Culture & Medicine Module 1 PDF

Culture & Medicine Module 1: Principles & Perspectives II Suzzana R. Roldan, MD | Asynchronous TABLE OF CONTENTS I. ANTHROPOLOGY.............................................................................. 1 A. DEFINITION OF CULTURE............................................................. 1 B....

Culture & Medicine Module 1: Principles & Perspectives II Suzzana R. Roldan, MD | Asynchronous TABLE OF CONTENTS I. ANTHROPOLOGY.............................................................................. 1 A. DEFINITION OF CULTURE............................................................. 1 B. EDWARD HALL’S 3 LEVELS OF CULTURE....................................... 2 C. INFLUENCES OF CULTURE.............................................................2 D. AVOIDING ABUSE OF CULTURE BASED ON FACTORS................... 3 ● More definitions emerged over time beyond the classical definition ○ There are so many views and these can be misconstrued/misinterpreted ▸ E.g. practicing high culture, culture of the elites, etc. ▸ Goes against anthropologist’s point of view that everyone has culture E. UNDERSTANDING CULTURE..........................................................3 KOTTAK (2009) F. SIGNIFICANCE OF STUDYING CULTURE OR EXPLANATORY MODELS........................................................................................... 4 Culture is Learned II. MEDICINE........................................................................................5 A. MEDICAL SYSTEM.........................................................................6 B. INTERSECTION OF ANTHROPOLOGY & BIOMEDICINE..................6 C. MEANINGS OF BIOETHICS............................................................ 6 D. MEDICAL SETTINGS......................................................................6 E. PERSPECTIVES, APPROACHES, TECHNIQUES................................ 6 F. APPLICATION: EXPLORING ALTERNATIVE SYSTEMS.......................6 QUESTIONS......................................................................................... 7 ANSWER KEY.......................................................................................7 ● Learning is a continuous process ○ E.g. ways of learning about medicine is a process of acquiring skills that takes long years of training from medical school, up to apprenticeships ○ You become a great surgeon because you keep practicing and training ○ E.g. in smaller/traditional societies, a hilot also goes through a series of training, some since they were young ○ Also acquire different ranks and specializations ▸ E.g. expelling spirits, treating diseases caused by mangkukulam, etc. RATIONALE..........................................................................................7 Culture is Shared I. ANTHROPOLOGY ● In the past, culture was perceived to be confined ○ During periods of colonization: ▸ Westerners would go to exotic spaces inhabited by homogenous groups and totally describe that culture ● We have long departed from the idea of having exact shared commonalities in everything ○ There is definitely something shared that defines a cultural community ○ E.g. medical professionals have a standard way of looking at things, while in other societies it is less standard ○ Both may share commonalities ● Study culture ○ Includes our understanding of notions of medicine, biomedicine, our notions of health and wellbeing ▸ Medicine is seen as a social phenomena that is riddled with cultural notions ▸ Thus, the importance of viewing medicine as an aspect of culture ● Medical Anthropology ○ “Social and cultural aspects of health, illness and systems of medical care” (Singer, 2011, quoting Weidman 1986:118) ○ “Medical anthropology can be viewed as one of the domains of Applied Anthropology” (John van Willigen, 1986) ▸ The anthropology of solving human problems ○ “The application of perspectives, theory, methods, and data to identify, assess, and solve social problems” (Kottak, 2009) ○ Areas of interest: ▸ What are the medical conditions? ▸ What do we do to address our health? ▸ How do we effectively and appropriately provide public health, especially for the non-accessible groups? ⎻ Especially relevant now because of the pandemic A. DEFINITION OF CULTURE ● “Complex whole which includes knowledge, belief, arts, morals, law, custom, and any other capabilities and habits acquired by man as a member of society” (Edward Tylor, 19th century) ○ First attempt to define culture YL6:01.37 Culture is Symbolic ● E.g. for medical doctors, the white coat is a symbol of professionalism ○ Doctors in PGH were called fake because they were not wearing their white coat ○ Your level of skill does not change whether or not you have your white coat, but this is how patients understand it ○ When Doctor Ting Tiongco (author of “Surgeons Don’t Cry”) just finished medical school ▸ He was called to help a person who collapsed on the street because he was wearing his white coat ● At that time, he was not yet a seasoned medical surgeon and did not know how to address the condition of the patient Culture & Nature ● Some concepts, notions, and practices are intricately connected ○ What we think is natural can actually be culturally driven ● Examples of different notions of beauty ○ Ancient China ▸ Practice of foot binding was done, until war broke out TG3: Austria, De Guzman, Galope, Gregorio, Llanes, So, T., Sotelo, Suarez, & Uy, D. CG16: Cases, Domalanta, Flores, Geolin, Jegillos, Lipana, Lumagbas, Macalintal, Mata, Mendoza, Saz, Sta. Cruz 1 ⎻ Women who practiced foot binding could not flee for their lives ▸ An example of altering what we are naturally born with ○ In some cultures, people add brass rings around their neck to elongate it ○ The Philippines ▸ The notion of whiteness or having fair skin as being beautiful ▸ Skin whitening as a method of altering the melanin pigment of skin ⎻ Melanin offers natural sun protection, given our tropical climate and geographic location Culture Is All Encompassing ● Everything that we do and everything around us represents/reflects culture ○ E.g. the way we dress, the way we eat, and our technologies Culture is Used Actively ● We do not follow everything that is prescribed ○ We take ideas from our cultural influence ○ We have the agency to choose whether we would follow these prescriptions or not (if it does not make sense to us) Culture is Integrated ● As society changes, the notion of being integrated means that: ○ A change in one area of culture or the way that we address our health can change the types of illnesses or diseases ○ E.g. women’s participation in economics ○ A shift in the way we do things affects other aspects of culture (i.e. social, political, economic, etc.) Culture is Adaptive & Maladaptive ● Culture helps us adapt ○ If the ability to propagate is a measure of success ▸ Then we would be successful because our populations have grown up to 7 billion globally ○ Technology can help us survive, propagate, and continue our lives ● Not all our cultural knowledge helps us survive or cope with our environmental conditions ○ E.g. modern medical technology is beneficial in prolonging our longevity and lowering mortality rates ▸ Creates a new problem of addressing the growing aging population who have less people that support them Levels of Culture ● National, international, subcultural, global ● Defining culture becomes convoluted ○ National level: What makes us Filipinos? What binds us together to have enough shared beliefs? ○ International level: What are the global guidelines for this? ○ Subcultural level: Not all Filipinos have the same kind of medicines ▸ We also consider medicine of indigenous population ○ These levels are different from Edward Hall’s, which will be discussed below B. EDWARD HALL’S 3 LEVELS OF CULTURE ● Anthropologists look at this in terms of intercultural communication ● Tertiary ○ You can easily see what this is YL6:01.37 Culture & Medicine ▸ E.g. language, how we dress, posture, rules, etiquette, cuisine, festivals ● Secondary ○ You can see it and understand it, but it needs a little explanation ○ Rules and assumptions that are not shared with outsiders ▸ E.g. we know Muslims do not eat pork, they want kosher or vegetarian diets ⎻ If you are not a member of this culture, you might need deeper explanations why these are their rules ● Primary ○ Deepest and more difficult to let go ▸ E.g. OFWs might imbibe what is easily seen, but they will never let go of the deepest level of culture ○ Values that are not easily seen (i.e. unwritten or unspoken rules) ○ No matter where you go, you will not give it up ○ It is difficult to change a framework or belief when it is rooted in the primary level and rooted in belief ▸ E.g. on New Year’s, DOH always reminds people to avoid engaging in fireworks because of health repercussions ⎻ Difficult for people to let go of this tradition, especially for older generations ▪ Carry the belief of having loud noises in order to expel spirits ○ The reason why anthropologists stay long in communities is to uncover the primary level C. INFLUENCES OF CULTURE INDIVIDUAL FACTORS ● Refer to what makes things different for you ● Examples ○ Gender ▸ E.g. Being male or female or an in-between in the continuum and its effects on one’s health ○ Age ○ Size (stout or thin) ○ Appearance ○ Personalities (outgoing or introverted) ▸ E.g. Dealing with a pandemic ⎻ Extrovert: Very difficult and having a harder time being on lockdown and confined to your house ⎻ Introvert: May find it easier ○ Intelligence ○ Level of Experience ○ Physical or emotional states EDUCATIONAL FACTORS ● Level of education ○ What type of education are you receiving when it comes to knowledge about health? ○ Did you stay in a confined space in the outlands? Or are you in the city and are influenced by formal education? ● In more isolated societies, when all societies have ways of transmitting knowledge, how we transmit them varies ○ Even in formal education, there is still a way of varying skills ○ Professionals have to go to formal channels of learning ● Would impact the way that we think about health and wellbeing SOCIO-ECONOMIC FACTORS ● Class and status 2 ○ Are you very influential in your community that your decision making impacts the rest? ○ Are you in charge of your own health-seeking behavior? ● Occupation ○ Makes a difference on what you are exposed to ▸ E.g. Being a medical doctor or a nurse: ⎻ During COVID, they are taking more risks compared to other professions ● Social support networks ○ Whether you can call on others to address your health needs ENVIRONMENTAL FACTORS ● Weather ● Population and density ● Types of infrastructure: Housing, roads, bridges, public transport systems D. AVOIDING ABUSE OF CULTURE BASED ON FACTORS ● Do not abuse or overgeneralize based on the factors under influences of culture ○ Avoiding abuse: overgeneralization and stereotypes leads to prejudice ● E.g. Age ○ For some cultures, age matters a lot ○ For other cultures, it doesn’t really matter ● E.g. Indigenous people ○ The way we look at the aging population would be different compared to how an indigenous person would ▸ An indigenous person would value the elders in their community differently ○ In modern society, we tend to value elders less (they are disenfranchised or forced to retire) ● E.g. Doctors ○ Newer, younger, professional doctors may have more advanced knowledge than older doctors ▸ Unless the older doctors really keep pace and continue gaining experience ● E.g. Teachers ○ More respect for senior professors who have had years of understanding ● E.g. Flight stewardess ○ There is an age limit for hiring Active Recall Box 1. At what Edward Hall’s level of culture is it difficult to change a framework or belief when it’s rooted in the primary level and rooted in belief? A. Tertiary B. Secondary C. Primary 2. T/F. Based on the definition of culture, we do not follow everything that is prescribed. 3. Name all influences of culture. Answers: 1C, 2T, 3Individual factors, Educational factors, Socio-economic factors, and Environmental factors E. UNDERSTANDING CULTURE ● Michael Agar (2006) ○ Has an article called “Culture: Can You Take It Anywhere?” from the international journal of quantitative methods YL6:01.37 Culture & Medicine ○ ○ ○ ○ ○ ▸ Based on a speech that he delivered for a graduating class Original definitions of culture being shared, maintained, and continuous originated at a certain time frame ▸ We must now include the complex, heterogenous and blurred boundaries among culture bearers Challenges the current notions of understanding culture ▸ Descriptions that anthropologists write with the things that have been documented in the past ⎻ Does not always mean that they continue to be the same descriptions of today ▸ Cannot generalize knowledge for all groups Have to recognize that people possess a lot of influences from different spaces Culture is not easy to grasp and describe Arthur Kleiman looks at exploratory models ▸ Getting to what is important ▸ Trying to uncover the bottom-line of what humanizes us ⎻ What is at stake or what it means when someone gets sick ▪ For the patient, the family, the caregivers, including medical professionals ▸ Partial and non-generalized descriptions ▸ Despite the depth of descriptions that we can draw from ethnographic studies ⎻ They are still not generalizable ▸ Up until now, there are changing, increasing diversity, blurring categories and domains RETHINKING “CULTURE” ● Membership in a single culture is an oversimplified generalization ● Culture is not contained ● Agar prefers the term of us having several cultures ● Examples ○ Age groups ▸ We are probably more alike with our age group who are across boundaries compared to our grandparents ▸ You are closer to your family members, but your values are closer to people farther from you ▸ As a Filipino, you might possess values that are more western than the indigenous people ⎻ Due to globalization ○ Language is one of the reflections of the level of influence that we would have ISSUES WITH REGARD TO CULTURE Hegemony ● Pertains to what is dominant at the moment ● Questions to consider when dealing with people ○ What is your dominant culture right now? ○ Which do you practice the most? ○ What is your identity and affinity to a particular culture? ○ What culture do you bring into a particular space? ○ Which part of your culture are you expressing the most? Generation “Couples” with Everything ● References, events, and values are dependent on the generation one was born into ○ E.g. Discussions of people belonging to older generations ● Different references, different cultures ○ Healthcare costs in their generation were cheaper compared to now ○ Healthcare delivery 3 ▸ Before: HCWs doing house visits can accommodate every aspect of health ▸ Now: Team of specialized medical doctors Density ● The proportion that occupies one’s time ● What occupies your time the most? ○ E.g. students who speak Filipino at home, but in school they speak in a foreign language Attitude ● What we conceal or what we are proud of ● What do you reveal about yourself in a given context? ● Examples: ○ What patients would conceal to medical doctors ○ What doctors would reveal in terms of their healing practice Integration ● How you integrate aspects of mixed cultures ○ Due to multiple influences (i.e. home, school, folk beliefs, etc.) ● How do you integrate knowledge? Which becomes more dominant? Volatility ● Definition of culture is very volatile — it changes all the time ● Continued exposure to different cultures ○ E.g. during lockdown, we still receive ideas from all directions ○ E.g. Indigenous People ▸ We cannot generalize that Indigenous people are “cut off” as seen in the past ▸ They can be influenced by external cultures when they interact with towns and markets CULTURE IS PARTIAL ● People have many “labels” (e.g. generation, religion, gender) ● All of us are a mix of different cultures ● “Any community is about cultures now, plural, and everyone in that community has a different mix available, and everyone draws on a different subset of that mix in different ways. No person, or group, can be described, explained, or generalized completely with a single cultural label” (Agar, 2006) F. SIGNIFICANCE OF STUDYING CULTURE OR EXPLANATORY MODELS EXPLANATORY MODELS ● Important in understanding the complexity of culture ● It impacts the way we practice our medicine and understand the people within the systems we operate REASONS FOR STUDYING CULTURE Culture Competence ● E.g. a characteristic that nursing schools look for ○ Listen and understand where people are coming from to improve service ○ Good listening skills for understanding beyond what is being said ○ Not for political correctness Improve Healthcare Delivery ● Cultural brokerage and sense-making, systems and procedures ● Anthropologists YL6:01.37 Culture & Medicine ○ Act as cultural brokers ● Cultural brokerage ○ Interpreting unwritten rules and deconstructing what is not codified, written or memorized ▸ To bridge information from one level to another ○ i.e. Explain and understand how people understand an illness event ▸ And how this affects patient’s decision-making Designing Appropriate Programs ● Addressing pressing issues in local communities ○ “How do we improve healthcare delivery systems?” Gain Trust in the System ● Trust is a very significant issue in Public Health ● Difficult to regain trust when it is broken ○ E.g. Dengvaxia Issue ▸ This increased anxiety for dengue outbreaks, especially for those who were inoculated and seronegative ▸ Has affected general vaccination efforts ⎻ E.g. trust issues regarding the vaccinations that are being developed for COVID-19 ▸ Because of the complications with this mass vaccination program, it made people distrust inoculations Growing Intersections Between Anthropology (& Other Social Sciences) In/Out of the Biomedical Setting ● E.g. There are now veterinary medical anthropologists who bring up issues that have not been raised before ○ Such as the hazards of raising animals in confined spaces ○ Intersections between disciplines are increasing ○ Consider zoonotic diseases - how they are spread and transmitted due to human interaction with animals ▸ E.g. TB, cholera, Zika outbreaks WHY IS UNDERSTANDING CULTURE IMPORTANT? ● Factors that affect culture do matter ● What we think as objective standards are mediated and thus are complicated by cultural factors ● It is very difficult to come up with one design of medical programs, especially in public health ○ It is difficult without considering the variation of how people understand a particular disease or illness ○ People have different frameworks of understanding of what is right or how we should deal with an illness ● "One's cultural background influences people's beliefs, behavior, perceptions, emotions, language, religion, rituals, concepts of time and space, attitudes to illness, pain, misfortune... all of which may have important implications for health or health care" (Helman, 2000) CASE: “Cultural Variations in Placebo Effect: Ulcers, Anxiety, and Blood Pressure.” Medical Anthropology Quarterly. Moerman, Daniel E. (2000) ● Discusses the variation of placebo, even in medical situations ● People tend to look at others as “it’s all in the mind, it’s a placebo effect” ● Moerman focused on the factors of placebo, and observed in a clinical setting that: ○ Patient understanding could affect healing rates ● What factors mattered in healing rates? ○ Physician enthusiasm ○ Dosing regimen 4 ▸ 201 of 618 patients (32.5%) took two placebos a day healed in 4 weeks ▸ 405 of 1,058 patients (38.2%) took four placebos a day healed in 4 weeks ▸ More dosage, regardless if placebo, leads to more healing and faster healing process ○ National differences ▸ E.g. placebo healing rate for peptic ulcers varied across different countries ⎻ Brazil: 7% ⎻ Germany: 59% ⎻ Rest of the world: 36% ▸ Germany had the highest placebo rate for peptic ulcer diseases ⎻ However, the placebo rate for hypertension was only 7% ▸ Therefore, placebo healing rate varies for different conditions ○ Gender and age were insignificant QUOTE: Moerman, Daniel E. (2000: p. 65) ● “Medicine’s symbolic reality is the first principle of medical anthropology (Kleinman 1973). Meaning is the inescapable complimentary treatment, accompanying all specific treatments – pharmacological, herbal, surgical, or manipulative. Symbolic, meaningful acts in a medical context can have a substantial effect on actual physical lesions and, indeed, on mortality. The intervening processes (in any such case) are not all clear and likely vary in different circumstances, probably from individual to individual, from illness to illness, and probably also from society to society. To specify these processes in more detail will require a very thick description indeed, one as sensitive to immune processes and gastric secretions as it is to metaphor and symbol.” ABUSE OF CULTURE ● Understanding culture is important ○ E.g. If others believe that a disease is explained by sorcery ▸ How do we bridge the gap between knowledge and knowledge of others? ● It is also important to avoid abusing the concept of culture ● Discrimination and sterotypes leading to misunderstanding (under differentiate people) ○ Examples: ▸ Blanket statements such as “the Chinese are the ones spreading covid” ⎻ Therefore, they are being attacked and discriminated in the US, even if they are not from Wuhan, China ▸ Medical doctors being kicked out of the spaces they rent due to assumed COVID-19 exposure ● Victim blaming disregarding structural violence ○ Explanations like: ▸ The poor are the ones spreading the diseases ⎻ Because they are not following the prescriptions of medical doctors ⎻ They still continue to not socially isolate themselves, or ⎻ They don’t wear masks properly ▪ Without considering the structures where they live and interact with one another ○ Blaming it on ignorance YL6:01.37 Culture & Medicine ▸ The poor being lazy because they only go to the doctor when: ⎻ Their medical conditions are difficult to deal with ⎻ They are at the last stages of their conditions ○ We have to consider the type of society we have in terms of creating the medical conditions of people ○ Structural violence in the everyday life of people living in the margins, fringes, and underdeveloped areas seen in: ▸ Nancy Scheper-Hughes ⎻ Study on organ donations ⎻ Global trafficking of kidney donations come from underprivileged groups/nations ▪ Global south ▪ Underdeveloped nations ▪ Poor spaces (e.g. harvesting of organs being used for transplantations in Baseco compound) ⎻ While procedures address health conditions of people in well-developed countries ▪ Procedures like kidney transplants ■ It ignores where those kidneys are coming from ▪ Tells health inequalities ▪ These things come into play in terms of coming up programs that makes harvesting more ethical ■ More careful about organ donations now after having uncovered inequalities ⎻ Study is not critiquing the act of saving lives, but the way that it is being done unethically ▪ Would give more value to lives in developed countries than underdeveloped countries when: ■ Welfare is not considered or when donors are not considered as patients ○ We have to be very empathetic as to why people cannot follow the rules ▸ What are the conditions na pasaway sila? ▸ Mary Racelis in her engagement with underprivileged groups ▪ Not so concerned with pandemic or in moving around ▪ Greater concern is survival and how to feed themselves ● Misinterpreting idiosyncratic behavior as culture Active Recall Box 4. What are the issues with regard to culture? A. Hegemony B. Density C. Attitude D. AOTA 5. T/F: Culture is easy to grasp & describe 6. Misunderstandings are caused by … Answers: 1D, 2F, 3 Discrimination and stereotypes II. MEDICINE ● Medicine as defined by Michael Tan (1987 and 2008) ○ Consists of practices, methods, techniques and substances ▸ Embedded in a matrix of values, traditions, beliefs and patterns of ecological adaptation ▸ Provide the means for maintaining health and preventing or reducing disease or injury to its members ● The definition is not always biomedicine 5 ○ Conditions right now [pandemic]- more risky to give birth in hospital because of cases of infants contracting COVID ▸ Some pregnant women will go to midwife would rather give birth in alternative ways (e.g. water birth) ⎻ They do not have to go to hospital A. MEDICAL SYSTEM ▸ CDC, WHO, UNICEF, etc. ● Biomedical systems settings ● Perspectives ● Approaches and techniques C. MEANINGS OF BIOETHICS ● The dichotomy between medicine and non-biomedicine is a very blurred distinction ○ Before, there is dichotomy between what you learned in medical school and the knowledge of Traditional Chinese Medicine or Filipino traditional healing system (e.g. hilot) ○ Now, the dichotomy is being blurred ▸ Non-biomedical systems are finding their way into medical systems ⎻ E.g. Acupuncture and TCM are performed by doctors in hospital setting now ● Have codified practices ● Levels are becoming more intertwined as flow of people becomes easier and more frequent ● Risk of spreading new communicable diseases becomes a public threat ● (E.g. OFW phenomena - OFWs who bring back outbreaks) ○ H1N1 2005 ○ Dengue 2007 ○ MERS-CoV ○ SARS 2011 ○ Zika virus 2015 ● Informed consent (testing vaccines among Indians; prisoners participation in research for freedom) ● Public good ○ Programs to eradicate diseases raised other kinds of questions ▸ Why consent is applied variably ⎻ AIDS vs smallpox ● How resources are allocated ● Which diseases to address and prioritize CONCERNS OF PUBLIC HEALTH D. MEDICAL SETTINGS ● Medical System as defined by Michael Tan (1987 and 2010) ○ Refers to the total organization of a society’s social structures, technologies, and personnel ▸ Enable it to practice and maintain its medicine ○ Healthseeking is so ‘convoluted’ ▸ E.g. Difference in maintaining medicine in a hospital setting vs. informal village setting B. INTERSECTION OF ANTHROPOLOGY & BIOMEDICINE ● How do we improve healthcare delivery? ● How do we now equalize access and expand options across the different sectors? ● How do we motivate continuance of healthcare vs understanding what practices are helpful? ● Areas of intersecting interest ○ Epidemiology, healthcare delivery programs, outbreaks/epidemics/pandemics - NIPAS, SARS, Dengue ○ Understanding culture bound or ethnic specific illness (bangungot, usog, pasma, amok, sinapian) ● Micro-meso-macro-global level interactions and connections ○ Micro-level ▸ Clinical interactions and relations (doctor-patient: e.g. Bioethics, power relations) ▸ Explanatory models or people’s explanations (e.g. Paul Farmer explaining Ems of doctor, patient, traditional healer on move san le gatte) ○ Meso-level (national, provincial) ▸ Ranking of hospitals and medical schools, municipalities, regions ▸ Some private hospitals now are more efficient and trusted in terms of dealing with diseases ▸ What medical schools are regarded as good vs those that are regarded as less degrees of training ▸ Rural vs urban spaces of where one gets their training ▸ Training abroad vs. training locally ○ Macro-level ▸ National priorities ▸ Whose frameworks/standards do we adhere to? ⎻ E.g. implementation of the protocol for dengue ▪ There has to be a connection between the different levels of culture ▪ We have to look at the specific historical variations in the different levels of explaining health programs ○ Global YL6:01.37 Culture & Medicine ● ● ● ● ● ● ● Clinics HCs in rural villages Hospitals Medical schools Nations Province International organizations E. PERSPECTIVES, APPROACHES, TECHNIQUES ● Individual explanatory models or social justice ● Qualitative methods (ethnographic – in-depth interviews, participant observation, FGDs, case studies) ● Quantitative methods (health statistics) ● Interdisciplinarity (respect of domains, specializations or appropriating domains) F. APPLICATION: EXPLORING ALTERNATIVE SYSTEMS ● Folk medicine, traditional knowledge, alternative medicine ● Herbal remedies ○ For cough, sore eyes, LBM, fever ● Acupuncture, Maggots ○ For diabetic wounds ● Turkey (Dr. Fish) ○ For psoriasis etc. ● Hilot (4B industry since 2003 in Japan) ● “Culture is not a simple thing to understand. We have to consider all its complexity when we try to understand what the different notions/ideas are regarding health and well-being that can impact program success.” QUICK REVIEW QUESTIONS 1. T/F: A meaning of bioethics is how resources are allocated. 2. According to Kottak, culture is… A. Shared B. Learned 6 3. 4. 5. 6. 7. 8. 9. C. Symbolic D. AOTA In Edward Hall’s 3 Levels of Culture, which level posits that it is difficult to change a framework when it is rooted in belief? A. Primary B. Tertiary C. Secondary D. AOTA Under influences of culture, where does level of experience fall under? A. Individual Factor B. Educational Factor C. Socio-economic Factor D. Environmental Factor Overgeneralization and stereotypes leads to prejudice. In modern society, we tend to value elders more. A. Only statement 1 is true B. Only statement 2 is true C. Both statements are true D. Both statements are false Which of the following statements accurately captures how culture is partial? A. No one can be described without a single cultural label B. Everyone is a mix of different cultures C. AOTA D. NOTA Who are considered as the cultural brokers? A. Medical Doctors B. Psychologists C. Sociologists D. Anthropologists The following are all considered as individual factors in which culture influences except? A. Gender B. Personality C. Level of education D. Level of experience Which of the following statements is false? A. There is no clear dichotomy between medicine and non-biomedicine now. B. Nancy Scheper-Hughes’s study on organ donation is a critique on the act of saving lives. C. For underprivileged groups, their greater concern during pandemic is survival. D. Medical system refers to the total organization of a society’s social structures, technologies, and personnel that enable it to practice and maintain its medicine. RATIONALE 1. T. A meaning of bioethics is how resources are allocated. 2. D. All of the above. According to Kottak, culture is shared, learned, and symbolic, among other things. 3. A. Primary. The Primary Level also includes values that are not easily seen (i.e. unwritten or unspoken rules). These are deeply rooted values wherein no matter where you go, you won’t give them up. 4. A. Individual Factor. Individual factors include gender, age, size, appearance, personalities, intelligence, level of experience, and physical or emotional states. 5. A. Only statement 1 is true. In modern society, we tend to value elders less since they are forced to retire and disenfranchised. 6. C. AOTA. Culture is partial as all of us are a mix of different cultures. Agar also states that No person, or group, can be described, explained, or generalized completely with a single cultural label.” 7. D. Anthropologists. Anthropologists are considered as cultural brokers. 8. C. Level of education. Level of education is under the educational factors in which culture influences 9. B. Nancy Scheper-Hughes’s study on organ donation is a critique on the act of saving lives. Dr. Roldan emphasized that Scheper-Hughe’s study is not critiquing the goal of saving lives, but the way that it is being done unethically. 10. A. Micro-level. Clinical interactions and relations (doctor-patient: e.g. Bioethics, power relations) is an example of micro level interaction. Explanatory models or people’s explanations (e.g. Paul Farmer explaining Ems of doctor, patient, traditional healer on move san le gatte). REFERENCES REQUIRED 📄 Online Source Lecture: ASMPH2026. 01.27: General Overview of Radiology by Koa-Sales, R., MD. ● 📄 Online Source Lecture Slides: Roldan, S. (2023). Culture & Medicine [Lecture slides]. ● SUPPLEMENTARY IMPORTANT LINKS: Concerns and Feedback form: http://bit.ly/YL6CFF2027 How’s My Transing? form: https://bit.ly/2027YL6HMT Mid-Semester Evaluation form: https://bit.ly/2027YL6MidSem 10. Clinical interactions and relations (doctor-patient: e.g. Bioethics, power relations). What level is being described? A. Micro-level B. Macro-level C. Meso-level D. Global-level End-of-Semester Evaluation form: https://bit.ly/2027YL6EndofSem ANSWER KEY 1T, 2D, 3A, 4A, 5D, 6C, 7D, 8C, 9B, 10A YL6:01.37 Culture & Medicine 7