Determinants of Health

12. Culture

Some persons or groups may face additional health risks due to a socio-economic environment, which is largely determined by dominant cultural values that contribute to the perpetuation of conditions such as marginalization, stigmatization, loss or devaluation of language and culture and lack of access to culturally appropriate health care and services.1

Personal history, social connections, political views, the geography we live in, the geography we left behind, our ethnicities, our income, our debt, our government’s priorities, popular entertainment – it all comes together as culture.

Customs, traditions, beliefs and values influence how we think. They affect health, and set the agendas and approaches regarding the health-care system. Culture as a determinant of health is not just about the point of view of the individual. The culture of the system itself can either help or discourage efforts to make sure the population is as healthy as possible.

Social norms – culture – can shut people out, as well as bring people in.

The relationship between an individual and her experience of the larger culture can affect:

  • how she deals with the health-care system
  • whether she can get involved in programs of prevention or health promotion
  • her ability to get information about health concerns
  • her decisions about how to take care of herself

Prejudice, harassment, language barriers, racism, ableism, sexism, stereotypes, cultural differences, homophobia, transphobia, assumptions and social isolation – they all have a direct and immediate way of hurting an individual’s physical and mental health. Unfortunately, they can also find their way into the health-care system itself.

Cultural barriers are a significant contributor to the vulnerability of women to HIV and AIDS.2

“Men are dogs. They sleep around. They go through women like candy. Everybody knows that. It is what men do.”

“Good women aren’t interested in sex. A woman who says something about using a condom either doesn’t trust her sexual partner or is admitting that she sleeps around or has a disease. Otherwise, why would she bring it up?”

“A loving mother breastfeeds. There is no other choice.”

“It’s just common sense.”

So-called normal assumptions in a culture aren’t very fair. And yet they are a powerful way to make each of us behave in particular ways. To challenge any of these ideas is to risk being labelled as difficult. As an oddball. As someone to avoid. As someone to break away from.

Because many women are dependent on others financially, this price can be too high.

But our understanding of normal can change.

Just like gender, culture is a work in progress. It is always changing. Community groups, organizations and institutions can help shift cultural norms and end HIV stigma, making us all healthier in the process. This is done through something called gender mainstreaming.

UN Women is the United Nations Entity for Gender Equality and the Empowerment of Women. It explains that “gender mainstreaming involves ensuring that gender perspectives and attention to the goal of gender equality are central to all activities – policy development, research, advocacy / dialogue, legislation, resource allocation, and planning, implementation and monitoring of programmes and projects.”

It is through approaches like this that service providers will be able to transform our culture into something healthier and more supportive for everyone.

 

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1What Makes Canadians Healthy or Unhealthy?, Underlying Premises and Evidence Table, Public Health Agency of Canada, online as of June 2011
2IWD 2011: Culture & Women’s Vulnerability to HIV and AIDS, The Global Herald, online as of June 2011