ARCHIVED - Chronic Diseases in Canada
Volume 30, no. 4, September 2010
Book review — Culture and Health: Applying Medical Anthropology
G. Ko, BScH, MD candidate (1); A. Kukaswadia, MSc (1)
- Queen's University, Kingston, Ontario
Author: Michael Winkelman, MPH, PhD
Publisher: Jossey-Bass, USA
Publication date: November 2008
Number of pages: 512
Price: $90 CAD
ISBN (13): 978-0-4702-8355-4
ISBN (10): 0-4702-8355-6
Culture and Health: Applying Medical Anthropology compares and contrasts models of health around the world with the Western biomedical model. The text goes beyond individual factors affecting health care and explores macrolevel effects on health, such as government policies and economic issues. While the book is written for those with a health sciences background, scientific jargon is kept to a minimum, and the author aims to broaden the reader's understanding of health from different ethnocultural perspectives.
The self-assessment questions included at the end of each chapter highlight the focus on students as readers. However, these questions encourage all readers to reflect on their own experiences and critically evaluate their own cultural competence in comparison to the information in the chapters. The most interesting aspect of the text, however, are the practitioner profiles, case studies and examples of cultural concepts in health that supplement and illustrate the information provided.
The ten chapters of the book can be grouped into two categories: the first five chapters provide an introduction to medical anthropology, while the remainder focus on applying these concepts to explain the complex cultural, ecological, political and psychological factors affecting physiological responses and health.
In the first two chapters, the author compares and contrasts cultural concepts of health and illness, highlighting how these can be affected by the physical and cultural environment. While our understanding of health is effective in certain situations, these chapters illustrate how the biomedical definition of disease is extremely limited and can be complimented by the Cultural Systems Model, where a person's cultural milieu is also considered. This is illustrated in the book with the example of increased prevalence of cardiovascular disease among African Americans compared to their Hispanic American counterparts.
The author investigates the implications of cultural competency in health care, advocacy, research and administration in Chapters 3 and 4. He also discusses guidelines for developing culturally sensitive policies and programs, as well as how communities can act to support treatment and assist with the healing process.
Introducing ethnomedical systems in health care in the fifth chapter, the author discusses how various cultures have different interpretations of symptoms, and analyzes folk and alternative medicine. He points out how the professional sector of medicine can be considered a culture by itself because of the traditions it adheres to. The author uses transcultural psychiatry in Chapter 6 as an example of how there are different ethnomedical views of psychology and psychiatry, and how "normal" behaviour should be considered in the cultural context. The in-depth example used to highlight this was particularly interesting given the policies being currently developed in Canada to help combat stigma associated with mental illness.
Chapters 7 and 8 delve into the ecological factors affecting health, such as race, ethnicity and social contexts. The argument used in this discussion is the analysis of alcoholism from a critical medical anthropology perspective. Oftentimes, the focus is on the individual, using terminology such as "their drinking problem"; historical and societal values that may cause the individual to be more susceptible to alcoholism are not considered by health care professionals. The author raises a compelling argument in favour of this approach when designing interventions and programs.
Chapter 9 discusses psychobiological dynamics of health, focusing specifically on how religion, rituals and symbolic healing can affect our bodily processes. In this chapter, the physiological response to various symbols is discussed alongside the effects of placebos and other non-prescription medications. Lastly, the author introduces the field of psychoneuroimmunology, a relatively new area focusing on how symbols, personal expectations and social relations can affect our immune systems.
The book concludes with a discussion of shamanism, a relatively foreign concept in Western medicine. The author demystifies the practices of shamans by explaining how they achieve their altered state of consciousness. At the end of the chapter, he highlights the benefits shamanism has for current psychotherapy practices, including highlighting specific aspects of shamanism that are currently used.
The author's purpose for writing this book is to advocate that many issues affecting multicultural communities have social, economic and cultural origins. Established clinical or pharmacological solutions provide a "band-aid" solution and, in order for the issues to be resolved completely, we need to manage the social and cultural conditions affecting health. His analysis provides an alternative way of conceptualizing the etiology of a disease, and he uses literature to support his arguments.
As medical students and researchers, we found the examples of cultural concepts in health, health care and expressions of illness and the biocultural interactions most applicable to our work. This approach is not emphasized in Western medical education and should be considered as a potential alternative to current medical practices. Using this approach could lead to novel interdisciplinary research approaches to existing healthcare problems.
The main limitation of the book was the lack of diversity in the health practitioner profiles. While they may be applicable to students of anthropology, the significant focus on successful academic researchers does not offer concrete methods that could be used by non-anthropologists while developing interventions or research programs. In future editions of the book, the author may want to consider expanding the profiles to include front-line health care professionals discussing the cultural issues they have faced in their careers.
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