Culture , Behavior , and Health

“If you wish to help a community improve its health, you must learn to think like the people of that community. Before asking a group of people to assume new health habits, it is wise to ascertain the existing habits, how these habits are linked to one another, what functions they perform, and what they mean to those who practice them” (Paul, 1955). People around the world have beliefs and behaviors related to health and illness that stem from cultural forces and individual experiences and perceptions. A 16-country study of community perceptions of health, illness, and primary health care found that in all 42 communities studied, people used both the Western biomedical system and indigenous practices, including indigenous practitioners. Also, there were discrepancies between services the governmental agencies said existed in the community and what was really available. Due to positive experiences with alternative healing systems, and shortcomings in the Western biomedical system, people relied on both (Scrimshaw, 1992). Experience has shown that health programs that fail to recognize and work with indigenous beliefs and practices also fail to reach their goals. Similarly, research to plan and evaluate health programs must take cultural beliefs and behaviors into account if researchers expect to understand why programs are not working, and what to do about it. This chapter draws on the social sciences, particularly anthropology, psychology, and sociology, to examine the cultural and behavioral parameters that are essential to understanding international health efforts. It begins with some key concepts from the field of anthropology and the subfield of medical anthropology. It continues with lists and brief descriptions of types of health belief systems and healers around the world. Next, some key theories of health behavior and behavioral and cultural change are described and discussed. Issues of health literacy and health communication are then addressed, along with health promotion strategies. Methodological issues are presented, followed by a case study of AIDS in Africa. The chapter concludes with a summary of how all these areas need to be considered in international health efforts.