients. Be aware of the fact that people define themselves

culturally)

- what should health providers do with such knowledge?

Cultural competence

Cultural competence concepts

Cultural Awareness: involves the understanding of the

importance of cultural differences. Also entails being conscious

of one’s personal reactions to people who are different

Cultural Sensitivity: which goes beyond awareness and

comprises an appropriate attitude towards cultural differences

Cultural Competence: involves having the capabilities of

dealing with differences effectively

Cultural Responsiveness: which falls between sensitivity and

competence, is the ability to respond to a patient's care needs

in a way that matches the patient’s expectations

Reference list

Source: Boundless. “Mechanisms of Cultural Change.” Boundless Sociology. Boundless, 26 May. 2016. Retrieved 12 Jul. 2016 from https://www.boundless.com/sociology/textbooks/boundless-sociology-textbook/culture-3/culture-and-adaptation-31/mechanisms-of-cultural-change-200-8100/

Pretorius, E. Matebesi, Z and Ackermann, L. (2013). Juta’s Sociology for healthcare professionals. Lansdowne, Cape Town, South Africa. Page 9- 24.

Read more at http://examples.yourdictionary.com/examples-of-cultural-diffusion.html#6D6wS4JVGtBGJoA8.99

Read more at http://examples.yourdictionary.com/social-norm-examples.html#T6HapslVwsHTDhm2.99

http://examples.yourdictionary.com/examples-of-cultural-diffusion.html#6D6wS4JVGtBGJoA8.99

1 sociocultural context of health and health care delivery

Health & Medicine