Francis Musa Boakari University of the Incarnate Word
In matters of health and culture, For some, uncertainty is the motor of life;
For others, anything only is because it is explainable;
Not just any explanations, but those that are “data-based.”
Still for some individuals, phenomena can be both certain and uncertain.
For this third class, “believables” are found in-between what is and what can be.
Subjectivity and context may be primordial in many things HUMAN, but
Equity in opportunities and access to social goods and services,
Dignity for all human beings under every circumstance, and
Respect for self and others at all times, are even much more basic.
(FMB, San Antonio, March 1, 2008)
In most cases, many people assume that questions related to health are universal givens. However, this is a questionable issue. Like other human conditions, health is socio-culturally determined. This idea is captured by hyphenating two central terms of the discussion. Health is much more cultural than most happen to be aware of. The way it is conceived, described, explained, and dealt with happens to make sense only within a specific context as determined by temporal, spatial, and human agency factors that are also affected by subjectivities dependent upon the collective. This context is determined by culture, understood as all those elements that embody and define the conceptions, values, symbolisms, and behaviors every group and its members consider appropriate. Culture serves as a general framework for understanding all social phenomena, and not only those that are health-related. Social justice in all its rich complexity as the universal standard against which being human is measured, is expected to serve as the basis for a true appreciation for what health and culture are all about. More than ever before, the challenges humans face because of the characteristics of our societies and the demands these carry with them, provide more than sufficient reason not to under-estimate how crucial social justice is in order to guarantee a proper measure of dignity for all human beings.
"Culture and health can only truly be human and humanizing when they attend to the need of the individual..."
Each of the first two central phenomena under scrutiny in this reflective essay is both universal and particular. Health and culture do influence members of all societies, but at the same time, individual perceptions, conceptions, explanations, and effects have much to do with them being real and important, or imagined and irrelevant. Questions of health are complex, and any answers offered about any of its dimensions are duly influenced by each culture, as well as by each and every individual. Even the kinds of questions posed are culturally and individually determined. It can be said that health as a human condition makes sense because it is bounded by a network of ways in which humans engage in meaning-making, value-construction, belief-development, attitude adoption, and behavior manifestation. In the absence of a cultural dimension, health would tend to disappear as each group/individual knows it. Health and culture entail individual perceptions, meanings, and choices mostly compatible with collective values that are contextualized. These phenomena are not only a constant in human life but are also dynamic and considerably fluid. In their essence, they are permanent and always in flux in their manifestations because they are social life-givers. Culture and health can only truly be human and humanizing when they attend to the need of the individual to relate to others in ways that reciprocally respect their dignities. To a much greater extent, social justice encompasses all these considerations because it provides the backdrop expected to guide and serve as yardstick for all that is considered human in the relationships developed in the world the just and ethically responsible, strive to build.
What best describes today’s world is diversity in its myriad of forms, dimensions, and levels. Diversity easily describes most societies in many parts of the world. In the last three decades, the movements of peoples within and across regional, national, and local frontiers, as well as those crossing international boundaries, have not only been constant, but have also considerably increased in quantity and expanded geographically. These human movements now cover most communities, societies, and countries. Diversity, explained as the combined set of differences between individuals and the groups they belong to, is the most remarkable characteristic of this 21st century. Individuals and the groups they constitute could be easily differentiated along ethnic, racial, economic, political, gender, cultural, and social lines. Though all these factors are social constructions, for human beings they are real, especially in their consequences. It was in this sense that Durkheim (1938; 1978), the French sociologist, talked of social facts as all those elements in society that influence us in significant manners. Social facts refer to the ways in which people see, feel, talk about, understand, and try to explain the reality in which they live, as well as those of other people. They form the reality that we construct and which, in return, exerts considerable pressure upon all that we are and do in different situations under particular circumstances. These phenomena may not be explicit, but they are determinant of what the individual and his/her group as well as their community define and live by. The influences of social facts provide abundant evidence of their existence in human society.
"Diversity … is the most remarkable characteristic of this 21st century."
Diversity constitutes differentiating characteristics and conditions as defined by human beings in relationships with other individuals in one context or the other. When these elements are used as criteria for treating people differentially, these normally neutral factors become potent instruments for exclusion or inclusion depending upon the interests and goals of whoever is the dominating figure in that relationship. As I have mentioned somewhere else, “social justice refers to the equal treatment and access to opportunities by all persons in society who continuously seek to co-exist as harmoniously as possible in balanced social and natural environments. Social justice has everything to do with inclusion. It is against any form of social exclusion” (Boakari, 2006, p. 2).
"… all of the group’s members, and even all of human society, have a shared destiny."
Social diversity can also serve as a source of new possibilities for solving problems when its component parts are utilized as bases for collaborating to deal with situations considered undesirable. When accepted as a social positive, differences between societal agents could be harnessed to make the circumstances of these individuals more human. This possibility has been explained by Joel Barker (2000) with the basic thesis that sameness can prevent change and growth, and could even prove dangerous for survival. According to this researcher, sameness in society does not necessarily stimulate creativity because challenges for collective survival or improvements are either absent, greatly reduced, or even difficult to perceive, if and when they appear. In such situations, the tendency to maintain the status quo would be more prevalent. Opportunities for positive changes could easily go unnoticed too. However, this situation is reversed when the members of a group have varied characteristics, backgrounds, and experiences. These differences interact and could produce renewed energies and insights that could be potential change factors. When such renewing elements really lead to new situations, these could be beneficial to the whole group. This becomes more evident when there is the realization that all the group’s members, and even all of human society, have a shared destiny. Whereas sameness tends to favor group conservation and more traditional forms of control, diversity is more likely to provoke creativity and unleash the energy for innovations because new situations demand approaches and solutions that are also new.
In this article, I develop a discussion about health and culture, as well as social justice. I will present some implications related to each in order to emphasize the importance of culture in determining such crucial human conditions as health. The various ways in which cultural factors are related to health will be discussed. Relevant comments and observations pertaining to social justice will also be made along the way. My primary objectives include provoking social agents to be more critical in their approaches (scientific, professional and personal) in trying to understand, explain, and engage with a complex phenomenon like health. Considerations will also be made regarding health issues as cultural concerns in societies that change constantly, especially in terms of the differences between the members and their levels of access to social goods, services, and opportunity structures. This line of thinking is congruent with the understanding of social justice as the indispensable call to reflective action by all normal human beings in all societies, and at all times. How health questions affect us in today’s globalized world, whose population groups continuously become more diversified within the context of a market economy, are issues that will be mentioned. At the same time, raising questions related to the need for the world to act in ways that are accepted as more socially fair and just, will help enrich the discussion.
"For some other cultural groups though, questions of health are not so straightforward."
In Western culture, particularly that based upon Greco-Roman and Judeo-Christian philosophical frames of reference, one that relies unquestionably upon information pieces (data) considered empirical, determination of health is also based upon evidence defined as concrete. In this culture, in contrast to such others as the African, Asian, and Indigenous (AAI), a healthy condition fundamentally refers to an individual’s physiological condition. Other human conditions are placed in different areas of concern because of the over-departmentalization of thinking about and conceiving of reality. Each phenomenon is placed within a specialized field of scientific inquiry and has to be studied in a compartmentalized manner. Questions regarding health tend to primarily fall into the field of human physiology within the positivist realm of scientific explanations. Unhealthy conditions can also be “proven” through observable evidence that can be measured. That is, though they are individual states of being, society has a way of ascertaining their validity in ways believed to be neutral and somewhat universal. For some other cultural groups though, questions of health are not so straightforward. Health constitutes much more than a person’s physical condition; it also involves the psychological and spiritual states of the individual. It is a matter of mind, soul and body. To say that one is healthy in these latter groups is equivalent to claiming to be in an integrated state of well-being. Health and its opposite condition, illness or sickness, can be explained in different ways dependent upon cultural background, interests, experiences, and social goals. Of these explanatory determinants, cultural factors are the most important as they set the tone for any other influencing elements.
Western science, ontology and epistemology are underpinned by concepts of universality. Important principles include objectivity, true/false dichotomies, and notions of Cartesian-Newtonian science that the nature of “reality” is mechanistic – a series of compartmentalised systems which together combine to form a whole. Central to this view is the belief that any of these systems can be reduced to causally significant parts which can be isolated, manipulated, altered or reconfigured, and that as long as the output is consistent with what is expected then the whole remains unaffected. Thus “reality” becomes in essence only those factors deemed causal to an outcome; all else is irrelevant. This process appears to have been particularly successful in medicine (Morgan, 2003, p. 38)
"Health and its opposite condition, illness or sickness, can be explained in different ways..."
Generally, western society is dependent upon health professionals to establish whether an individual is in good health or not. In the case of illness, the professionals in question also assume the responsibility of trying to get the person back to a healthy condition. It is expected that these professionals use verifiable criteria to determine healthy conditions and then prescribe appropriate treatments when necessary. Obeying the cultural norms of neutrality and universalism in determining what health should be, three fundamental models are utilized in the west. These are the medical, the World Health Organization’s (WHO), and the ecological models. The first model defines health in terms of a disease-free condition, a state of being when an individual exhibits no symptoms or problems that amount to dysfunctions of the physical-bodily structures and functions. The WHO model refers to a general state of well-being, one in which people’s feelings of satisfaction about themselves as a totality are emphasized. This is a holistic understanding and may not be very common in the west as evidenced from the number of medical professionals who adopt non-integrated medical practices as the person’s condition is divided into separate states – physiological, spiritual, and emotional. This compartmentalized approach to health is in contrast to homeopathic medicine that treats the whole person in an interdependent manner. The third model, the ecological, stresses the individual’s ability to function; it refers to that condition in which the person is able to carry on his/her social functions as effectively as possible. In the ecological perspective, a healthy person is one without any debilitating conditions who can carry out his/her responsibilities reasonably well. (Boruchovitch and Mednick (1997) The three models emphasize the need for evidence. Health, as it were, only exists when there is sufficient evidence to prove it. An individual may claim to be sick, but without universally acceptable empirical evidence, such a claim could mean little or nothing to the western-minded person or health professional.
"Health … only exists where there is sufficient evidence to prove it."
There is a movement that wholly adheres to the three human dimensions’ (physiological, spiritual, and emotional) perspective by using an “evidence-based medical approach.” According to this method, in medicine, like other natural sciences, one needs to work with “hard, cold, empirical” (Gorman, 2007, p. 52) information in order to distinguish between what works and that which does not. Nonetheless, there are concerns about whether it is really humanly possible to deal with health purely based upon evidence, whatever this may turn out to be for those individuals or professionals making the decision. In fact, the question could turn out to be “Are doctors just playing hunches?” as Christine Gorman appropriately poses. To this question, she replies that “Medicine, after all, is a personalized service, one built around the uniqueness of each patient and the skilled physician’s ability to design care accordingly” (Gorman, p. 52). The sub-title of this article, “We expect them to use hard data. But that’s not always the best kind of medicine,” is all too explanatory. As it can be imagined, there are several stakeholders
This generally happens when insurance companies demand “medical evidence” in order to honor a claim. Claiming to be sick is not enough; there has to be empirical proof, medical evidence based upon tests. The more test results the person presents, the better the chances of having the claim honored.
interested in this approach. Drug manufacturing companies, pharmaceutical conglomerates, insurance organizations, medical professionals, not to mention those people who seek medical services, all have stakes in decisions to use this western-based strategy. In the end, the central question tends to be one of monetary gains and losses. The individual (as client, patient, or insured) generally gets forgotten in this shuffle of interests that are pushed along by powerful health-connected business organizations.
"...the central question tends to be one of monetary gains and losses."
Illness or the state of being unhealthy is conceptualized in terms of the Illness Representation Approach (IRA). According to Boruchovitch and Mednick (1997), the IRA consists of how laypeople represent this human condition. For these people, illness can be understood along the dimensions of “identity … consequence … time-line … cause … and cure” (p. 449). Identity refers to an identifiable and named symptom; consequence refers to the attention paid to the effects of the physical indisposition; time-line is reference to the temporal dimension of the condition; and cause is understood in terms of the factors believed to be responsible for the condition. Finally, cure concerns those ways in which the illness can be treated for complete elimination and return to a healthy state of life. The three human dimensions’ approach in dealing with health assist in defining illness, which in turn, collaborates in elucidating what health is about in Western culture. An individual is either well or sick physiologically, spiritually or emotionally. Each of these states is based upon a world vision sustained by empirical data accepted as evidence derived from tests and measurements that employ instruments and procedures believed to be infallible. Even if the methodology, techniques, measuring tools, and basic frame of reference were valid, what of the humans who gather and interpret the data – are they totally impartial at all times and in all cases? What of their levels of knowledge, range of skills, idiosyncrasies, and personal interests – could these not negatively impinge upon their scientific-medical judgments? Who evaluates these medical professionals’ competency, dedication, level of neutrality, and world vision? Max Weber (1974) appropriately reminded social scientists, and consequently policy makers and social agents, that objectivity is as objective as the scientist’s subjective world vision and belief system!
"...many medical professionals employ common assumptions in a society plagued by a history of discriminatory practices..."
Gorman’s (2007) warning above is corroborated by Garcia (2003) who describes “the misuse of race in medical diagnosis.” This medical practitioner, a Hispanic who prefers being called Mexican, though he claims not to have been to Mexico, emphasizes the need for people to sharpen their conceptions and attitudes toward health issues. He cogently argues that in western (US-based?) medical practice, the individual’s health is sacrificed on the altar of differentiating characteristics and sociocultural conditions because most doctors do not see an individual person seeking to regain his/her health. They are only able to see a socially defined biological entity that happens to be in a dysfunctional condition. Garcia informs us that medical textbooks and schools of medicine, most likely with the implicit intention of reducing public service costs, teach “that knowing the patient’s race helps the doctor make an accurate diagnosis … a patient’s race3 can, and should, influence the doctor’s thinking about possible diagnoses” (2003, p. B3). As a result of this kind of training in the US, many medical professionals employ common assumptions in a society plagued by a history of discriminatory practices to come to “incorrect medical conclusions” about a person’s health. With erroneous diagnoses, irrelevant treatments that could worsen the person’s overall well-being could easily be imagined as the next steps in the line of helping the sick get better. It must be clarified that it is normally the poor who find
3 Those who use medical jargon prefer the word “patient” in referring to anyone seeking medical assistance. However, I think this presents a problem in that an individual defined in such an objectifying manner loses the individuality that is his/her essence. The individual is ‘de-personalized,’ and unconsciously, maybe, this depersonalization of the individual visitor to the health center/office facilitates practices like labeling and stereotyping. Making someone a “patient” can indeed, turn the individual into a person in need of attention concerning his/her health. The dangers that could emanate from such acts of social labeling and the possible self-fulfilling prophecies should be concerns regarding terms like the one in discussion.
themselves in this kind of situation. Most of those who can afford the high costs for good medical attention may have more individualized examinations if they are medically well-informed, and make a strong enough case for such a basic right!
"...another perspective that has increasingly become evident is the conception of health as a commercial product/service."
In the last few decades, another perspective that has increasingly become evident is the conception of health as a commercial product/service. Like all consumer-oriented goods, maintaining one’s health basically amounts to the ability to buy it either through expensive medications or high priced professional services. The reasoning here is that what the consumer needs is the correct information about his/her condition and simple instructions as to how to treat this particular problem. The result of this trend has been the proliferation of advice pertaining to health issues and the recommendation of different medical products and drugs to deal with illnesses. Most media forms are replete with special advertisements in this regard. The result is that it has become commonplace in the west for an individual to visit the doctor’s office with a list of drugs that he/she has researched and concluded is appropriate for his/her health condition. In other words, the knowledge base health professionals were supposed to use to improve upon their diagnostic skills is now available to the layperson who can decide what health product/service he/she needs. The health professional, as it were, is demoted to the secondary role of having to agree with and sign off on the consumer’s perceived medical wants and desires. Medical and health needs as perceived by the specialists, tend to take backstage in these health client-professional interactions. Though there are physicians who refuse to play this role of medical product and service pushers, there are many in several parts of the world, especially where medical services have become much more commercialized, who go along with their health clients as consumers of medical products and services. In our market economy, health becomes just like any other commodity on the market for many people, especially those who can afford to pay for services believed to help maintain their health, stay young, and modify their physical endowments to become more beautiful. In the market economy we maintain, everything is on sale for the right price, and each person could have his/her price.
"In most of Western culture, health is a complicated phenomenon..."
In other words, what may be at stake in most of Western society is the acceptance that in the final analysis, health is neither merely a business commodity nor a purely individual matter. Rather, it comprises socio-medical goods and services that must be made accessible to all citizens because it is a basic human need. Access to reasonably good health services is also one of those factors that determines the quality of life of all the members of any community. In the larger picture, it becomes necessary to deal with health as a question of social justice because it is directly related to the dignity of the individual. When considered from a non-Western perspective, the true significance of a statement like the preceding becomes more easily evident.
In discussions of health in contexts other than the Western, it is crucial to understand that
Despite its dynamic and diverse nature, Indigenous thinking is mostly holistic and contextual. Identity, place, time, knowledge, spirituality, learning and assessment are all inseparable aspects of each other. By contrast, Western culture remains largely committed to a reductionistic, mechanistic worldview in which reality is divisible and knowable in terms of discrete things. (Morgan, 2003, p. 44).
"… it becomes necessary to deal with health as a question of social justice because it is directly related to the dignity of the individual."
These characteristics and the philosophical framework within which such thinkers function are very similar to those of the traditional African and Asian. The African, Asian, and Indigenous (AAI) cultural groups drink from the waters of tradition, cultural conservation, solidarity, mutuality, and community vitalization as a collective mission. Western culture and its philosophical frames of reference do not share these characteristics. These macro-cultural orientations and belief systems are easily noticeable in the conceptions of these groups about social and natural phenomena and about the individual and his/her community.
In most of Western culture, health is largely conceptualized and treated as a condition with observable and measurable features. Consequently, in medical practice with the objective of returning the body to its normal state of good health, any empirical data collected serve as bases for orientations and treatments. For most other cultural groups, especially the AAI, the universe is complex (mysterious), and everything that relates to it has to be understood and treated in a manner that has to be complex too. This is most feasible if done in a holistic manner. This is even more so in the field of health, since these peoples generally believe that life for the individual and his/her community revolves around conditions of health and non-health (sickness or illness). So what then is health for most non-Western traditional people, particularly the AAI peoples?
"...an individual should have a meaningful relationship with those powers … that influence human beings on this earth."
The concept of health covers the generalized condition of an individual. It is the summary state of a person based upon the values, attitudes, and behaviors of the community of which he/she is a member. It is physiological as it could refer to the body, its organs, structures, and general functioning pattern. When the whole system is working in harmony and according to how it should perform, a healthy condition is the result. Health is psychosocial too because it is used to describe the psychological state of mind of an individual and how this state interferes with or collaborates in shaping relationships with other individuals. In this case, health is related to intra- and inter-personal relationships. When one develops relationships that are meaningful, goal-directed, and respectful of self and others, it can be said that the person is a balanced psychosocial human being; the individual is enjoying satisfactory mental and social conditions. For the non-Western, health is also a reference to a person’s spiritual state of being. It is believed that an individual should have a meaningful relationship with those powers (spiritual forces) that influence human beings on this earth. These powers can be the divine, ancestral spirits, animated objects, or even magical forces that always accompany the individual and the community. These forces determine how the whole community lives and, better still, how all members should live in order to guarantee individual and communal continuities. What can be said is that for many traditional AAI persons, health is an integrated condition that a human being as a whole enjoys. As a condition that is simultaneously physical, psychological, social, and spiritual, one can only be healthy when all these elements are in a balanced state and are all performing in a mutualistic manner. The individual for these cultural groups is much more than any of these elements. He/She is a composite with structures (forming a unified system) in an environment that is collective and determinant. Health in these cultures is unequivocally multi-dimensional, and in its treatment, this multi-dimensionality has to be taken into account all the time.
With this understanding, Kanwen (2001) in discussing medical exchanges between East and West, observes that in Chinese medicine,
"To be in good health means to be in a balanced state of being..."
The traditional system puts emphasis on analyzing all the symptoms and signs of the patient, taking the body, mind and external environment as a whole. The objective is the patient and the internal causes of disease. Holism is its chief characteristic. In Western medicine, the objective is usually the specific disease, and its external causes. The Chinese approach is more flexible, and does not treat a patient from beginning to end according to one principle or prescription, but according to the patient’s changing condition … Preventive medicine has always been emphasized (p. 195).
Like in most of Chinese culture, preventive medicine is prioritized because it is the most logical. The same holds in other non-Western cultures where reality is always holistically conceived of. This is even more so in the field of health that has all to do with body, mind, soul, and the physical environment. To be in good health means to be in a balanced state of being wherein all the human organs communicate appropriately with one another and the entire universe. The person is required to be in harmony with him/herself, other community members, the divine, ancestral spirits, and the environment.
The holistic nature of the human being and the universe he/she inhabits is another of those philosophical underpinnings of the notions of life-living, health, and sickness prevalent among the AAI sociocultural groups. At the same time, sickness and most certainly health, constitute social phenomena, and each presents a condition that involves the whole family. For the members of these groups, the family is reference to the whole community. Family as community is emphasized because it is this reality that gives meaning and purpose to the individual’s existence as agent of fair play, respect, dignity, and social participation. For instance, Kukeya (2006) observes that
There is a belief among Latinos that life events result from luck, fate, or other powers beyond an individual’s control. Illness may be rooted in physical imbalances or supernatural forces. In the absence of adequate access to healthcare, some people use the services of traditional folk healers including “Curanderos,” herbalists, etc. Great value is placed on the family and interdependence. The sick are cared for in the home. Hospitals are viewed as a place to die and are avoided as long as possible (p. 39).
"Family as community is emphasized because it is this reality that gives meaning and purpose to the individual’s existence..."
A prevalent characteristic of this non-Western epistemological framework is the belief in the power of the supernatural that is ubiquitous and can be manifested in various forms. The active and intervening presence of supernatural forces is also permanent. As it were, the human being is believed to be always under the protection and guidance of these spiritual beings. One advantage of this permanent presence is that they can assist an individual to stay healthy. For most Africans, this idea involves accepting that “a person cannot be healed unless God permits it, and that sometimes he assists the spirits to cure the sick. When a person is sick, the people pray and sacrifice to God, asking him to heal the sick” (Mbiti, 1970, p. 67). During such prayers, and even on other occasions, many Africans pour libation to the ancestral spirits not only to call upon them for help, but as a reminder that both the dead and living are one family. The work of the “Curanderos,” spiritualists (shamans and magicians), and the practices of other healers in non-Western cultures are fundamentally founded on this assumed guarantee of a divine being (supernatural force) that is always willing and ready to help people regain their health. Though this notion implies acceptance of some determinism in human life, it only goes to underline the importance of the holistic conceptualization of the human being and all that pertains to him/her.
Even though it can be said that “to accept fatalism would mean relinquishing control over events, denying the laws of cause and effect, and denying individual’s agency in action” (Morgan, 2003, p. 40), for the non-Western traditionalist, whether African, Asian, or Indigenous, the important point is that human life has a spiritual component. Though this element can be more powerful than the individual person, its presence emphasizes the communal nature of human life, both at the societal level and in the universal spirit-filled domain.
"Health is as social as it is individual..."
In a society like the US, best characterized by continuous growth in population figures and the diversified racial-ethnic composition of its inhabitants, these considerations about health are important for all to bear in mind. This is even more so when we remember that health is both social and biological (an individual body), and that in a diverse and complex society, a balance should be established between the universal and the particular in dealing with this all-too-important condition that relates to all members of any society. Health is as social as it is individual; as evidence-based as human skills-oriented (an art); as economic as political; as opportunity-guided as framed by social justice principles that define our humanity in community. Finally, health and all-related aspects are as cultural as they can be contextualized (spatially and temporally determined). Our next discussion that relates to culture underlines the importance of this last statement.
Culture provides the elements that facilitate discussing health in contemporary society with its various kinds and levels of diversities. In this paper, this discussion will be enriched by the incorporation of some basic considerations pertaining to social justice. There is a need to remind the reader that some understanding of the crucial aspects of human culture in society would be helpful for a discussion of the principles of social justice. These orientations that serve as guiding light for living well and relating appropriately to others in society can be said to be uniquely universal and a-historical. The principles in question lead to demands in all social relationships and interactions developed by anybody in society. These ideas will be more adequately clarified when social justice is explained and commented upon later in the paper.
What makes any human being what he or she is? While sociologists claim that it is basically socialization that transforms individuals into human beings, anthropologists believe it is the process of acculturation; a series of learning activities and relational experiences that help make a person an accepted member of a social group, a community. Through acculturation, the individual acquires a specific culture and becomes a participating member of a determined cultural group. Culture is developed and produced by people acting as social agents. Its components are validated through traditional beliefs and practices. It is transmitted from one generation to the next. At the same time, culture provides guiding principles for social cohesion. It also controls the behavior of all members of a community and helps determine the members of the in- and out-groups. The most classical of definitions of the concept of culture was offered by Kluckhohn (1951). According to Hofstede (2001, p.09), that definition was culture
"Culture is developed and produced by people acting as social agents."
consists in patterned ways of thinking, feeling and reacting, acquired and transmitted mainly by symbols, constituting the distinctive achievements of human groups, including their embodiments in artifacts; the essential core of culture consists of traditional (i.e. historically derived and selected) ideas and especially their attached values (Kluckhohn, 1951, p. 86, no. 05).
Culture is both material and symbolic. The material dimension refers to the valued objects produced by a contextually bounded group. Symbolic productions include language and all other forms of communicative instruments through which meanings are developed, reflected upon, shared, and accumulated to compose the collective memory of the group. This is also passed on to future generations. It is from the past; but is also of the present and constitutes preparation for the future. Culture and its composite elements become real for each person as these influence what he/she believes in and does. These factors strongly influence how a person behaves; when he/she does one thing or the other; what he/she values; and what meanings he/she gives to certain phenomena in the world. It is an all-encompassing element that permeates every aspect of an individual’s life as each person is a cultural being, limited and defined by his/her culture. Culture also sets the limits, bounds, and possibilities of each and every human community. constitutes preparation for the future. Culture and its composite elements become real for each person as these influence what he/she believes in and does. These factors strongly influence how a person behaves; when he/she does one thing or the other; what he/she values; and what meanings he/she gives to certain phenomena in the world. It is an all-encompassing element that permeates every aspect of an individual’s life as each person is a cultural being, limited and defined by his/her culture. Culture also sets the limits, bounds, and possibilities of each and every human community.
"… Aristotle argued that the individual is a social being."
While Aristotle argued that the individual is a social being, anthropologists posit that without a specific culture, nobody attains the condition of being a member of a community, a contextually defined group of persons with certain fundamental goals, interests, norms and expectations on both the collective and individual levels. In other words, culture makes the person a community member and also goes on to form and structure that same group. And as such, it is always contextual. A person’s world view has everything to do with his/her culture. All societies, their macro and micro groups, have their own cultures not as sub-cultures, but cultures with a limited scope of influence. Each individual also shares in this pluri-dimensioned cultural baggage of the larger human community. It is at the intersection of these complementary characteristics that a person finds him/herself as an individual who belongs to a particular community. All are determined and determinant. Just as it is culture that holds the community fabric together, it is the individual’s personality, assisted along by his/her culture(s), that keeps him/her grounded and meaning-filled. The group (collectivity) strives to sustain its culture; but it is each individual (subjectivity) that feeds into its values, beliefs, attitudes, symbolic world, heroes, and practices. These elements constitute every culture’s essence. All groups have their own cultures, but each is different, specific, binding (inclusive), and bounded (exclusive).
For instance, in comparing western and African cultures, Somé (1994) holds that the former is much more dynamic and mechanical. He believes the latter is more natural, slow, and humanly paced. He refers to African culture as the rhythm of life. Like the Asian and Indigenous, it is cyclical, conservative, and human-centered. Though the AAI cultures are present-time-focused, the members have their minds’ eyes on the past. In Western culture, fundamentally future-oriented, people are always running to catch up with something or somebody; they live very hectic and mobile lives. It seems that to be on the move constantly defines what it is to be a member-participant of western culture. Apparently, there are expectations that each and every individual needs to be engaged, or at least perceived to be involved in some activity, project, or program; doing something considered useful because time is money and should not be wasted on doing nothing. For most people in the West, to be effectively alive (a recognized member of a group), a person has to be engaged in some activity whose effects/results can be measured. In the West, it may not be sufficient to merely give one’s name; the individual is also expected to say what one does (professional activity as contribution to society) in the same breath. One is supposed to be primarily a contributor to society. It seems this is what justifies one’s individuality. In the non-Western cultural milieu, the individual is defined by the relationships he/she maintains, his/her family and circle of friends/acquaintances. They are relational cultures whose vital forces come from family and group living.
Accepting that culture is complex because it concerns humans and their contexts that are also intricate and dynamic, some of the ways in which the former can be looked at will be briefly discussed. It is expected that these perspectives will help elucidate the basic thesis of this discussion, positing that health as a human condition is social but also very individual and contextual. So as to appreciate the complexity of culture, it would be interesting to examine it along some dimensions that have been established by different analysts. For instance, Kluckhohn and Strodtbeck (1961) looked at culture in terms of six frames of reference that included the basic nature of people, how they relate to nature and one another as well as, attitudes about reality (accept as it is or attempt to bring about change); vision regarding space (treat it as private or public); and finally, time orientation in terms of their emphases on either the present, past, or future (Gannon, 2004). Along this same dimensional perspective is the contribution of Hall & Hall (1990). They suggest understanding and dealing with culture along the lines of the amount of explicit information needed to carry on social activities in different contexts, interpersonal space in social interactions, conception of time and its use (one task at a time [“monochronic”] or several at the same time [“polychronic”])4 and the speed at which information goes from one individual to the group.
"Culture has been compared to an “onion” in which each ring that is peeled reveals another …"
This same conception of cultural dimensions was utilized by Hofstede (2001) in his conclusions about “Culture’s consequences: comparing values, behaviors, institutions, and organizations across nations” based upon his study of IBM employees in several countries. Using this study, Hofstede went on to state that people all acquire “mental programs” developed in society with the assistance of our family, school, church, and other such institutions. For him, “mental programs” are manifested through certain attitudes, values, and belief systems that influence behavior in one context or the other as can be seen with regard to – “power distance,” “uncertainty avoidance,” “individualism versus collectivism,” “masculinity versus femininity,” and “long-term versus short-term orientation” (Hofstede, 2001, p. 29). These conceptions of culture and its ramifications only further emphasize the complex nature of this phenomenon as it can be seen that within each of these possible dimensions, other categorizations are still feasible. Culture has been compared to an “onion” in which each ring that is peeled reveals another, different but very much like the other. The separate but interrelatedness of these layers serves as a good metaphor for human culture that is the basis for all that is human.
"In our diverse world today, this needed care may be the responsibility of someone whose background and social conditions happen to be different from the individual in need."
Gannon (2004) argues that there are situations where culture may not matter. Using the example of a couple of medical practitioners working on a case, he believes that “their medical backgrounds can help them to work together smoothly regardless of cultural backgrounds” (p. 14). He also contends that this is the same case
4 The “monochronic” and “polychronic” aspects of cultures may not be so valid today because there is almost no society where people either completely concentrate on one task at a time, or ordinarily execute several tasks simultaneously. It seems multi-tasking is more prevalent today. However, what could still be a relevant differentiator is the degree to which most people in all culture are either more or less “polychronic,” but most unlikely that they are” monochronic.” It is worth noting that social justice can only reinforced when it is a permanent focus of attention when one person related to another or to several others.
with regards to middle class families all over the world who predominantly use positive reinforcements in their child rearing endeavors. This position presented by Gannon may be accepted, but with several caveats. It could be most common that culture always matters because it is what determines how people define, understand, and act/react in all relational contexts. It may be less debatable that culture is always present in all that pertains to human beings. Whether it affects an individual or his/her group in this or that way, is dependent upon several factors. Since all cultural elements cannot be controlled for in all situations, it is more logical to employ the reasoning that culture is crucial in all that pertains to human beings. Of all areas of human concern, health is one that relates to everybody, in one degree or the other, at all times. Everybody either has to engage in measures to preserve or regain their health. Under normal circumstances, humans try to prevent falling sick. Because of the pervading nature of health and how all its aspects affect the individual and his/her macro and micro groups, there is an inevitable need for people from different backgrounds with varied experiences to have to deal with it together. This is especially the case for medical professionals, but also for laypersons who might need attention because of health problems. In our diverse world today, this needed care may be the responsibility of someone whose background and social conditions happen to be different from the individual in need. What considerations then, should one make when health becomes the intermediating factor for inter-cultural interactions? In the case of someone from a different cultural background, what could be of greater concern – health or culture? Which of these two could be key to understanding the other? What other factors should be given serious attention in this dynamic process?
Communication Across Cultures and Between Cultural Groups
"… people must learn to utilize the characteristics and factors that unite them and those others that easily wedge chasms between them..."
In an attempt to offer some answers to the questions above, it will be necessary to be aware that “Knowing as much as possible about culture is critical, especially in a globalized world where people from different ethnic and cultural groups must work together effectively” (Gannon, 2004, p. xiii). In order for human beings to survive and flourish as one large and diverse group, not only those numerous similarities that easily bound us together, but also many dissimilarities that separate us in many situations, must be recognized and respected. At the same time, people must learn to utilize the characteristics and factors that unite them and those others that easily wedge chasms between them, as opportunities that should be transformed into tools for participatory5 involvements in discussions and engagements that relate to the definition and solution of perceived problems. A very important task in this proposed common vocation is that of an easy readiness to learn all that is available about oneself and the members of other human groups.
The knowledge actively acquired about culture is two-fold. The person should shamelessly strive to know as much as possible about his/her own culture (historical, political and social characteristics; its good and not-so-good elements). As a complementary task, this individual should also make every effort to learn all he/she can about other cultures, especially those cultures with whose members the person interacts, and with whom relationships could be established. In such endeavors, it is always beneficial to strive to formulate reasonable answers to the cardinal questions critical theorists openly pose in relation to – what, who, when, why, how, where, and for/by whom. Answers to questions along these lines have the power to reveal “truths” that can become evident in situations that are inter- or cross-cultural. In both cases, when it comes to questions of health, the need for communication that is rational and tends towards purposeful collaboration is ultimately the most evident. This idea receives support from Mullavey-O’Byrne (1997) when she states,
"…cross-cultural interaction refers to social engagements between people from more distant contexts…"
The ability to appreciate the relativity of values, including one’s own, an interest in learning about cultural differences, and the ability to accept the cultural identity of others, provide the basic building blocks on which to develop communication skills to use empathic understanding effectively in intercultural interactions. (Mullavey-O’Byrne, p. 217)
5 The idea of participation here is crucial. Participation can only truly come to be when those engaged do so as equals with interconnected interests and explicitly accepted means and goals. For this kind of group to develop, there has to be dialogue; open exchanges between all those involved in the activity that is purposeful and directed towards changes that are expected to be lasting and human-centered. For Freire (1970), this is the process of conscientização. It is the awareness that moves a person from mere reflection to discussion, then to some action, which is followed by constant evaluation. The results of this final sep form the preliminary basis for re-initiating and continuing the whole process. The conscientious development of these activities is crucial because together, they provide an important element for making communities more human.
According to Aldridge (2004), “Intercultural communication is the mechanism (the mixing of cultures and languages via speech communication) by which human beings have compared ways of living, economic order, social order, and values from other cultures” (p. 88). In this sense, this kind of interactive engagement is reference to those relationships between members of the same group who come from different backgrounds. An intercultural relationship, only possible when there is communication (exchange of meaningful symbols between parties who consider each other as equals with comparable interests and goals), would develop between someone whose background experiences are very different from another person, though both could live in the same locality or neighborhood. The important criteria are that the participants are of different backgrounds, although they may live in geographical proximity to one another. On the other hand, cross-cultural interaction refers to social engagements between people from more distant contexts (national, regional, and international) and generally, with sociocultural experiences that are also very different. A good example of cross-cultural interaction, also founded upon communication, could be one between an immigrant from Brazil and a Texan. These individuals could be perceived as being very different in terms of both spatial and experiential factors. However, it is possible that under normal circumstances, the kinds of interactions that they are able to develop based upon communicative activities could lead to a shared knowledge [that] makes it easier to see the world from the other’s perspective. However, even when people share similar cultural values, individual differences in personal values still pose a challenge to the communication of empathic understanding. A clue to dealing with this issue appears to be linked to the ability to appreciate that values are relative, not absolute. (Mullavey-O’Byrne, p. 215)
"In the area of health, ideas of sickness and health must be evaluated from a perspective that recognizes other visions of the world."
Knowing about different cultures is important, but what may even be more needed is critical knowledge and appreciation of one’s own culture and the belief systems of the group one belongs to. This situation points to the urgent need “to adopt the culture of interculturality, in order to create the conditions for a possible philosophical conversation conducted in mutual respect and tolerance” between persons belonging to different cultural groups (Mall, 2004, p. 327). In the absence of such progress to communicate and understand others, it would become more difficult to recognize that respect for the rights of those other persons with whom one interacts is the fundamental building block for peaceful co-existence in today’s society. If this co-existence is to be beneficial for everybody, issues related to health have to be taken care of because it is one of those factors that should concern every member of any group. “Cultural pluralism” becomes the philosophical basis of every social interaction (Hernandez-Truyol, 2004, p. 339). In the area of health, ideas of sickness and health must be evaluated from a perspective that recognizes other visions of the world. Notions about these last categories that merely reflect the Western or the non-Western perspectives would not be sufficiently equipped to satisfy the diverse needs of society’s diversified population groups.
If cultural pluralism becomes the order of the day, accepting that cultural meanings are relative would be an easier attitude to adopt. As Hofstede (2001) has reminded us, cultural relativism does not imply normlessness for oneself or for one’s own society. It does call for one to suspend judgment when dealing with groups or societies different from one’s own. One should think twice before applying the norms of a given person, group, or society to another. Information about the nature of the cultural differences between societies, their roots and their consequences, should precede judgment and action (p. 15).
"… cultural values, attitudes, and practices do define the basic ways in which people relate to others."
An awareness of the relevance of treating cultural questions in ways that are relative and never dependent upon strategies that over-generalize, becomes a permanent requirement today. This attitude and practice imply that in dealing with other people, each individual must remain conscious of those differences that everybody carries around with him/herself in different contexts and relationships. Principles of social justice are expected to serve as the larger umbrella that protects and determines the human dimension needed for all social interactions and relationships.
I believe that it is social justice that helps hold together the meaning and significance of this discussion about health and culture. As an over-arching set of guiding principles, social justice assists people who try to humanize social relationships in community. It can be appropriately observed that these principles that guide the construction of a humanly just society, under normal conditions, apply to all human beings, at all times, and in all places. It is crucial to remember that cultural values, attitudes, and practices do define the basic ways in which people relate to others. So the guidelines that serve as criteria for understanding those behaviors that should be considered human, may be culturally and contextually dependent too. In a way, while the principles of social justice provide the general background for recommended human behavior in relationships, contextual factors may actually influence how men and women specifically behave in different situations. In no way does this mean that the individual is not responsible for the choices he/she makes. Many would recommend that how the individual behaves in social relationships should be dependent upon cultural factors, principles of fair-play and fairness, as well as rational decisions and conscious choices. These observations are merely an attempt to emphasize the importance of remembering the complex interrelatedness between cultural issues and questions related to social equity, human dignity, and respect for others. With these observations as a general background for further understanding the important relationships between health, culture, and social justice, I remind the reader that
Social justice refers to those elements in any relational situation wherein all the individuals involved have their humanity respected. There should also be explicit and open opportunities for everybody to achieve their own goals while respecting others. Social justice is human, interactive, existential, and real. It entails the use of wisdom (non-subjective discernment), courage (mediation), moderation (balance) and justice (fairness) in the human relations that are part of daily existence. (Boakari, 2006, p. 4)
"…Catholic Social Teaching has provided certain basic principles that should guide social agents in developing societies that are more human."
Building upon such fundamental assumptions, Catholic Social Teaching has provided certain basic principles that should guide social agents in developing societies that are more human. Communities are considered to be more human because, as much as it is feasible, each member’s individuality is respected while the collective responsibilities of the group are not subverted to respond to sectarian interests. These guidelines refer to the dignity of the individual, the individual’s rights and responsibilities, priority for the common good, community spirit and solidarity in family, explicit support of the poor, active social participation, dignity of work and workers, environmental protection, presence of a government, and peaceful co-existence.6
6 See various documents posted on the web site of the Office of Social Justice, a Division of Catholic Charities, at www.osjspm.org These principles are intertwined, and obtain their essence and final meaning from the main goal of assisting ordinary people to humanize their communities as much as possible.
Basically, one can maintain that social justice entails safeguarding the dignity and respect of every individual as a human being simply because he/she is. Respect for human life and all those conditions that make this a viable option should be advocated in order to guarantee the common good of the whole group in terms of both the collectivity and the individuals. As members of human groups, there are certain rights that should be maintained, and responsibilities that have to be taken care of all the time. Both social responsibilities and rights go hand-in-hand because the former validates the latter, and vice versa. Since there are both natural and socially created differences in any society, the group must never forget to take care of the less fortunate. It is in this regard that the spirit of community becomes reality while the value of family in the broader sense is given the attention it deserves, not only to guarantee the present, but above all, to lay very strong foundations for a more human society in the future. All these should ideally involve a continuous process of planning, construction, and evaluation of procedures and their results by everybody in a particular society. To further strengthen the commitment to the individual, the value of workers’ labor should be fully recognized and duly compensated for, making sure that such workers fulfill their obligations under explicitly humane conditions.
"…social justice entails safeguarding the dignity and respect of every individual as a human being simply because he/she is."
The protection of the environment as the whole planet, is another of these principles because this requirement under-girds all the other elements that have been mentioned. A safe physical environment that supports appropriate human growth and dignified social development is also of vital importance as it makes it not only possible to follow the other principles, but determines the conditions under which they would be allowed to grow. Finally, it is important to recognize the central nature of the responsibility that a central government should play in all of this. As the embodiment of power and authority, the members of all governing agencies must make sure that both the individual and collective rights-responsibilities of all those for whom they are administratively responsible, are always understood, prioritized, and guaranteed. As public officials, their first responsibility is to remain servants of the people! These may be considered high standards, but they have to be attainable to a high degree because they constitute the minimum requirements that societies need to have in place in order to establish healthy intersections between health as an integrated human condition, culture as a defining factor in society, and social justice as the true measure of humanity in community.
In today’s world of extensive cultural diversity, ever-increasing economic inequalities, solidification of political marginalization, extreme subjugation of the under-represented, and excessive social exclusions, a critical understanding of and responsibility for making real these universal recommendations cannot be emphasized enough. Article 25 of the Universal Declaration of Human Rights approved by the General Assembly of the United Nations (December 10, 1948), states the following:
Everyone has the right to a standard of living adequate for the health and well-being of himself (herself) and of his (her) family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his (her) control (United Nations, Universal Declaration of Human Rights.
"The notion that the best way to humanize society is to guarantee social justice without question, remains universally valid."
As we can see from these words, the provision of basic services in the areas of health, education, housing, sanitation, protection of the weak and sick, as well as upholding law and order, go directly to the heart of social justice. Each of these areas or spheres of life in society is not only of vital importance, but is interconnected with all the others. The notion that the best way to humanize society is to guarantee social justice without question, remains universally valid. It is in this regard that the protection of the health of members of society through the provision of medical goods and services that are accessible and of the highest quality possible, becomes basic for humanizing any society. So as to guarantee that serious efforts are made in these regards, since 1979, the Office of the United Nationals High Commissioner for Human Rights (OHCHR), instituted the office of “Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”7 As independent specialists, each works in a country, examining and assessing the performance of different health agencies exactly as their full title implies. Their reports serve as the bases for follow-up actions and subsequent programs, especially those developed by the United Nations, through the World Health Organization (WHO) and other agencies. It is very instructive to note that what is expected is the best in terms of health matters in every society. The involvement of such local experts in these vital questions of health only goes further to indicate how important culture is in matters of health, and consequently, in any efforts to make human societies more dignified.
"… the provision of medical goods and services that are accessible and of the highest quality possible, becomes basic for humanizing any society"
The role of the Special Rapporteurs indicates that there is still room for several questions. Some of these could include the following: How much access do the people in a community have to the medical goods and services available in that community? Who supervises the provision of health care that the majority receive in any community? To what degree do they enjoy the benefits of scientific progress? Are the meanings different individuals have for health understood by health professionals and other public policy officials? Are people’s cultural values, assumptions, and preferences given the consideration that they deserve in societies that are culturally diverse?
The main goal of this discussion is to emphasize that there is an urgent need for what has been called “cultural competency” (Diller & Moule, 2005) in most societies today. This is a set of attitudes and behaviors that an individual or agency utilizes in dealing with other individuals and groups from different cultural backgrounds in order to communicate effectively and move on to engage in collaborative activities. Cultural competency is built upon values that accept that cultural differences are a positive, and in today’s world, they should be used to strengthen interactions between different peoples. As pointed out, this capability is a broadening of perspective that acknowledges the simultaneous existence of differing realities and requires neither comparison nor judgment. All exist in their own right and are different. Farther along the continuum, differences are not merely accepted or tolerated, but are truly valued for the richness, perspective, and complexity they offer. A culturally competent educator actively and creatively uses these differences in the service of teaching and learning (Diller & Moule, 2005, p. 15).
As a social process, cultural competency is important not only for professional educators but for all social agents; all individuals who want to determine what happens in their environments. The fundamental purpose of cultural competency is to empower underrepresented group members so that they can benefit the most from participating in diversified societies, and in doing so, enrich the life of the whole community. This enrichment has much to do with health since it is an area that is related to all the other aspects of community life.
"Cultural competency is built upon values that accept that cultural differences are a positive…"
Cultural competency is also an important factor in this process of general awareness of diversity and the ensuing human engagement with people from different backgrounds, because it facilitates what I have called a Pedagogy of the different:
Questions related to differences in their myriad manifestations (meanings), especially their everyday questions, are an integral part of people’s lives. These days, there are numerous incidents indicating that anyone who refuses to pay attention to discussions, activities, actions, and decisions about those who are “different from us,” is basically refusing to look at him/herself because “those others” are really we ourselves. It is within this framework that I call attention to Pedagogy of the different ... for today’s socially conscious. All are human beings. However, there are natural characteristics and other, constructed qualities we employ in order to either affirm differences or build barriers when we so choose. Through this process, people develop their identities that serve as necessary points of reference for a self-knowing that needs confirmation from others who are expected to affirm that the person’s primary identity positively compares to what they know of the individual; that is, to support the fact that the person is who he/she considers him/herself to be. Other persons help the individual know him/herself better because they provide the necessary comparative element. This way, elements of difference play the fundamental role in the construction of diverse individualities that are supported by the multiple identities that pertain to each individual. There is a need to incorporate differences and multiple identities (diversity) in all their varied dimensions in order to initiate Pedagogy of the different (Boakari, 2007).
"Health and culture are complex and... need to be treated from a complex perspective."
I am referring here to a process of social education. This is the passing on of information to citizens in different social contexts to stimulate reflections and discussions about social issues that are of general concern and need engagement at all levels to solve. Questions related to health squarely fall within such a purview because it is a factor that is both individual and social, individually collective at the same time, in all situations, and at all times.
Health cultures are complex and so they need to be treated from a complex perspective. This is even more so when they are examined within the context of social justice. It is only from such an integrated vision of today’s complex realities that one can begin to appreciate the challenges we face in trying to understand, explain and work to make health a social right while respecting cultural values and practices. This kind of thinking is in line with the suggestions of such contemporary social observers like Edgar Morrin and Fritjoff Capra who posit that since our world is becoming more complex each day, the best strategy to begin to understand it has to be complex too. A world that is diverse and globalized with a market economy dependent upon knowledge as its raw material can only be a complex reality that demands analytical instruments and skills that are also complex in all their dimensions. When objective efforts are made in these areas, then the likelihood of bringing about more social justice also increases.
Health–culture–contemporary human (humanizing) society constitute a tripartite system of complexities in a complex world that can only be explained, reflected upon, understood, and discussed from perspectives that are also complex. This perspective of complexities that need multi-dimensioned instruments in order to attain a reasonable level of comprehension about them demand that we remain always aware of the cultural contexts and subjectivities that color these contexts. At the same time, it is an irrefutable necessity to be conscious about issues related to social inequities and human dignity (ethical concerns).
"… the notions of health and sickness do not necessarily mean the same in different cultures"
What is the issue at stake in this discussion? Fundamentally, I argue that the notions of health and sickness do not necessarily mean the same in different cultures. Whilst in some societies these concepts can be explained and understood mostly in uni-dimensional terms believed to be irrevocably valid because empirically dependent, in most others, especially non-Western cultures, health and sickness are integrated human conditions. Each refers to a whole set of factors that are not only physiological, but even spiritual, social and psychological. Whereas in the West one might suffer from a specific illness or a set of illnesses with defined symptoms and pre-defined medical interventions (one solution fits all), in other contexts, these conditions are understood in a much looser sense. Health and sickness are believed to be dynamic, interrelated, contextual, social, and also extremely individual. In my Sierra Leonean community, to claim to be sick is an open invitation for help from the whole group. Since the group is affected because the sick person cannot effectively contribute to group life, remedies and cures are readily offered and even facilitated. When and if these simple (laypeople’s) solutions fail, mutually inclusive specialized interventions (physical, mental, spiritual, and social) are sought after. This is a collectivist group, and the individual’s wholeness that returns him/her to the group is the responsibility of all. In order to continue to belong, the individual may be obliged to define him/herself and his/her conditions according to the terms set forth by the group. Just as the body is an organic whole, so too is the community which functions in an organic fashion. Consequently, a sick person is indeed a sick community. Sickness and health are individual conditions whose significance is real in/for the whole local group among traditional African, Asian and Indigenous peoples. For most people in Western culture, this is not the case. As a general expectation, all individuals merit the same treatment and should receive the same attention in all similar situations. The individual may belong to a group, but it is believed that his/her personality and performance are evaluated and rewarded in all situations, at all times.
"As a general expectation, all individuals merit the same treatment and should receive the same attention in all similar situations."
Western culture emphasizes the individual’s understanding and attitude toward health. For most traditional people from AAI backgrounds, the group’s role in this whole process is given priority. Apparently, these two cultural perspectives, the Western and non-Western, are not easy to reconcile. However, social scientists have been able to glean from the experiences of human progress and social change that there are strategies that can facilitate beneficial exchanges between people from these two general cultural backgrounds. These strategies include inter-cultural interactions and communication, as well as cross cultural interactions and communication. For these to take place in a meaningful manner, people have to be educated to be open and empathic to other peoples, especially those who seem most different from them. Medical professionals, policy makers, educators, and other human service professionals need to become aware of these needs and the necessary training made available to them. For all practical purposes, common citizens also need to be aware of these dynamic social needs in order to be participatory citizens. Some crucial factors for social success during this century include cultural interaction capabilities, inter- and cross-cultural communication skills. When there are more people with these capabilities, questions related to basic services like health, will be more easily resolved as social agents would be more open to listen effectively and interact positively with others in their diversified societies. With effective cultural competency, the willingness and strategies to develop more social justice could also increase. Under such favorable conditions, not only health but satisfying other needs that help humanize society could become a major focus for everybody, especially those who are decision takers, policy makers, and those who finally make things happen in the everyday life of ordinary people. The main goal should be that cultural competency leads to more humanizing competencies because this is what human life and social richness should be all about.
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