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Martha O. In addition to teaching and research and publication in academia, Loustaunau has worked directly in healthcare policy and administration; she served with the New Mexico Health Systems Agency for 10 years and was chair of the State Health Planning Committee and Governing Body.


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A successful synthesis of socio-behavioral science, health services, and public health knowledge which advances the field and should help to improve the quality of care and health outcomes experienced by our increasingly diverse population. This is a valuable text that I greatly enjoyed and highly recommend for use in undergraduate courses; medical, nursing, and public health schools; and other health professions training programs that are interested in transformative education that makes a difference.

It is a unique book to provide health leaders and consumers refreshing new ways to know and understand cultures. It is an essential book to serve cultures in creative and effective ways.


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The authors provide new and diverse cultural insights about health, illness and wellness that have been woefully missing until the advent of transcultural nursing. Libraries Unlimited. Need Help?

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Sobo introduce readers to the practice of culturally sensitive health care. With engaging examples, they describe the special approaches sociologists and anthropologists take to health, clearly illustrating the main concepts used in the two fields.

Manual The Cultural Context of Health, Illness, and Medicine

Loustaunau and Sobo demonstrate the ways in which cultural and social factors shape medicine and health care. After a discussion of culture, the social structure and the impact of poverty, class, gender, and family patterns on health, illness and care-seeking, they explain the similarities and differences of medical systems cross-culturally. The authors call for a more flexible and culturally sensitive system of health care that expresses caring in more holistic ways, and offer examples as to how this might be accomplished in the increasingly multicultural USA.

However, Mrs. Hibbert never extended her understanding of pork to include pork fat. She served Snow a tasty lunch of greens and cornbread, prepared with liberal portions of bacon grease. Likewise, a man diagnosed with high blood pressure stopped taking his pills.

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When he went in for his monthly exam, the staff was shocked to see that his pressure was elevated. They asked about his medication, and he freely reported not taking it. He reminded the staff that a blood test he had been given last time indicated that he should stop the medication.


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  7. This caused much confusion, for the only blood test the man had had was a routine blood count. But then he reminded them that the doctor had said his count was a little low. The man took this to mean that his blood pressure medication had thinned his blood and needed to be discontinued until balance was restored Snow , This is the case across the board, for all ethnic groups, albeit for sometimes different reasons.

    Many prefer their own home remedies to those that doctors might prescribe. Others go to make sure that their own treatments are doing the job or that their health conditions are under control. This is particularly so for black Americans. Many link black fears about the intentions of white health professionals directly to their knowledge of the historic and exploitive Tuskegee Syphilis Study.

    The study, which began in the prepenicillin year of , involved documenting the natural course of untreated syphilis in about poor black men. The study was originally planned as cross-sectional: It was to involve a single, time-limited effort in which researchers would examine men in various stages of the disease to ascertain the damage that it would theoretically do over time to a male body. The original recruits did receive the then-standard heavy-metals therapy which involved mercury and arsenicals.

    The men did not receive antibiotic therapy when it became available in the s Edgar ; Jones Exposure of the study by the media in led to its termination and, ultimately, to the passage of the National Research Act in In any case, the Tuskegee research—research funded by the U. Knowledge of this fuels rumors. For example, people often assume that the Tuskegee participants were intentionally infected with syphilis. While such assumptions may be false, the historic facts of the study cannot be denied. The feelings and knowledge that lead people who do hear about the Tuskegee study to draw erroneous conclusions often stem from life experiences.

    Genes certainly do matter.

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    For instance, the social structure contributes greatly to various susceptibilities and risks, as through poverty, and connections between stress and conditions such as hypertension see California Newsreel a, b; Dressler ; Economist ; Wyatt et al. Assumptions regarding genetically linked differences extend, to a certain degree, to visual characteristics such as skin color, facial features, and hair texture.

    This is the case with upper-eyelid surgery by which some East Asian people effect a more Anglo appearance. Minority peoples also have been made to feel badly about overall body shape and size, or ways of styling the hair that do not conform to mainstream U. For example, some African Americans who wear dreadlocks or beaded and braided hairstyles have been ordered by employers to alter their hairstyles. Hygiene concerns may be voiced to 28 The Cultural Context of Health, Illness, and Medicine rationalize such orders, although dreadlocked or beaded braided hair is much less likely to be shed than hair in a straight or loose white style.

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    And people whose body ideal is plumper than the thin mainstream cultural ideal have been pressured to lose weight, even though we now know that the ideal weights used by insurance companies to indicate health risks change periodically, and may be underestimated, and that some people are naturally heavier than and just as healthy as others. While obesity has generally been found to be unhealthy, the cultural perception, including that of biomedicine, of what constitutes obesity is variable Mumford , — Social class in the United States is generally measured by a combination of income, occupational prestige, and educational variables.

    Together, these index socioeconomic status, which can generally be expressed as upper-, middle- or lower-class membership. The United States is characterized as having an open class system, which ideally means that there is a great deal of social mobility between class categories or levels, and that social position is earned, or achieved.

    The Cultural Context Of Health, Illness, And Medicine by Elisa J. Sobo

    This structure is the opposite of a closed system, where social position is ascribed, or assigned at birth and in which there is no social mobility. In actuality, most systems—ours included—lie somewhere in between. Various ascribed characteristics, such as ethnicity and gender, may also affect our opportunities for achieving higher social positions. Poor health or disability also can block social mobility.

    Their life chances meaning opportunities for acquiring favorable life experiences are accordingly affected through loss of opportunities for advancement of personal and social goals. Barriers to mobility may also be created for other family members, who must care for those who are ill. The ill or disabled may be seen as lacking skills that they actually do possess, so they face discrimination much in the same way that members of ethnic minority groups do.

    Moreover, much poor health and disability is seen as resulting from individual behavior. This ignores the role of social structure as a causal factor. While poverty causes much sickness, in some cases it is also true that sickness causes poverty. For example, a person who becomes ill with a chronic condition may be denied employment and insurance and may expend all his or her resources and savings to the poverty level.

    A good part of this disadvantage can be attributed to structural factors such as the types of jobs available to these populations and the prevailing wage scales. Although risk factors are multiple and complex, studies consistently show higher rates of mortality death , morbidity disease , and disability among the lower classes see Isaacs and Schroeder ; Rose and Hatzenbuehler ; Pappas et al.

    Explanations have included all the concomitants of poverty—poor housing, more exposure to pathogens, unemployment, poor education, less access to health care, discrimination, strenuous and dangerous working conditions, poor sanitation, and high stress. Additional factors would include higher risks for violence, high levels of drug and alcohol use, and high-risk sexual behaviors, which can also be related to social structural pressure.

    Relative to need, the poor may still underutilize services. Although inadequate insurance coverage is a factor, so is a lack of emphasis on preventive care and denial of illness due to the more pressing needs of survival, such as the need for food and shelter. In general, cultural perceptions and variations tend to be less important than economic necessity in the decision to seek care.

    For example, Haitian peasants hold complex ideas regarding the link between sorcery and tuberculosis, and one might be tempted therefore to assume that this explains underutilization. However, cultural ideas often serve to ease the pain of lack of access rather than promoting it.

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    When a group of Haitians were afforded supported access to treatments previously out of reach, they were quite happy to accept them, with high rates of compliance too Farmer Moreover, as more recent studies have shown, the skill to gain access to begin with, and the ability to navigate the system once in, are crucial e. Of course, the poor are more likely to be uninsured or to receive Medicaid funds, which many doctors do not accept, so the places of treatment for the poor are more likely to be limited to hospital outpatient clinics and emergency rooms. Access to medical care, however, still falls far short of explaining class differentials in health status and life expectancy.

    Several studies done in Great Britain, where health care is available to all through the National Health System, show that the provision of health care to poor populations did not affect the levels of disease and illness in that population; nor did it eliminate the difference in health status between social classes Hollingsworth ; Reid ; Marmot, Shipley, and Rose ; Whitehead Both blacks and whites in lower—socioeconomic status groups have higher rates of illness than blacks and whites at higher income levels. Syme and Berkman point to the existence of gradients in which the lower the social class, the greater the mortality and morbidity rates also see Barr The differential includes virtually all disease conditions.

    Learning to cope may help alleviate stress, thereby lowering the risk of illness Benson with Klipper, However, there is a danger that focusing on individual coping and the idea that teaching people to cope with their poverty or life changes will solve the problem. Simply blaming people for not coping—or for coping through the use of tobacco, alcohol, narcotics, or drugs and violence—only relieves pressure on the social system to change. And with no real change in the expanding structural environment of poverty, there will be no real change in the health of the poor.

    It is also essential for those providing care to examine their own attitudes, beliefs, and motivations relating to racism. It is also useful to have some knowledge of support systems, agencies, and contacts where some help may be found, including referral services, social workers, food supplement programs, support groups, or other public services and agencies. Wealth confers power, and also affects attitudes toward health workers, as the following hospital case study shows.