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Cultures of Health, Cultures of Illness. George Davey Smith, Mary Shaw (Scientific eds). British Medical Bulletin Vol 69, Oxford University Press, 2004, £63, ISBN 0-19-856735-9.

Identifieur interne : 001402 ( Istex/Corpus ); précédent : 001401; suivant : 001403

Cultures of Health, Cultures of Illness. George Davey Smith, Mary Shaw (Scientific eds). British Medical Bulletin Vol 69, Oxford University Press, 2004, £63, ISBN 0-19-856735-9.

Auteurs : Cc Jinabhai ; Myra Taylor

Source :

International Journal of Epidemiology [ 0300-5771 ] ; 2006.

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https://api.istex.fr/ark:/67375/HXZ-G1HLKTXC-4/fulltext.pdf

DOI: 10.1093/ije/dyi268

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    <p>The special issue of ‘Cultures of health, cultures of illness’ is both a timely and a major contribution to the discourse on the relationship between scientific and complementary/traditional forms of heath care; and, it raises an excellent set of critical issues for future research and further exploration. The publication of this volume by the British Medical Bulletin provides an eclectic review of cultural, social, historical, and geographical perspectives on health and illness in the 21st century. In both the developed and developing world where the burden of disease is no longer dominated solely by infections and the causes of diseases are frequently well understood and no longer a source of controversy, we need insights that move away from the biomedical paradigm and explore other discourses that contribute to the psychosocial influences detrimentally affecting health. The limitations of biomedicine in solving the many health problems influenced by behaviour and the increasing support for complementary medicine are practices witnessed throughout the world.</p>

    <p>Although globalization has resulted in a ‘global village’, health status in differing parts of this village vary dramatically. Dorling suggests that the power of nation-states is waning and that the connections between the health of the world's population are increasing. Cliff and Haggett provide a historical perspective and link the effects of travel and the spread of diseases such as measles and cholera. This link between travel is highly topical as in the first few years of this 21st century we have already experienced the spread of SARs, bird-flu, and the Ebola virus. The spread of HIV/AIDS from other primates to humans is one of the most fascinating hypotheses and the further spread of this virus throughout the world indicates the complexity of controlling the transmission of infectious diseases, in a world reduced in size through mass travel. The roots of the HIV/AIDS epidemic, which is devastating so many countries in the developing world, have not received direct attention in this review, but the cultures described could be appropriately applied to this modern day scourge. The processes of social change and the associations with risk of disease that Dressler describes are driving forces for the behaviours exacerbating the spread of HIV/AIDS in developing countries in Africa, Asia, and the Caribbean, and Dorling raises questions about the influence of flows of money on health. As a result of the interconnectedness of countries, the lack of resources in countries in the developing world to address their burdens of disease can result in epidemics or pandemics that affect the health status of populations in the developed world. The global response providing funding to the developing world to address HIV/AIDS, TB, and malaria is indicative of this realization. Addressing targets such as the Millennium Development Goals may further enhance this view.</p>

    <p>Many different perceptions of culture are described in this review. Perhaps one of the most pertinent aspects is the way in which systems that are supposed to provide for clients are perceived by the said clients to denigrate their very being. Perhaps this is a pointer to the increasing use of alternative therapies. The importance of traditional healing practices is increasingly being recognized as a useful strategy for reaching clients whose needs remain unmet by the health system. These practitioners appear able to relate better to their clients and to meet their specific needs. Perceptions of stigma influence people's help seeking behaviour and Charlesworth <italic>et al</italic>
. describe the detrimental impact of class differences on the perceptions and practices of clients. The educational and economic differences between the service providers and clients' feelings of inferiority pertaining to such differences in class are highlighted in their article, and they note that class differences in life expectancy in England and Wales increased considerably during the 1980s. The issue of stigma has been of major concern during the HIV/AIDS epidemic with relatively few people of any class willing to disclose their status owing to the opprobrium that results. In South Africa the stoning to death of a young woman brave enough to disclose her HIV positive status by her community has sunk deep within the country's psyche.</p>

    <p><fig id="FIG1" position="float"><graphic xlink:href="dyi268f1"></graphic>
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In attempting to build a more cohesive, caring, and healthy society the insights provided by social capital are controversial and Kunitz suggests that the consequences of social capital may be positive or negative. At the first level of analysis, the primary groups consisting of close relationships that provide social support should have a positive influence on health. The World Health Organization in attempting to improve adherence to tuberculosis programmes has encouraged the use of DOTS (Directly Observed Treatment Short Course). One of the key components is the use of a DOT supporter, where it is envisaged that a responsive community member will motivate and ensure adherence to the 6 month treatment programme. Such persons may be volunteers strengthening the social capital (primary) in a community. Secondary groups comprise voluntary associations and a more nefarious use of such groups is the suicide bomber, a phenomenon of the late 20th and 21st century.</p>

    <p>The influence of industrialization on health is reviewed by Szreter who highlights the importance of the state in redistribution of resources to benefit the whole population rather than a small proportion of favoured individuals. The current forces of globalization concentrating increased wealth in fewer hands emphasize the need to address this concern, as does the burden of disease in countries in Africa, in particular, and other countries of the developing world.</p>

    <p>Issues of public health resonate in a world of conflict and danger where people are forced to flee their homes, and the health impacts are formidable. Whether because of natural disasters such as the tsunami of 2004, or the dislocation caused by ongoing festering conflicts in countries such as Sudan, the increased vulnerability of populations coupled with the lack of basic facilities place the health of such populations at increased risk. Thomas and Thomas emphasize that long-term public health prevention and education campaigns are required to meet the needs of these displaced communities. In addition, the lifestyle changes resulting from migration can result in mental distress and alienation, as individuals attempt to cope with diverse factors such as socioeconomic disadvantage and discrimination as described in this volume by Bhigra.</p>

    <p>Immunization has been one of the success stories of science preventing epidemics of infectious diseases and reducing morbidity and mortality. Despite the fact that the risks resulting from immunization are low, the media has highlighted these risks rather than the enormous benefits. In a world where there is increasing scepticism about the pronouncements of prominent public persons, perceptions of distrust are also negatively influencing the public response to an immunization policy supported by doctors, scientists, and politicians. Fitzpatrick emphasizes the risks that this culture poses for society. This wariness in respect of conventional scientific explanations is highlighted by Greenbaigh and Wessely who describe the phenomenon of healthism where middleclass Western people with a distrust of doctors and science seek their own alternative explanations. This distrust of science has resulted in a controversial discourse in South Africa initially about HIV/AIDS and subsequently about the role of nutrition in the treatment of HIV/AIDS. The president's querying as to whether HIV infection caused AIDS and his support for dissident groups of a similar opinion sowed much confusion within South African society.</p>

    <p>The selection of issues that public health officials address is interrogated in the papers: issues such as teenage pregnancy and lead poisoning. Teenage pregnancy is an emotive public health concern, which is viewed as a social problem in many countries. Geronimus notes that this is a relatively recent concern since for many centuries fertility timing in societies permitted this practice. The author emphasizes the inequalities that currently facilitate this practice, the structural barriers that impede full participation of Afro-Americans in American society, and the importance of public health professionals considering such issues in a critical evaluation of this issue. Fassin takes up the concern of childhood lead poisoning in France and the public health response to lead poisoning in children considered either as a disease with cultural origins, since mostly African families are affected, or alternatively as the outcome of immigration and housing policies.</p>

    <p>Simon Sinclair raises critical questions whether evidence-based medicine (EBM) either changes individual clinical practice or improves patient outcomes for the better, and raises concerns about the ‘ritualisation’ of medical science. These concerns are echoed in Jackson's paper, which notes that expressions of genotypes are modified by several filters—cultural, behavioural, and environmental—that in turn influence health outcomes. She proposes an alternative bioanthropological strategy to understand the complex interrelationships of human genetic variability and health, which recognizes that genetics and ethnicity are intertwined.</p>

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Cultures of Health, Cultures of Illness. George Davey Smith, Mary Shaw (Scientific eds). British Medical Bulletin Vol 69, Oxford University Press, 2004, £63, ISBN 0-19-856735-9.

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