Notes on culture and ethnicity Definition of culture and ethnicity Culture has been defined as systems of shared ideas,

, systems of concept and rules and meanings that are expressed in the way human beings live (Keesing, 1981). Ethnicity on the other hand, is a socially constructed term based on distinctive shared origins, culture, traditions, group identity, language or religion, (Dein, 2006). Ethnicity is a much contested term, as it has been used as a synonym of race, (the idea of race having been broadly discredited, in part because of the lack of actual biological support for its basis and also due to its popular usage in Social Darwinism/ eugenics). Background and examples of cultural variation in health processes Historically, the study of culture/ ethnicity in relation to health fell under the remit of medical anthropology and medical sociology. However, recently it has been suggested that culture and ethnicity are fundamental to health beliefs and health behaviour, and as such require inclusion into theory and research by health psychology, (Landrine & Klonoff, 1992). Angel and Thoits (1987) suggest that the subjective experience of illness is culture-bound. Definitions of what constitutes health and illness vary between cultures. Cultural factors determine what symptoms are seen as abnormal and how these symptoms are dealt with, (Helman, 1984). Illness does not occur in isolation of the broader socio-cultural context. The mediating factor of culture in health/ illness is evident from the outset, where the political economy results in the differential production of health threats and risks, (Farmer, 2004). Once illness becomes manifest, further cultural disparities present. In the US, breast cancer mortality is higher among African American women than among white women, even though there is a lower incidence of breast cancer among the former group. This is partially explained by the fact that African American women present at a more advanced stage of the disease, (Eley et al., 1994). Though in the US discrepancies exist in the healthcare access afforded to people (Ku, 2001), socioeconomic constraints alone cannot account for the differential breast cancer presentation stage/ survival rates between African American and white women. Lannin et al, (1998) in a case-controlled study found that cultural beliefs and attitudes along with socioeconomic variables influenced the stage of breast cancer presentation.

In a qualitative analysis of the literature, Lannin et al, (1998) found that some of the African American women interpreted their symptoms to a folk-model of illness. In this model, breast lumps were not necessarily problematic. Some of the women reported that lumps that arent bothering you are better left alone. The majority of African American women in the study believed that excising the lump should be avoided as it would cause the cancer to spread. Rather they advocated using OTC medication, herbal remedies and prayer. Why disparities exist between cultures Ashton et al., (2003) suggest that even when access to healthcare is the same for all in society, disparities in uptake exist. The authors postulate that this may be due to the nature of the doctor-patient interaction. They suggest that both the doctor and the patient have their own explanatory model for illness. When the patient believes that the diagnosis/ treatment offered to them is incongruent with their own illness representation, they are less likely to be satisfied with the consultation and less likely to adhere to treatment (Berenbaum, 1998). Medical anthropologists and medical sociologists have researched illness schema for over 80 years, and health psychology has been criticised for its neglect of the role of culture as a determinant of health (Landrine & Klonoff, 1992). However, the variation of illness representations held by different cultural groups has been noted within health psychology research (Diefenbach & Leventhal, 1996). They state that illness representations are influenced by the social and cultural context in which we live, as much as they are a product of our own somatic and psychological experiences. They suggest that cultural contexts provide frameworks for illness representations via shared common knowledge and that this extends to sick-role behaviour. All the illness representation variables may, to some extent be culturally constructed, (e.g., attribution of disease cause to supernatural forces, Murdock, 1980). How health psychology does/ doesnt address culture Most health psychology theories include variables which may be acted on by cultural factors (e.g., Theory of Planned Behaviour- attitudes, subjective norm, etc). Though the role of culture is not specifically demarcated, health psychology models can and are used to examine cross-cultural health behaviour differences, (e.g., smoking beliefs, Hanson, 1999). Psychology has recognised diversity and health psychology qualitative research allows a distinctly emic perspective, providing thick description of the individuals cultural viewpoint.

Furthermore, health psychology has noted the importance of providing culturally sensitive interventions (Lerman, 1999a). Therefore, whilst a call has been issued for cultural competence in health psychology (Yali & Revenson, 2004), to a certain extent health psychology is already culturally competent. Whilst the health psychology models may not specifically delineate the influences of culture and ethnicity, these factors can be accessed through demographics, and by qualitative methods of research. In fact, the recognition of the role of culture in health is already evident in much of the current research. Conclusion: does health psychology pay sufficient attention to culture? In conclusion, the fact of the matter is that though illness cognitions may be culturally influenced, they remain the cognitions of an individual. Culture does not operate in isolation, the sole determinant of illness beliefs and behaviours. Gender, SES, attitudes, past history and many more factors play a role. Health psychology pays sufficient attention to the role of culture, but retains a sense of proportionality, and recognises that the remit of health psychology is the study of the individual cognitions and behaviours as affecting health, irrespective of their origins.