Читать книгу The Wiley Blackwell Companion to Medical Sociology - Группа авторов - Страница 59

The contributions of the classics are the foundation of our understanding of culture and of its impact on behavior. Research over the past six decades support their interpretation of culture. The corpus of contemporary sociological and anthropological research on culture is expanding rapidly and in different directions. “Neoclassical” approaches emerged from the work of Weber, Durkheim, and Marx but have taken a life of their own as seen, for example, in interpretations of religion, studies of social control, and feminist perspectives of the body and gender (Alexander 1990). Research is also advancing on multiple aspects of the impact of culture and ethnicity on health status (e.g. Fox et al. 2017; Gage-Bouchard 2017; Nelson and Wilson 2017; Versey et al. 2019); on utilization of healthcare services (e.g. Galbraith et al. 2016; Kikuzawa et al. 2019; Korous et al. 2017; Miller et al. 2019); and on the link of socioeconomic inequalities and health (e.g. Downing 2016; Lane et al. 2017), including the differential impact of the COVID-19 pandemic among ethnic minorities in the US (Borjas 2020), among other aspects.

Attention to the body as an important subject of social analysis was brought up by Michael Foucault’s work on The Order of Things (1970), The Birth of the Clinic (1973), and Discipline and Punish (1977). He eschewed research in favor of formulating assumptions, but his effort at awakening alertness to the symbolic and perceived meaning of the body is, to me, his vital contribution. Research findings over the past two decades show that the symbolic meaning of the body in relation to health and illness, manipulation and completeness, varies across cultures. A dramatic illustration is the cultural interpretation of female genital mutilation/cutting (FGMC) by Western groups advocating the eradication of FGMC as opposed to the symbolic meaning of FGMC held by some African communities that are struggling to preserve it (e.g. Fox and Johnson-Agbakwu 2020; Greer 1999; Grose et al. 2020).

On the effort to elucidate how culture affects the individual’s behavior, the work of Erving Goffman (1968a, 1968b) using the symbolic-interaction perspective is important. Goffman focuses on the person’s subjective definition of the situation and the concept of stigma. He proposes a three-stage stigmatization process (1968b): the person’s initial or “primary” deviation from a normative framework; the negative societal reaction; and the person’s “secondary” reaction or response to the negative reaction that becomes the person’s “master-status.” Goffman’s “normative framework” is socially constructed based on the community’s predominant culture. Disability and disease, particularly mental illness (Goffman 1968a), are typically perceived as stigma and trigger the stigmatization process. Unfortunately, Goffman and many of his followers have neglected to apply his conceptual approach fully to their own studies: they overlook cross-cultural comparisons (e.g. Locker 1983; Scambler 1984; Strauss 1975).

The preceding discussion might suggest there is consensus on what culture is and how to study it. Jeffrey Alexander (1990: 25–6) suggests that while contemporary researchers agree on “the autonomy of culture from social structure,” he finds “extraordinary disagreement over what is actually inside the cultural system itself.” Is it symbols, or values, or feelings, or metaphysical ideas? He proposes that culture might embrace all these because culture cannot be understood “without reference to subjective meaning” and “without reference to social structural constraints.” For the same reason he favors a multidisciplinary approach to the study of culture.

The multidisciplinary approach is indeed one of two main trends in contemporary research on the link between culture and health. Focusing on the understanding of culture and health behavior, the disciplines of sociology and anthropology have produced research findings confirming that culture or ethnicity influence health behavior and attitudes significantly. A second main trend in the literature is the wide variety of conceptual perspectives on the influence of culture, although no dominant theory has yet emerged to explain that influence systematically and comprehensibly.

Multiple angles of analysis are as important as multidisciplinary approaches. Renée Fox (Fox 1976, 1989; Parsons and Fox 1952a, 1952b) illustrated this decades ago. She demonstrated the advantages of close collaboration between sociology and anthropology in the study of health-related behavior, particularly on the aspect of culture. Fox has also contributed to the search for evidence on the impact of values and beliefs on health behavior at the micro-level through her analysis of individuals and at the macro-level by focusing on institutional aspects of medical care such as the medical school and the hospital.

A final note before moving on to culture and health: Researchers’ attention to ethnicity is now common in international studies in medicine and medical sociology. However, despite the relevance of culture in understanding patterns of health and illness behavior, the research focus in the US is more on race. Cockerham (2021b) suggests that this is due to race being used as a standard variable in almost every study in order to measure racial health disparities. Nevertheless, efforts to assist clinicians and medical researchers to appreciate the complexity of culture continue (e.g. Fox et al. 2017; LaVeist 1994; Williams 1994). The social sciences and, in particular, sociology and anthropology remain the disciplines most dedicated to the study of culture or ethnicity per se and of its association with health and illness phenomena.