By John Curran
Why does culture matter to health and human well-being? That was the question asked on Sept. 15, Tuesday evening in Hynson Lounge. The guest speaker was David Napier, a professor of medical anthropology from University College London and director of a multi-disciplinary coalition called the UCL Science, Medicine and Society network.
Napier’s lecture, titled “Why Culture Matters to Health and Human Wellbeing” represented research done in conjunction with The Lancet and UCL. The Lancet is a peer-reviewed journal covering topics related to medicine, society, and industry, and holds the title of being the most widely distributed medical journal worldwide.
During the lecture, Napier’s presentation detailed all aspects of his research, beginning with an overview of its origins and structure. Napier first described a commission that was created in order to bring together the professionally diverse selection of researchers that would be required.
The commission itself brought together 27 multi-disciplinary authors whose focus would be communication based, along with 27 global advisers who would serve as topic experts. “Oddly enough we had exactly the same number – it wasn’t matched – it just happened to turn out that way,” said Napier. In addition to these 54 writers and advisors, the commission also consisted of external reviewers, The Lancet’s own review committee, and community focus groups.
“After several different rounds of readings and surveys of our group members, and surveys of communities we ended up with a number of cultural domains,” said Napier. Through these domains, which include cultural competency, communities of care, health inequalities, human well-being, and agency, the commission was able to focus its members.
Napier then expanded on the commission’s research and some of the group’s findings. In short, the commission’s purpose is to explain or seek to explain the impact that culture has on an individual’s health.
This research topic led to the commission first establishing an understanding of what culture is. Napier said that, “culture is about the identities that we feel deeply and identify with, but it is also about overlooked practices.” Napier then identified a definition of culture from the World Health Organization. “Culture is not restricted to nationalism, race, ethnicity, or religious preference. We all have cultures we participate in, and how we participate determines how we negotiate illness for better or worse,” he said.
This understanding of culture was then applied by the commission to individuals who are ill and seek care at medical facilities. If culture influences the eventual outcome of a patient’s visit with a doctor, is it a negative or a positive influence? Is there even any influence at all? This was the question the commission began to explore, and the research demonstrated that culture does have a very distinct impact on health and well-being.
In particular, Napier cited examples such as migration and the recent Ebola crisis as evidence of cultural differences clashing disastrously with effective medical care. A large focus of the lecture was on the diabetes epidemic as well as a discussion related to migration, social standing, and identity. “We need to understand local cultural drivers more generally in order to understand vulnerability more specifically because as we know, in local settings vulnerability emerges in unique ways,” said Napier.
As a last step, the commission presented a series of recommendations, which can be found published in The Lancet, that seek to address this issue of health care failing to adapt to changes in culture. These recommendations were as basic as “culture should be defined better,” and as specific as, “exported and imported practices and services should be aligned with local cultural meaning.”
“The unavoidable conclusion is that we spend much of our effort on only a very small part of a very big problem. This itself is a cultural choice. It’s a value judgement that we make about where we want to put our resources,” said Napier. “In the European Commission, 40 percent of all the health care research funding goes to clinical research and about two percent goes towards culture,”