New Cultural Public Health

Understanding why and how individuals respond to illness, as well as what they do to maintain their health, requires that we go beyond traditional health belief models to a better understanding of both the cognitive and the structural factors that influence action and individual's illness vocabularies (Lane, 1997; Pelto & Pelto, 1997; Vecchiato, 1997; Whiteford, 1997; Yoder, 1997). The overwhelming majority of humanity is moving rapidly into a world characterized by medical pluralism, in which they draw from several health-care systems, including that of modern medicine. Today, public health focuses on urban populations, rather than isolated tribal societies. The factors that affect both the beliefs and behaviors of individuals in such environments include many factors associated with social class and economics. Understanding social structures, and their impact on health, requires an emphasis on both the cognitive aspects of culture and the social and the material resources that individuals have at their disposal (Sewell, 1992).

This new reality calls for the combination of traditional epidemiological methods with ethnographic techniques that are better suited to assessing the terminology that individuals use to talk about disease and the meaning it has for them. Pelto and Pelto (1997) offer several techniques that the researcher can use to efficiently determine what terms individuals use to refer to specific illnesses and symptoms. Often these terms are borrowed from clinical medicine, yet the meaning that these terms have for locals may be very different than the meaning attached to them by medical professionals. Traditional health surveys and epidemiological studies would benefit greatly by such an initial attempt to better understand how people label symptoms and illnesses and what they actually imagine the illness to be.

The traditional approaches discussed earlier involve classifying and rank ordering symptoms to determine which are seen as belonging to the same or similar domains (D'Andrade, 1995; Pelto & Pelto, 1997). These techniques remain valuable, especially when they are combined with more narrative approaches that are aimed at determining the meaning systems (schemas) that give rise to the groupings.

Ultimately, our objective is to understand how and why individuals respond to specific symptoms and illnesses in the way they do. Traditional public health approaches assumed that risky health behavior or noncompliance with health-maintenance regimens was simply the result of ignorance and that this ignorance could be remedied through educational campaigns. Such campaigns, like the antismoking campaign of recent decades, met with less than complete success. Such efforts made it clear that people's behavior is determined by a combination of knowledge, culturally based beliefs about personal risk and the severity of potential outcomes, as well as practical factors like income and the availability of transportation. A new cultural public health will allow us to focus on traditional public health objectives, but to do so with a much better understanding of the complex interaction between knowledge, beliefs, and practical factors that determine behavior and individuals' overall sense of well-being.

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