Cultural Perspectives on Public Health

Cultural perspectives on
public health challenges
University of Liverpool Online
Public Health Thought Leadership Webinar Series

Ask Your Questions in the Q&A Box
Dr Barbara Kreling
Faculty Member
Erin Gilgan MPH
Alumni
Joseph O’Brian
MBA Student

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Congratulations
Erin
2016 MPH Student of The Year

What do you believe is the impact
of culture on public health?

“Culture is important to health
in many ways. It defines the
environment into which we are
born and the health behaviors
we adopt. It shapes our
definition of both health and
disease and our relationship
with health care providers.
For instance, is pregnancy
and childbirth a medical
condition requiring a doctor?
- in some cultures, no. Is
sadness a medical condition
requiring a doctor?”
Barbara Kreling

Culture affects our
understanding of the
causes and treatments of
diseases. Did your
mother tell you to put on
a sweater or you would
catch a cold? Although
most of us know that
colds are caused by
viruses, folk medicine is
a part of most cultures
and co-exists with
modern medicine
Barbara Kreling

What are the key cultural challenges
that you face and how are they best
approached?

Final Research Project
Erin Gilgin

“the way consumers use
restaurants, especially in a
convenience culture,
may not have caught up
to the functional role they
provide in home meal
replacement”
Erin Gilgin

For understanding another culture and how it might impact public health
programs, qualitative research is the best method. Through rigorous
qualitative study, cultural themes emerge which can inform public health
efforts.
Barbara Kreling

Do attitudes to food vary based
on culture?

“the American food environment promotes abundance & consumption. Food is
available everywhere at any time, in great variety. Supermarkets have infinite food
choices and restaurant portions are huge. In this context, the culture promotes
convenience, which allows easy access to energy, with little energy expenditure. “
Erin Gilgin

“In France meals are a
social event that promotes
moderation in consumption
and has a pleasure aspect.
Meals are eaten more
slowly, portions are smaller,
snacking has a negative
connotation and restaurant
menus are less varied”
Erin Gilgin

Collectivist cultures, like Latin
American countries uses food
in a social and inclusive way.
They take care of each other
and the food needs to meet
the needs of the group as a
way of bonding and
belonging. These cultures
may also have less concern
with body image than either
American or European
cultures
“Collectivist cultures, like Latin American
countries uses food in a social and
inclusive way. They take care of each
other and the food needs to meet the
needs of the group as a way of bonding
and belonging. These cultures may also
have less concern with body image than
either American or European cultures”
Erin Gilgin

Collectivist cultures, like Latin
American countries uses food
in a social and inclusive way.
They take care of each other
and the food needs to meet
the needs of the group as a
way of bonding and
belonging. These cultures
may also have less concern
with body image than either
American or European
cultures
In some African and Asian
cultures, women often have
lower access to food (and
education and empowerment)
than their male partners.
Women are at higher risk for
being malnourished, can be
married at a young age and
are undereducated on sexual
health and reproduction.
Erin Gilgin

How important is the role of the
table in terms of habit setting
for families ?

“Family mealtime can be a time for the
family to communicate, for the
parents to monitor childrens’ activities,
bond and support social development.”
Erin Gilgin

Is there a correlation between how
healthy your diet is and your socio
economic status?
$

“The paradox arrives with new
immigrants with low socioeconomic
status having better health than their
native born counterparts in developed
countries. The longer the immigrant
stays and becomes more
acculturated, health status decreases
and becomes more similar to those
that were native born.”
The Healthy
Immigrant
Paradox
Erin Gilgin

How important is it for public health
professionals to be aware of
cultural nuances?

“It is important to
understand that culture
affects the persons we
study or work with. It
affects their
perceptions,
assumptions,
preferences. It also
affects their heath
behavior and their
understanding of health
and illness. The culture
of the population must
always be considered
when planning or
evaluating a public
health program.”
Barbara Kreling

Can you give me an example of a
theory you took from the MPH
programme that makes you a more
effective Public Health
professional?

“general the concept of
social determinants of
health and looking at
them using ecological
models was particularly
interesting and relevant
for me. While perhaps
past efforts (such as
nutrition facts panels on
food products) have been
placed on providing
people with information to
make their own decisions,
this is only a small part of
the puzzle. What if a
person has all of the
information, but their
environment is
surrounded with poor
choices? .”
The concept of social
determinants of health and
looking at them using ecological
models was particularly
interesting and relevant for me.
While perhaps past efforts
(such as nutrition facts panels
on food products) have been
placed on providing people with
information to make their own
decisions, this is only a small
part of the puzzle. What if a
person has all of the
information, but their
environment is surrounded with
poor choices?
Erin Gilgin

Elective Modules
Preventing & Managing Communicable
Diseases
Managing Crisis and Disasters
Health, Economics & Governance
Programme & Policy Challenges in Low
Income Countries
Research Modules
Applied Epidemiological Research for
Public Health
Applied Qualitative Research for Public
Health
Dissertation
Topic or work programme research
Health Inequalities: Integrating Public
Health Practice
Dissertation pathway
Professional Learning Log
Masters in Public Health
Module Outline
Core Modules
Practicing and Promoting Public Health in
a Global Context
Generating and Evaluating Public Health
Evidence
Integrated Research in Public Health:
Epidemiology and Qualitative Methods
Leading and Managing Health Systems
Monitoring and Evaluation of
Systems and Programmes

The Case Study
Breast Cancer in the American
Latino community

Breast Cancer in the American Latina community
The problem: “ Breast
cancer is the leading cause of death
in Latina females in the US. Latinas
with breast cancer underuse
recommended follow-up
chemotherapy, decreasing their rates
of survival. Although several factors
may have been responsible, cultural
influences were a possible barrier.
Although there was a disparity in
mortality between groups, there was
a gap in the literature about how
culture affects decisions about breast
cancer treatment. “
Barbara Kreling

The Research: As part
of the Latin American
Cancer Coalition, I
conducted a focused
ethnographic study
examining the role of
cultural beliefs and
perceptions in the decision-
making process for Latina
women about whether or
not to receive
chemotherapy following a
breast cancer diagnosis.
“
Barbara Kreling

Use of Theory:
Douglas’s cultural theory of
risk arises from cultural
anthropology. It posits that
the perception of risks
arises from each society’s
attempts to explain disease
and misfortune. It was
important to obtain an in-
depth understanding of how
women understood disease
and treatment to form a
perception of risk.
“
Barbara Kreling

Results: Results of this qualitative analysis revealed that various cultural factors including
underlying cultural views of health and disease, social role-related themes, avoidance of
information and communication, as well as employment and immigration status influenced the
treatment decisions of Latina women.
 Latino reliance only on family -“having no one” if family is not around.
 Traditional gender roles - mothers alone are responsible for child care - self-care is a low priority- family needs are
more important than the individual.
 Sexuality and body image - losing hair - not attractive to the male
 Employment immigration status - no sick leave or job security
 Respeto - power distance -women reluctant to discuss their health with employers and to ask for time off
 Secrecy because of social death
 Fear of information - cultural norm of secrecy about cancer
 Many misperceptions - chemo not effective- chemo means death - chemo very painful- can’t have children after.
 Fatalism -avoidance of knowledge or bad news - “leave it in the hands of god.”
 Present-oriented culture - problem with treatments that make you sicker in the present for long term recovery.

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Questions!
Enter your question into the
Q&A Box

Cultural Perspectives on Public Health

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