Particularly Vulnerable Tribal Groups (PVTGs)

 

In 2006, during the United Progressive Alliance Regime under the leadership of Prime Minister, Mr. Manmohan Singh, the Government of India initiated National Tribal Policy. The primary aim of the policy was to correct several mishaps of the earlier policies centering on the Tribal population of the country. It became particularly intriguing because of the rising concern in areas like Red Corridor where Maoist insurgency was on the rise that became a threat to the integrity of the country. The overall goal of the National tribal Policy was to bring tribes into the ‘mainstream’. This policy sees Neheruvian Panchsheel as rather abstract ideas and puts thrust on the target orientation and specifications in the ‘development’ of the Tribal population. The following issues were prioritized in the National Tribal Policy:

·         Formal education

·         Traditional wisdom

·         Health infrastructure

·         Displacement and resettlement issues

·         Forest and villages

·         Shifting cultivation

·         Land alienation

·         Intellectual property rights

·         Tribal languages

 

This policy focuses on Primitive Tribal Groups (PTGs) which is since then revised as Particularly Vulnerable Tribal Groups (PVTGs).  

Definition:

PVTGs constitute the most vulnerable section among tribals and inhabit isolated, remote and difficult areas in small and scattered hamlets/ habitats. The scheme aims at planning their socio-economic development in a comprehensive manner while retaining the culture and heritage of the community by adopting habitat development approach and intervening in all spheres of their social and economic life, so that a visible impact is made in improvement of the quality of life of PVTGs. During the Fourth Five Year Plan, a sub-category was created within Scheduled Tribes to identify the most vulnerable groups which were considered to be at the lowest levels of development. Consequently, on the basis of the Dhebar Commission report, a criterion for identifying Particularly Vulnerable Tribal Groups was established as:

·         Pre-agricultural level of technology,

·         Low level of literacy,

·         Economic backwardness,

·         A declining or stagnant population.

 

Policy Thrust for PVTGs

Activities which are prioritized under the PVTGs include:

a)      Livelihood,

b)      Employment opportunities and economic development of PVTGs through Agriculture, Horticulture, Animal Husbandry, Dairy, and Skilling/ Vocational Training

c)      Education, (Literacy, Drop-out, Residential schools in addition to SSA/RMSA).

d)      Health, (Gap filling for effective health service delivery beyond NHM etc).

e)      Provision of safe drinking water (gap filling where line Ministries do not provide complete/universal coverage),

f)       Land distribution, land development,

g)      Social security,

h)      Housing and Habitat,

i)        Connectivity (Road and Telecommunication),

j)        Supply of Electricity (gap filling where line Ministries do not provide complete/universal coverage), Solar power, with provision of maintenance,

k)      Irrigation (gap filling where line Ministries do not provide complete/universal coverage),

l)        Urban Development,

m)    Culture,

n)      Sports including traditional and tribal games and sports,

o)      Any other innovative activity for the comprehensive socio-economic development of PVTGs

For detailed description of the Policy prescription follow this link: https://tribal.nic.in/downloads/NGO/Latter-Notice/14.pdf

 

List of the PVTGs

 

STATE	TRIBES FOUND
Andhra Pradesh and Telangana	Bodo Gadaba, Bondo Poroja, Chenchu, Dongria Khond,  Gutob Gadaba, Khond Poroja, Kolam, Kondareddis, Konda Savaras, Kutia Khond, Parengi Poroja, thoti
Bihar and Jharkhand	Asurs, Birhor, Birjia, Hill Kharia, Konvas, Mal Paharia, Parhaiyas, Sauda Paharia, Savar
Gujarat	Kathodi, Kohvalia, Padhar, Siddi, Kolgha
Karnataka	Jenu Kuruba, Koraga
Kerala	Cholanaikayan (a section of Kattunaickans), Kadar, Kattunayakan, Kurumbas, Koraga
Madhya Pradesh and Chhattisgarh	Abujh Macias, Baigas,  Bharias, Hill Korbas, Kamars, Saharias, Birhor
Maharashtra	Katkaria (Kathodia), Kolam, Maria Gond
Manipur	Marram Nagas
Odisha	Birhor, Bondo, Didayi, Dongria-Khond, Juangs, Kharias, Kutia Kondh, Lanjia Sauras, Lodhas,  Mankidias, Paudi Bhuyans, Soura, Chuktia Bhunjia
Rajasthan	Seharias
Tamil Nadu	Kattu Nayakans, Kotas, Kurumbas, Irulas, Paniyans, Todas
Tripura	Reangs
Uttar Pradesh and Uttarakhand	Buxas, Rajis
West Bengal	Birhor, Lodhas, Totos
Andaman and nicobar islands	Great Andamanese, Jarawas, Onges, Sentinelese, Shorn Pens

 

 

 

 

Tribe in the evolutionary scheme of social type

 

Different words like French Tribu, English Tribe and Latin Tribus were used to designate social divisions among the Roman population. Similarly the Greek word Phule also represented Indo-European Social Organisations. The word "tribe" has a long and ignoble history and remains one of the most variably used terms within and outside of anthropology (Helm 1968). Anthropologists often use it as a catch-all substitute for "primitive," avoiding the invidious comparison of "nonstate." But most who use the term analytically narrow it to mean some form of political unit, as distinct from "ethnie" or "nation," which suggest a cultural identity.

The foundation structure of the tribe is Kinship. The smaller Kinship unites were known as Genos in Greek and Gens in Latin. Scottish people used to call them Clan. One can only be a member of a clan if s/he is connected through kinship relationships. A person is a member of a tribe by birth. Each of these clans had a separate name and a tribe constituted a number of clans. Since, tribal system is pre-state condition, there is no centralised administration among the tribal societies. The social order is maintained by the kinship organisations. Kin rules framed primarily on the basis of systems of affinity and consanguinity were used to determine the right over a geographical location or selection of the headman.

Tribe in the evolutionary scheme of social type

About a century later than what was written by Morgan, Marhshal Sahalins and Elman Service have tried to classify pre-industrial societies. Service (1962) followed a long tradition in positing tribe as a stage in political evolution falling between more independent BANDS and more centralized and hierarchical CHIEFDOMS. Sahlins (1968b) also saw tribes as evolutionary predecessors of states but was more concerned with mechanisms of integration than boundaries. Here tribes were seen as unified and bounded by kinship or other ties and constituted the broadest level of cooperation in a segmented hierarchy of functions.

They have classified societies according to the relative socio-political complexity into four major categories. These are a) Band, b) tribe, c) chiefdom, and d) state.

Band is the simplest form of social organisation. Its simple amalgamation of a number of families. The population of a band is quite small, usually range between 10 to 50. The concept of a single leader or headman is absent. The leadership is rather situational and it is never transmitted from one generation to the next. A band collects food from a designated locale. Since, band societies are always foragers, they are most often than not seen as roaming from one to place to another to collect their resources. Because of such movement, there is a general lack of the concept of private property system among the bands. Every member of a band has the equal usufructuary rights over every resources of the region where they inhabit. The kinship ties are usually patriarchal, but there is a relative prevalence of gender equality. In India we have Onge, Jaroa, Cholanakan, Birhar as bands. Africa has !Kung (bushmen), Mubti Pygmy. The patriarchal nature of band suggests that the contention that early men had matriarchy may not be true.

Tribe is relatively more complex. Tribe system is also pre-state and pre-inustrial entity. Tribes have team-leaders of headmen but they do not have institutional mechanism to maintain power relations within the society. Their economy is based on animal husbandry or farming. The primary difference between band and tribe lie in the existence of social segments. The presence of social segments and their integration is what characterises a tribe. It should be remembered that state system has developed about 4000 years ago, but human society survived without them for thousands of years. Even today, there are tribal and band societies which is surviving alongside the state. Therefore, it is important to understand what inner system has enabled these people to keep their social system intact for so many years. E.E. Evans-Pritchard has tried to explain this puzzle by his study of Nuer in Sudan, Africa. Prichard shows that Nuer are divided into different lineages. These lineages do not have hierarchy in terms of economy, politics, ideology or economy. They do not have much of interdependence, yet, together they form the tribe Nuer. Using classical Participant Observation method, following Malinowskian method Evans-Pritchard argued that there are conflicts between these lineages but then by some unwritten agreement and rules the conflicts are resolved. Sahalins in 1960s have argued that Nuers could beat Dinkas because of their effective lineage systems.

In india the Nagas, in Africa the Zulus and Asantis represents typical tribal system.

Chiefdom system is formed if one of the lineages among a tribe claims supremacy. For a variety of reasons ranging from natural to technological, it is seen that often among many lineages one becomes more powerful. They can achieve it by acquiring a relatively higher social prestige and position or by winning a war with others. In this way a new family system can be developed. After a few generations this family/lineage can become the king’s family. This is a system of state formation which is evidenced in Peru the Inca family. This has been studied by Robert Leonard Carneiro. Similarly Romila Thapar has studied the formation of state in Ganga-Yamuna valley and argued along this line.  

By contrast, Fried (1967, 1975) disputed the evolutionary existence of such bounded groups, arguing instead that tribes arose from interactions with existing states. Despite their differences, all three agreed that boundedness of tribes was a result of external conflict, or WAR.

 

 

 

Class lecture on the concept bilingual, meant for my students

Introduction

Different words like French Tribu, English Tribe and Latin Tribus were used to designate social divisions among the Roman population. Similarly the Greek word Phule also represented Indo-European Social Organisations. The word "tribe" has a long and ignoble history and remains one of the most variably used terms within and outside of anthropology (Helm 1968). Anthropologists often use it as a catch-all substitute for "primitive," avoiding the invidious comparison of "nonstate." But most who use the term analytically narrow it to mean some form of political unit, as distinct from "ethnie" or "nation," which suggest a cultural identity.

The foundation structure of the tribe is Kinship. The smaller Kinship unites were known as Genos in Greek and Gens in Latin. Scottish people used to call them Clan. One can only be a member of a clan if s/he is connected through kinship relationships. A person is a member of a tribe by birth. Each of these clans had a separate name and a tribe constituted a number of clans. Since, tribal system is pre-state condition, there is no centralised administration among the tribal societies. The social order is maintained by the kinship organisations. Kin rules framed primarily on the basis of systems of affinity and consanguinity were used to determine the right over a geographical location or selection of the headman.

Tribe as a Pre-political and pre-contractual society and in the evolutionary schema (Morgan and Maine)

The idea of tribe as a pre-political and pre-contractual society is rooted in the evolutionary schema of which dominated anthropology during the 19^th century. The evolutionism of 19^th century saw human beings as making uniform ‘progress’ and evidences such as the continuation of ‘primitive’ traits like pottery is example of cultural survivals (Tylor 1871). At the same time, the society was moving through a variety of stages like Savagery, Barbarism and ultimately the civilisation (Morgan 1877). Tribal people around the world have then provided the empirical evidences to support the theory of social evolution.

It was L.H. Morgan’s Ancient Society (1861) and Systems of Consanguinity and Affinity of the Human Family (1871) that made investigation on Tribal society a systematic enterprise. Morgan emphasised that even though there is a general absence of state system, yet, tribes are quite organised and disciplined society. He noted that there is a general absence of hierarchical division between Clans and Lineages. In “Ancient Society” (1877) Morgan defines tribe as a completely organised society where all forms of social relation are dominated by kinship. For Morgan, tribal society is organised in such a way that their form of social organisation is capable of reproducing itself. A tribe, according to him, is a collection of a number of clans who have distinct nomenclature, separate language, distinct political organisation and a territory under their own possession. It is important to note that Morgan's conception of the tribe and Durkheim's conception of the polysegmental society were both rooted in the same evolutionary perspective. Their successors chose their examples not from India, China and the Islamic world, but from Australia, the Pacific Islands and North America where recent historical experience brought out the disjunction rather than the co-existence of tribe and civilization.

Along the similar line of generalised and universal idea of social evolution Sir Henry James Maine has given a theoretical idea of the emergence of human civilisation. His theory that political organization had originally been based on blood (kinship) and later moved to territory, which is part of that famous transition from societies based on status to ones based on contract that he developed in Ancient law (1861), has provided a solid foundation for much work in political anthropology. His work on the difference between early communities and modern associations strongly influenced the contemporary work of Tönnies and Durkheim and later that of Redfield. His analysis of corporate institutions helped lay the foundation of modern studies of kinship as developed by Fortes and Evans-Pritchard.  Maine showed the complexity of the "bundle of powers" in property and the way in which these had been gradually separated into the institution of private, individual property. He outlined the importance of the development of notions of primogeniture and impartibility and the central device of wills. Supplemented by the work of F. W. Maitland, his characterization of the nature of property rights within feudalism is still valuable because he saw very clearly the mixing of political and economic power and the different layers of tenure in the feudal period.  His most famous work is on the development of the "individual" from the "group," that movement whereby status (family) is replaced by contract as the basis of modern nation-states. Although many other great Victorians, including Spencer and Marx, were developing parallel ideas, his insight is unique. There is much debate concerning his methodological importance and some criticism of his accuracy. Some believe that he introduced a new comparative and historical approach that laid the basis for the disciplines of anthropology and comparative jurisprudence. Others argue that his work was distorted by an evolutionary bias. In fact part of the tension in his writing results from the fact that he straddled the paradigm shift to evolutionism. He believed that stability was the norm and that the evolution of certain "progressive" societies was the exception. He was much more cautions in his generalizations than most of his critics realize. As Pollock wrote of him in the year of his death, "Maine can no more become obsolete through the industry and ingenuity of modern scholars than Montesquieu could be made obsolete by the legislation of Napoleon," for "At one master-stroke he forged a new and lasting bond between history and anthropology"

Major premises of tribe as pre-political and pre-contractual society

 There are several major aspects of the classical approach that sees tribe as pre-political and pre-contractual society. These are as follows:

1.       The general presence of the spirit of 19^th century unilineal evolutionism as a theoretical background

2.       For Morgan society’s progress through three stages is important and tribal people from various corners of the world exemplify such progress.

3.       For Maine, society has progressed from status to contract with law

4.       There is a rough parallel to the Durkheimian idea of progress from mechanical to organic solidarity.

 

Worldview

 

Worldview

Worldview  is the set of cultural and psychological beliefs held by members of a particular culture; the term was borrowed from the German Weltanschauung. It is a concept derived in part from the WHORFIAN HYPOTHESIS, which posited that highly habituated forms of language structured thought and thus, as Edward SAPIR (1929a: 210) argued, "The worlds in which different societies live are distinct worlds not merely the same worlds with different labels." The term fell out of use, or was replaced by "ideology," as anthropologists realized that all members of a society did not in fact share the same cultural values and points of view, and that the creation and contestation of cultural belief systems were never static (Hill & Mannheim 1992).

Background

The concept of world view is closely tied to an ambitious effort made in the early 1950s by a group of scholars at the University of Chicago, guided by Robert Redfield. In Redfield’s book The Folk Culture of Yucatan (1941), he expressed an embryonic concern with the concept of world view. Redfield’s encounter with an Indian culture which was at grips successively with Spanish and modern urban cultures aroused his interest in the evolutionary process and in sociocultural change. He was impressed by the incurable wound inflicted on the Indian past and, throughout his career, thought of primitive culture as a broken thing, persisting here and there and striving to defend itself. This view caused Redfield to stress the positive aspects of the primitive condition and to see any evolution therefrom —in spite of reconstructive attempts—as essentially disruptive and negative. In approaching modern urban culture via the peasant culture which is its rural counterpart, Redfield sought to rediscover the purity of folk culture and, indeed, to reimpose it by a concern with the good life and by an interest in the cause of peace and understanding among nations. In its final metamorphosis, influenced by the theories of orientalists, the concept of world view merged with the concept of “Great” and “Little” traditions, which contains a more balanced evolutionary view of the loss of purity. Redfield’s original concern with levels of understanding among individuals who hold diverse world views developed into the study of interactions between high and low, intellectual and lay, urban and village cultures within a great civilization.

Theoretical development

In a seminal paper, “World View and Social Relations in Guatemala,” Sol Tax (1941) distinguished world view from social relations, although he suggested that perception of the latter enters into the “mental apprehension of reality” that is world view. Tax observed that Guatemalan Indians, who do not acculturate to Ladinos or to each other, continue to have a primitive world view, although they appear to have had a “civilized” type of impersonal, market-oriented system of socioeconomic relations since pre-Columbian times. The first explicit elaboration of the concept occurred in Redfleld’s article “The Primitive World View” (1952). Here he clearly emphasized the individual: self is the axis of world view, which is the way a man in a particular society sees himself in relation to everything around him. Redfield was primarily interested in world views that characterize whole peoples and have been generally developed without the assistance of the specialized philosopher; he distinguished these from a “cosmology,” or the systematic reflections of the specialized thinker. He hypothesized that there are certain universal elements of world views. Every world view distinguishes (a) part of the self from another part, thus establishing, as it were, a dialogue within the self; (b) a human nature from that which is nonhuman; (c) classes and categories of the human, i.e., social persons (e.g., groupings of persons who are intimate and similar, others who are far and different); and (d) an entity called nature and another described in shorthand as God, within the nonhuman. Further, every world view includes (e) an orientation of the self in time and space by means of major natural phenomena; and (f) a similar orientation to life crises in human existence. The first explicit elaboration of the concept occurred in Redfleld’s article “The Primitive World View” (1952). Here he clearly emphasized the individual: self is the axis of world view, which is the way a man in a particular society sees himself in relation to everything around him. Redfield was primarily interested in world views that characterize whole peoples and have been generally developed without the assistance of the specialized philosopher; he distinguished these from a “cosmology,” or the systematic reflections of the specialized thinker. He hypothesized that there are certain universal elements of world views. Every world view distinguishes (a) part of the self from another part, thus establishing, as it were, a dialogue within the self; (b) a human nature from that which is nonhuman; (c) classes and categories of the human, i.e., social persons (e.g., groupings of persons who are intimate and similar, others who are far and different); and (d) an entity called nature and another described in shorthand as God, within the nonhuman. Further, every world view includes (e) an orientation of the self in time and space by means of major natural phenomena; and (f) a similar orientation to life crises in human existence.

In its current connotation, worldview is seen as a combination of the following information which social scientists can gather from the field (E. M. Mendelson 1956):

1.       Cognitive systems at the level of the scientific world view

2.       Natural (biology, chemistry, physics)

3.       Social (psychology, sociology, communications, history, cosmology)

4.       Parasocial (theology, comparative religion)

5.       Attitude systems at the level of any world view (mineral, animal, vegetal, human, para-natural)

6.       Action systems at the level of direct behavioral observation (medicine, agriculture, technologies, ritual, etc.)

Further reading: https://www.encyclopedia.com/social-sciences/applied-and-social-sciences-magazines/world-view

Further reading for research:

Bunzel, Ruth 1952 Chichicastenango: A Guatemalan Village. Seattle: Univ. of Washington Press.

Durkheim, Emile; and Mauss, Marcel (1903) 1963 Primitive Classification. Translated and edited with an introduction by Rodney Needham. Univ. of Chicago Press. First published as “De quelques formes primitives de classification” in Volume 6 of Annee socio-logique.

Geertz, Clifford 1957 Ethos, World-view and the Analysis of Sacred Symbols. Antioch Review 17:421-437.

Guiteras-Holmes, Calixta 1961 Perils of the Soul: The World View of a Tzotril Indian. New York: Free Press.

 

Horton, Robin 1960 A Definition of Religion and Its Uses. Journal of the Royal Anthropological Institute of Great Britain and Ireland 90, no. 2:201-226.

Kluckhohn, Clyde 1951 Values and Value-orientations in the Theory of Action: An Exploration in Definition and Classification. Pages 388-433 in Talcott Parsons and Edward Shils (editors), Toward a General Theory of Action. Cambridge, Mass.: Harvard Univ. Press.

Leslie, Charles M. 1960 Now We Are Civilized: A Study of the World View of the Zapotec Indians of Mitla, Oaxaca. Detroit, Mich.: Wayne Univ. Press.

Mendelson, E. M. 1956 World-view. Ph.D. dissertation, Univ. of Chicago.

Mendelson, E. M. 1958 The King, the Traitor, and the Cross: An Interpretation of a Highland Maya Religious Conflict. Diogenes 21:1-10.

Mendelson, E. M. 1959 Maximon: An Iconographical Introduction. Man 59:57-60.

Mendelson, E. M. 1965 Los escandalos de Maximon. Seminario de Integracion Social, Publication No. 19. Guatemala City: Ministerio de Educacion.

Redfield, Robert 1941 The Folk Culture of Yucatan. Univ. of Chicago Press.

Redfield, Robert 1952 The Primitive World View. American Philosophical Society, Proceedings 96:30-36.

Redfield, Robert 1953 The Primitive World and Its Transformations. Ithaca, N.Y.: Cornell Univ. Press. → A paperback edition was published in 1957.

Redfield, Robert 1955 The Little Community: Viewpoints for the Study of a Human Whole. Univ. of Chicago Press. A paperback edition, bound together with Peasant Society and Culture, was published in 1961 by Cambridge University Press.

Redfield, Robert 1956 Peasant Society and Culture: An Anthropological Approach to Civilization. Univ. of Chicago Press. A paperback edition, bound together with The Little Community, was published in 1961 by Cambridge University Press.

Tax, Sol 1941 World View and Social Relations in Guatemala. American Anthropologist New Series 43: 27-42.

 

 

Cultural Dimensions of health - Introduction

 

 

Cultural Dimensions of health

 

Contents

Cultural Dimensions of health. 1

Introduction: 1

Background: 1

Culture in population health: 3

Sick role model: 4

Cultural Competence and Responsiveness in health care practices: 4

Cultural Competence: 5

 

 

Introduction:

Anthropology studies human health problems and healing systems in their broad social and cultural contexts. A specialised branch of anthropology, i.e, medical anthropology has engage in both basic research into health and healing systems and applied research aimed at the improvement of therapeutic care in clinical settings or community public health programs in prevention and disease control. Drawing from biological and social sciences, as well as clinical sciences, medical anthropologists have contributed significantly to the understanding and improvement of human health and health services worldwide. As a result, the growth of the subdiscipline in recent years as reflected in publications and meetings, training programs, and influence outside of anthropology has been remarkable. Medical anthropology is not characterized by a single theoretical paradigm. For example, ethnographic description and analysis of religion and healing systems are as old as anthropology itself, while new approaches like critical medical anthropology are the product of more recent intellectual trends. This has sometimes led to intense debates within the field such as those between clinically applied medical anthropologists (interested in making cultural knowledge useful to the aims of medical practitioners) and critical medical anthropologists (interested in the phenomenology and political economy of biomedicine). But, even though the scope of intellectual inquiry is very diverse, it is possible to identify five basic approaches: biomedical, ethnomedical, ecological, critical, and applied. These approaches share three fundamental premises:

1.           illness and healing are fundamental to the human experience and are best understood holistically in the contexts of human biology and cultural diversity

2.           disease represents an aspect of the environment that is both influenced by human behavior and requires biocultural adaptations

3.           the cultural aspects of health systems have important pragmatic consequences for the acceptability, effectiveness, and improvement of health care, particularly in multicultural societies

Background:

The developed world has transformed from industrialized societies organized around the production of goods by machines into technocracies: societies organized around evolution through the development of sophisticated technologies and the global flow of information through these technologies. Thus, Davis- Floyd has labeled its dominant health care paradigm “the technocratic model of medicine” to highlight biomedicine’s precise reflections of technocratic core values. The technocratic model emphasizes the separation of mind and body and metaphorizes the body as a machine and the patient as an object (“the gall bladder in 212”). The resultant mechanicity and often impersonal nature of biomedical care have been mitigated in recent years by increasing emphasis on humanism within biomedicine. The “humanistic model” stresses the importance of “mind-body connection,” defines the body as an organism, and sees the patient as a relational subject; it views the relationship between patient and practitioner as an essential ingredient of healing. While encompassing the relational values of humanism, most alternative healing methods are ideologically grounded in a third transnational paradigm, the “holistic model of medicine,” which recognizes mind, body, and spirit as a whole, and defines the body as an energy field in constant relation to other energy fields, demanding attention to energy-based healing—a radical departure from the mechanistic approach of biomedicine.

Illness and disease as cultural constructs:

Disease is distinguished from illness, which refers to a person's perceptions and lived experience of being sick or "dis-eased"   a socially disvalued state that includes disease but is not limited to it. In recent years, the disease illness distinction has been criticized because the process of separating biological "facts" from cultural constructions falsely suggests the superiority of the non-cultural biomedical model (Hahn 1995).  From an anthropological perspective, diseases have played a significant role in the evolution of both human biology and cultural systems. Infectious diseases, for example, represent challenges to survival and therefore act as agents of selection for biological or cultural adaptation. Livingstone's (1976) analysis of the history of the sickle-cell genetic trait in West Africa remains a classic example of this phenomenon. Here the introduction of SWIDDEN horticulture resulted in increased P. falciparum malaria, which, in turn, increased the frequency of the sickle-cell gene that gave resistance to that disease, in spite of the huge costs sickle-cell anemia otherwise exacts on the human body. A cultural-ecological approach to understanding disease emphasizes the fact that the environment and its health risks are largely created by culture (Inhorn & Brown 1997). Culture determines the social-epidemiological distribution of disease in two general ways. From a microsociological perspective, culture shapes individual behaviors (diet, exposure to contaminated water, sexual practices, etc.) that predispose people to certain diseases. From a macrosociological perspective, political-economic forces and cultural practices make people interact with their environment in ways that may affect health   either by exacerbating disease problems or protecting people from disease. The building of dams for the intensification of agricultural production, for example, can increase rates of schistosomiasis or malaria. 

In epidemiology there is a distinction between epidemic diseases, which occur at greater than expected amounts, often in outbreaks linked by time or place, and endemic diseases, which occur at a more constant rate in a population. Epidemics are usually characterized by high mortality rates and socioeconomic disruptions, and have been very influential in history (McNeil 1976). Endemic diseases, often characterized by high morbidity, can be so commonplace in a population that they are considered normal rather than an illness. Infectious diseases caused by bacteria, viruses, fungi, unicellular parasites, and so on often trigger immunological responses in hosts so that individuals build up a repertoire of immunities to endemic (childhood) diseases. Infectious diseases can also be contrasted with chronic diseases (cardiovascular disease, hypertension, etc.); these are sometimes called the "diseases of civilization" because of their increased prevalence in wealthy populations. Chronic diseases have multifactorial causes, partly linked to diet and exercise patterns. Many anthropologists see the rise of chronic disease as a reflection of the discordance between ancient genes and modern lifestyles (Eaton et al. 1988). 

Disease patterns change over historical time. Through a process of mutual adaptation of host and pathogen, an epidemic disease can become an endemic one within a single population. Armelagos and Dewey (1970) have identified three "epidemiological transitions" in human history. The first was a general decrease in health and increase in infectious-disease burden associated with the domestication of plants and animals (Neolithic Transition). The second was a decrease in infectious disease and an increase in chronic disease as a result of improved housing, sanitation, diet, and (to a lesser extent) medical care in Europe and the United States at the beginning of the twentieth century. The third epidemiological transition is the rise of antibiotic-resistant pathogens and the emergence of new diseases such as HIV/AIDS or Ebola viruses at the end of the century. These are not isolated phenomena. In 1992, the list of new diseases included 17 forms of bacterium, rickettsia, and chlamydia, 27 forms of virus, and 11 forms of protozoon, helminth, and fungus (Lederberg et al. 1992). In an ecological sense, these new diseases reflect evolutionary processes in which pathogens exploit new ecological niches created by environmental changes.

  Culture in population health:

Scholars like Hruschka (2009) argues that culture is a powerful determinant of health outcomes and disparities. In such accounts, culture can be either a barrier to health or a protective factor, it can stymie health interventions, reinforce and perpetuate behaviors that impinge on well-being and explain otherwise inexplicable population differences in health (Health Canada 1998; Young 1998; Kindig and Stoddart 2003; Eckersley 2006). Yet, among the frequent references to culture as a factor in health disparities, the precise mechanisms by which cultural factors influence health outcomes are rarely   clarified, and relatively few empirical studies in the epidemiological literature actually operationalize and measure putative cultural mechanisms in an attempt to assess their plausibility. This mismatch between culture’s assumed role in health disparities and the relative lack of empirical investigation has lead to recent calls for more careful definition and investigation of the pathways by which culture might impinge on health and well-being (Dressler 2006; Janes 2006; Kelly et al. 2006). As a precursor to this goal, this paper systematically reviews how population health scholars use culture as an account for health disparities. To give a background to the culture concept, I briefly trace its history and provide a working definition of the term. Then, using published articles as a lens, I document the historical increase in how epidemiologists (and more recently population health scholars) have used culture as an explanation, and in more detail how they use the term today. Finally, I identify key weaknesses in how culture is currently used by epidemiologists and population health scholars, and describe promising ways to define and evaluate culture’s influence on variations in health. Key points of the review are that:

1.       Culture is not self-evident and needs careful definition if it is to be used as a scientific explanation.

2.       Culture comprises a number of different mechanisms and pathways that can be hidden if we simply invoke ‘culture’ as an explanation.

3.       Cultural explanations are only hypotheses, and they require careful specification and testing against other proposed explanations.

4.       Because culture is learned, and can differ arbitrarily between groups, cultural explanations require in-depth study of a particular setting in conjunction with population-based quantitative studies.

The 20th century invasion of academic discourse by ‘culture’ equally affected population health and epidemiology (Trostle 2005). There are several important questions that need to be answered in order to understand the concept of culture in population health. How is culture used as an explanation for health outcomes, health disparities, and the differential success of interventions? How are such claims about culture’s influence evaluated? And to this end, how has culture been measured, how have cultural variables been analyzed, and how has an understanding of cultural pathways been used to improve interventions?

Sick role model:

Talcott Parsons (1951:436) described the "four aspects of the institutionalized expectations system relative to the sick role." He argued (in The Social System, 1951) that whilst disease involves bodily dysfunction, being sick—that is, being identified and accepted as ill—is a role governed by social expectations, of which he listed four. First, exemption from normal social role responsibilities: this exemption must be legitimated by some authority, often a medical practitioner. Second, exemption from responsibility for being ill, which means that the sick must be looked after. Third, since sickness is deemed undesirable, the sick are obliged to want to get better; and also, fourthly, to seek technically competent help and co-operate in trying to get better.

The concept draws attention to the social regulation of illness: to the mechanisms that guarantee the compliance of sick persons, help to restore them to health, and ensure that only the genuinely sick are exempt from normal responsibilities. It also provides a means of analysing the motivational factors involved in illness. Indeed, Parsons suggested that because of these motivational components (he was influenced here by Freudian theorizing), illness could be considered a special form of deviance, functional to the social system in directing deviant tendencies away from group formation, solidarity, and successful claims to legitimacy.

Critics have questioned the universality of Parsons's specification of the expectations governing the sick role, the extent to which illness is motivated, the model's relevance to long-term sickness, and his focus on what is functional for society. None the less, the concept of the sick role has been central to sociological thinking about health and illness, and its importance would be hard to overestimate.

Cultural Competence and Responsiveness in health care practices:

The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and deliver culturally competent services. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.(1) A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities. Examples of strategies to move the health care system towards these goals include providing relevant training on cultural competence and cross-cultural issues to health professionals and creating policies that reduce administrative and linguistic barriers to patient care.

Cultural Competence:

Cultural competence in health care means delivering effective, quality care to patients who have diverse beliefs, attitudes, values, and behaviors. This practice requires systems that can personalize health care according to cultural and linguistic differences. It also requires understanding the potential impact that cultural differences can have on healthcare delivery. For example, race, socioeconomics, health literacy, and other factors can influence: How patients perceive symptoms and health conditions When and how patients seek care Patients’ expectations of care Patients’ preferences regarding procedures or treatments Patients’ willingness to follow doctor recommendations or treatment plans Who patients believe should participate in making healthcare decisions While cultural competence in health care initially referred to meeting the needs of people from distinctive ethnic and racial groups, it now also refers to meeting the needs of people with disabilities, those from diverse socioeconomic backgrounds, and members of the LGBTQ community.

The Need for Cultural Competence in Health Care

Differences between healthcare providers and patients can affect communication. This can, in turn, impact both clinicians’ and patients’ decisions with regard to treatment. For example, a clinician may misinterpret a patient’s silence as a lack of interestin receiving care. As a result, the clinician may not order a diagnostic test, when in fact the patient’s response reflected their notion of respectful behavior.

When healthcare providers fail to recognize the differences between them and their patients, they may inadvertently deliver lower-quality care. Cultivating skills that improve cross-cultural communication can play an important role in delivering equitable care.

Additionally, building teams with healthcare professionals who reflect the diversityof the patient populations served can also improve cross-cultural communication. Diverse teams have a wider cultural knowledge base that they can share with one another. This makes them likely to respond with empathy to the unique cultural needs of patients.

Language accessibility is also key. Language barriers keep patients from accurately describing their symptoms and providers from explaining diagnoses. Language barriers can also create unsafe and inappropriate situations in other ways.

For instance, clinicians may rely on children to serve as interpreters, putting young people in the position of telling a parent they have cancer. As another example, clinicians may rely on abusive spouses to interpret for their battered partners. Both situations pose significant problems.

The need for Cultural Responsiveness in health care:

Cultural responsiveness is a new way of thinking about culture. It means being open to new ideas that may conflict with the ideas, beliefs and values of your own culture, and being able to see these differences as equal. For example, in many cultures spiritual beliefs are an important part of overall wellbeing.

It means being respectful of everyone’s backgrounds, beliefs, values, customs, knowledge, lifestyle and social behaviours. It helps you provide culturally appropriate care and support, so people are empowered to manage their own health.

Cultural responsiveness is important for all social and cultural groups, including:

·         Aboriginal and Torres Strait Islander peoples

·         people from culturally and linguistically diverse backgrounds

·         refugees or displaced migrants

·         people at all life stages, including end of life

·         people with different abilities, including intellectual and cognitive disabilities

·         LGBTIQ people

·         people from priority populations and sub-cultures, such as the deaf and vision-impaired community.

Cultural responsiveness involves continuous learning, self-exploration and reflection. It draws on a number of concepts, including cultural awareness, cultural sensitivity, cultural safety and cultural competence

Evidence shows that when there is a lack of cultural responsiveness, health outcomes are much poorer.2 Improving cultural responsiveness can not only remove barriers to accessing healthcare, but may also reduce inequitable health outcomes for marginalised and vulnerable groups.

In Australia, there is a movement towards cultural support planning in health, social and community services.

This includes:

·         language, such as translating and interpreting services

·         food preferences

·         access to health professionals of the same gender

·         religion and spirituality for palliative care and end of life.

Materials used:

https://publichealth.tulane.edu/blog/cultural-competence-in-health-care/

https://aci.health.nsw.gov.au/resources/primary-health/consumer-enablement/guide/how-to-support-enablement/culturally-responsive-practice

https://hpi.georgetown.edu/cultural/

http://sumananthromaterials.blogspot.com/2017/08/medical-anthropology.html

Culture as an explanation in population health by DANIEL J. HRUSCHKA, 2009, Annals of Human Biology, MayJune 2009; 36(3): 235247

The Sick Role Concept: Understanding Illness Behavior By Alexander Segall: Journal of Health and Social Behavior, Vol. 17, No. 2 (Jun., 1976), pp. 162-169

 

See also: http://sumananthromaterials.blogspot.com/2017/08/medical-anthropology.html