Culture and Health Psychology: Insights from a Socio-Cultural Perspective

The beginning of the 20th century featured an understanding of health that was dominated by a biomedical perspective, characterized by a reductionist point of view in which health was defined as the absence of illness. This view has long been replaced by a biopsychosocial model that emphasizes the role played by socio-cultural forces in the shaping of health (and illness) and related psychological experiences (Engel, 1977). In 1948, the World Health Organization (WHO) defined health as a complete state of physical, mental and social well-being and not merely the absence of disease or infirmity, calling attention to the complexity and multidimensionality of the concept. Adding social well-being to the definition opened the way to conceptualizing the individual as a social being, with health being about more than mere physiology. This shift in the definition of health and the factors responsible for disease prevention and health promotion is mirrored by a shift in the study of health and illness in disciplines such as psychology that have traditionally focused on the individual as the unit of analysis and the force primarily responsible for avoiding disease and promoting well-being. In more recent psychological approaches to health and illness, individuals are increasingly viewed as part of a larger network of forces, significantly influenced by their socio-cultural environments (e.g., Helman, 2007; Gurung, 2010).

Developing a culturally sensitive and meaningful understanding of health and illness is important for both theoretical and applied reasons. From a theoretical standpoint, psychological models designed to understand health and illness are typically developed in the western parts of world and tested with local participants. Models can be expanded, modified, and improved by studying their generalizability across cultural groups. This exercise improves the validity of the scientific study of human psychology and thus enables models to develop and test culturally meaningful predictions.

Incorporating culture into the study of health and illness is also important from an applied standpoint. For example, developing interventions to improve health via promotive, preventive, curative, or rehabilitative activities is virtually impossible if this exercise is stripped of cultural knowledge. Further, health disparities, for example in the form of discrimination and prejudice in health care settings or vast differences in prevalence rates of certain diseases between different groups in a society, may be understood and tackled by having a better understanding of the cultural bases of such problems. Moreover, some diseases tend to be culture-specific, such as Hikokomori (prevalent in Japan) and anorexia (prevalent in developed western societies). Understanding the underlying reasons, ways of prevention and treatments for such diseases also necessitates a cultural approach to health and illness.

A framework for understanding cultural differences in psychology of health and illness

In the social sciences, culture has been defined in numerous ways. Most definitions refer to a set of contexts (e.g., structures and institutions, values, traditions, and ways of engaging with the social and nonsocial world (e.g., Shweder & LeVine, 1984) that are shared among members of a society and transmitted across generations through social learning (e.g., Richerson & Boyd, 2005). As can be seen here, such definitions of culture are typically broad and it is often difficult to decide how the concept of culture should be included in empirical work. Therefore, psychologists have proposed features of cultures to be used as organizing constructs. The most commonly used constructs to account for observed cultural differences and similarities in human psychology are  individualism and  collectivism (e.g., Hofstede, 1980; Kagitcibasi, 1997; Triandis, 1995). These constructs have been particularly useful for understanding cultural differences as to how people view themselves and their relationships with others. As we argue below, these differences are important in understanding cultural differences in health and illness related experiences.


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