Cultural perspectives on public health challenges University of Liverpool Online Public Health Thought Leadership Webinar Series

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Dr Barbara KrelingUniversity of Liverpool Online

Faculty Member

Erin Gilgan MPHUniversity of Liverpool Online

Alumni

Joseph O’BrianUniversity of Liverpool Online

MBA Student

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Congratulations Erin

2016 MPH Student of The Year

What do you believe is the impact of culture on public health?

“Culture is important to health in many ways. It defines the environment into which we are born

and the health behaviors we adopt. It shapes our definition of both health

and disease and our relationship with health

care providers. For instance, is pregnancy

and childbirth a medical condition requiring a

doctor? - in some cultures, no. Is sadness

a medical condition requiring a doctor?”

Barbara Kreling

Culture affects our understanding of the

causes and treatments of

diseases. Did your mother tell you to

put on a sweater or you would catch a cold? Although

most of us know that colds are caused by

viruses, folk medicine is a part of most cultures and

co-exists with modern medicine

Barbara Kreling

What are the key cultural challenges that you face and how are they best approached?

Final Research ProjectErin Gilgin

“the way consumers use restaurants, especially in a convenience culture, may not have caught up to the functional role they

provide in home meal replacement”

Erin Gilgin

For understanding another culture and how it might impact public health programs, qualitative research is the best method. Through rigorous

qualitative study, cultural themes emerge which can inform public health efforts.

Barbara Kreling

Do attitudes to food vary based on culture?

“the American food environment promotes abundance & consumption. Food is available everywhere at any time, in great variety. Supermarkets have infinite food choices and restaurant portions are huge. In this context, the culture promotes convenience, which allows easy access to energy, with little energy expenditure. “

Erin Gilgin

“In France meals are a social event that promotes moderation in consumption and has a pleasure aspect. Meals are eaten more slowly, portions are smaller, snacking has a negative connotation and restaurant menus are less varied”

Erin Gilgin

Collectivist cultures, like Latin American countries uses food in a social and inclusive way. They take care of each other and the food needs to meet the needs of the group as a way of bonding and belonging. These cultures may also have less concern with body image than either American or European cultures

“Collectivist cultures, like Latin American countries uses food in a social and inclusive way. They take care of each other and the food needs to meet the needs of the group as a way of bonding and belonging. These cultures may also have less concern with body image than either American or European cultures”Erin Gilgin

Collectivist cultures, like Latin American countries uses food in a social and inclusive way. They take care of each other and the food needs to meet the needs of the group as a way of bonding and belonging. These cultures may also have less concern with body image than either American or European cultures

In some African and Asian cultures, women often have lower access to food (and education and empowerment) than their male partners. Women are at higher risk for being malnourished, can be married at a young age and are undereducated on sexual health and reproduction.Erin Gilgin

How important is the role of the table in terms of habit setting for families ?

“Family mealtime can be a time for the family to communicate, for the parents to monitor childrens’ activities, bond and support social development.”

Erin Gilgin

Is there a correlation between how healthy your diet is and your socio economic status?

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“The paradox arrives with new immigrants with low

socioeconomic status having better health than their native born counterparts in developed

countries. The longer the immigrant stays and becomes

more acculturated, health status decreases and becomes more

similar to those that were native born.”

The Healthy

Immigrant Paradox

Erin Gilgin

How important is it for public health professionals to be aware of cultural nuances?

“It is important to understand that culture affects the persons we study or work with. It

affects their perceptions,

assumptions, preferences. It also

affects their heath behavior and their

understanding of health and illness. The culture of the population must always be considered

when planning or evaluating a public

health program.”

Barbara Kreling

Can you give me an example of a theory you took from the MPH programme that makes you a more effective Public Health professional?

“general the concept of social determinants of health and looking at

them using ecological models was particularly interesting and relevant for me. While perhaps

past efforts (such as nutrition facts panels on

food products) have been placed on providing

people with information to make their own

decisions, this is only a small part of the puzzle.

What if a person has all of the information, but their

environment is surrounded with poor

choices? .”

The concept of social determinants of health and looking at them using ecological models was particularly interesting and relevant for me. While perhaps past efforts (such as nutrition facts panels on food products) have been placed on providing people with information to make their own decisions, this is only a small part of the puzzle. What if a person has all of the information, but their environment is surrounded with poor choices?

Erin Gilgin

Elective ModulesPreventing & Managing Communicable Diseases

Managing Crisis and Disasters

Health, Economics & Governance

Programme & Policy Challenges in Low Income Countries

Research ModulesApplied Epidemiological Research for

Public Health

Applied Qualitative Research for Public Health

DissertationTopic or work programme research

Health Inequalities: Integrating Public Health Practice

Dissertation pathway Professional Learning Log

Masters in Public Health

Module OutlineCore ModulesPracticing and Promoting Public

Health in a Global Context

Generating and Evaluating Public Health Evidence

Integrated Research in Public Health: Epidemiology and Qualitative

Methods

Leading and Managing Health Systems

Monitoring and Evaluation of Systems and Programmes

The Case StudyBreast Cancer in the American Latino community

Breast Cancer in the American Latina community

The problem: “ Breast cancer is the leading cause of death in Latina females in the US. Latinas with breast cancer underuse recommended follow-up chemotherapy, decreasing their rates of survival. Although several factors may have been responsible, cultural influences were a possible barrier. Although there was a disparity in mortality between groups, there was a gap in the literature about how culture affects decisions about breast cancer treatment. “

Barbara Kreling

Breast Cancer in the American Latina community

The Research: As part of the Latin American Cancer Coalition, I conducted a focused ethnographic study examining the role of cultural beliefs and perceptions in the decision-making process for Latina women about whether or not to receive chemotherapy following a breast cancer diagnosis. “Barbara

Kreling

Breast Cancer in the American Latina community

Use of Theory: Douglas’s cultural theory of risk arises from cultural anthropology. It posits that the perception of risks arises from each society’s attempts to explain disease and misfortune. It was important to obtain an in-depth understanding of how women understood disease and treatment to form a perception of risk.“ Barbara

Kreling

Breast Cancer in the American Latina community

Results: Results of this qualitative analysis revealed that various cultural factors including underlying cultural views of health and disease, social role-related themes, avoidance of information and communication, as well as employment and immigration status influenced the treatment decisions of Latina women.  Latino reliance only on family -“having no one” if family is not around. Traditional gender roles - mothers alone are responsible for child care - self-care is a low priority-

family needs are more important than the individual. Sexuality and body image - losing hair - not attractive to the male Employment immigration status - no sick leave or job security Respeto - power distance -women reluctant to discuss their health with employers and to ask for time

off Secrecy because of social death Fear of information - cultural norm of secrecy about cancer Many misperceptions - chemo not effective- chemo means death - chemo very painful- can’t have

children after. Fatalism -avoidance of knowledge or bad news - “leave it in the hands of god.” Present-oriented culture - problem with treatments that make you sicker in the present for long term

recovery.

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