Photo by Melissa Gould An Introduction to the Geography of
Health Chapter 6: Culture and Identity
Slide 2
2 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Culture refers to the beliefs and practices acquired
from society that are lived by a particular group of people. Gesler
and Kearns (2002: 13) warn, culture should not be used as a source
of explanation; rather it is something to be explained as it is
continually being socially produced by people as they struggle to
achieve power and meaning. Can you think of an example of how
health and culture are related in your life? Health and Culture
What do Gesler and Kearns mean when they write that culture is
continually being socially produced? Can you provide an
example?
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3 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 What guidelines are you aware of regarding diet
during pregnancy? Where do you think you learned this information?
Health geographers focus on both how culture influences health and
how health influences culture. Culture may influence health via
health policies, social norms, or even cultural understandings of
what constitutes health or disease. For example, different
governments have issued different guidelines about diet for women
during pregnancy.
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4 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 France Avoid: soft cheeses with white rind (e.g.,
Brie), especially if made with raw milk; industrially- grated
cheese; cheese rinds; cooked pork; potted meat, pt, foie gras, and
gelatinous products; raw or rare meat; raw fish and shellfish;
smoked fish; alcohol; liver Consume in moderation: caffeine,
carbonated drinks and energy drinks; soy-based foods Source:
Program National Nutrition Sant (2007) Hong Kong Avoid: foods high
in calories but low in nutritional value such as soft drinks
Consume in moderation: salty and preserved foods; strong spices
such as chili Source: Government of Hong Kong Department of Health
(2004) Government-issued Pregnancy Recommendations United States:
Avoid: alcohol; certain types of fish Consume in moderation:
certain types of fish US Department of Health and Human Services
(2006)
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5 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Perceptions of what is considered to be disease can
be rooted in culture. For example, many behavioral disorders are
dependent on an understanding of normal behavior, which may have a
different meaning in different societies. How would you define
disease? How does your definition compare to others in the
room?
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6 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Data Source: CDC 2007 In the case of ADHD, a rapid
increase in diagnoses in the 1990s and regional differences in
incidence rates have led some to suggest that the diagnosis of ADHD
may be influenced by culture. ADHD Diagnoses by State, 2007
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7 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Sometimes cultural conceptualization of health are
highly contentious. The surgical removal of female genital parts is
considered inhumane in many parts of the world, yet is common
practice in some communities in Africa. This map shows the
percentage of girls who receive a clitoridectomyone form of genital
cutting. Data from Yoder et al. (2004)
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8 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Should practices such as clitoridectomy be banned or
vaccination programs be required? Who should make decisions like
this? Cultural beliefs can also contradict biomedical practice. In
the West, for example, there has recently been a backlash against
vaccination programs, related to concerns over the safety of
vaccines.
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9 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Health and Identity Important aspects of identity
include gender, class, race, ethnicity, and sexuality, with peoples
identities evolving out of a complex layering of these factors.
Facets of identity intersect with culture to produce expectations
and behaviors that affect health. How do you think your identity
might have affected your health? Incan symbols and clothing remain
important for this community in Andean Peru. Photo by Helen
Hazen
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10 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Sometimes the health impacts of social identities
can be measured. For instance, African American women are more
likely to have low birth weight babies than are mothers from white
or African-born populations in the US. This graph shows the birth
weight distributions of three populations in Illinois. Source:
David and Collins (1997) Copyright [1997] Massachusetts Medical
Society. All rights reserved. How could racial and ethnic identity
play a role in birth weight?
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11 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Gender Although biological distinctions may appear
to be the main difference between men and women, social theorists
have argued that much of what gives women and men different
experiences is how masculinity and femininity are socially
constructed. In this context, there is an important distinction
between sex (the biological reality of being male or female) and
gender (the socially- constructed aspects of being male or female).
How could social constructions of gender influence health?
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12 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 The notion of structural violence is used to refer
to the ways in which social structures and institutions prevent
people from meeting their basic health needs, and is often
considered to be gendered. For example, women are more likely than
men to be the victims of sexual violence. In some places, women and
girls may be less likely to receive healthcare when they are
sick.
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13 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Race Traditionally, studies of the influence of race
on health have focused on seeking genetic differences among racial
groups. These studies have typically identified few genetic
distinctions among races. More recently, studies have focused on
how the impact of race on health is frequently confounded by
socioeconomic status. Researchers have also begun to investigate
the ways in which race-based identities may have health
implications. How might a persons ethnic or racial identity have an
impact on their health?
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14 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Life-worlds Some scholars have argued that the key
to understanding these geographies of difference is to appreciate
the lived experiences of individuals, rather than groups of people.
This perspective suggests that individual life-worldsthe sum of
ones lived experiencesare important in understanding the uniqueness
of health outcomes and responses to them.
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15 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 How do you think the life-worlds of these people
differ? How could these differences influence their health? Photos
by Helen Hazen
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16 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Identity and Disability As identity can influence
health, so too can health influence identity. In particular,
ill-health can act as a significant facet of an individuals
identity. What diseases or conditions can you think of where
individuals may actively seek, or avoid, being labeled as having
the disease?
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17 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Geographies of Disability Geographies of disability
consider how the bodily and social experiences of people with
disabilities are unique. Social and spatial exclusions are a
particular focus. Source: NPS 2006
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18 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Conclusion Culture and identity are powerful
influences on our everyday livesthis influence extends to the realm
of health. Our beliefs about ourselves and others and about our
relative positions in society are integral to our health, how we
think about improving it, and how we perceive people who are not in
good health.
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19 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 1. How is health defined differently by different
cultural or social groups? How would you define health? 2.
Treichler (1999: 11) argues that the AIDS epidemicis simultaneously
an epidemic of a transmissible lethal disease and an epidemic of
meanings or signification. In what ways have these signifiers led
to discrimination and stigma? What other diseases show strong
evidence of the influence of socially-constructed meaning? 3.
Cultural practices are often viewed as distinct from other human
actions as somehow inalienable. How can we define a cultural
practice? Should groups be allowed to continue cultural practices
even if they are detrimental to health? Discussion Questions
Slide 20
20 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 Discussion Questions 4. Are there specific ways that
healthcare services or public health initiatives could be more
sensitive to the identities and cultural contexts of minority
groups? Can you think of examples of policies or programs that are
insensitive to issues of culture or identity? 5. Is the distinction
between disability and impairment a significant one? Why or why
not? How might characteristics of an individuals environment be
significant in turning an impairment into a disability?
Slide 21
21 An Introduction to the Geography of HealthAnthamatten and
HazenChapter 6 References [CDC] Centers for Disease Control. (2007)
State-based Prevalence Data of ADHD Diagnosis [Online]. Available:
(Accessed 01 January 2011). Gesler, W. M. and Kearns, R. A. (2002)
Culture, Place, and Health, London; New York: Routledge. Government
of Hong Kong, Department of Health. (2004) Nutrition for Pregnant
Women and Breastfeeding Mothers [Online]. Available: (Accessed 27
April 2010). [NPS]. National Park Service. (206). Map Symbols &
Patterns for NPS Maps [Online]. Available: (Accessed 13 January
2011). New Zealand Ministry of Health. (2008) Eating for Healthy
Pregnant Women [Online]. Available: (Accessed 27 April 2010).
Program National Nutrition Sant. (2007) Le guide nutrition pendant
et aprs la grossesse [Online]. Available: (Accessed 12 May 2010).
Treichler, P. A. (1999) How to Have Theory in an Epidemic: Cultural
Chronicles of AIDS, Durham: Duke University Press. US Department of
Health and Human Services. (206) What to Eat While Pregnant
[Online]. Available: (Accessed 27 April 2010).
