PART 1
Health Locus of Control
PART 2
CONCLUSIONS
METHODS
DISCUSSION
APPENDIXES
Part II; Culture and Health
The (Cultural) Etiology of Illness
Manifestation of illness in cultural groups in the United States:
We are aware that frames of reference alter the interpretation of illness, but what are the major agents which exert influence across such frames of reference? Socioeconomic status (SES), family/social support, other cultural norms and standards, and usually high levels of psycho-social stressors all seem to moderate illness. Economics, alone, has proven a powerful indicator: "The general increases in ours and other Western nations' economy and health, are reflected in lower infant mortality, better nutrition, and less poverty-related disease" (Watkins, 1996, p. 49). According to Duffy (1997) Mexican American women have twice the incidence of gall stones, have a higher rate of gall bladder cancer, and have higher blood pressure (but smoke less and have lower cholesterol). Among other variables these tendencies are coupled with lower incomes and insurance coverage, and a limited access to health care. The facts alone do not signify a connection to the socioeconomic variables, but the following does: "When Mexican American women's socio-economic status rose, their ‘obesity related' risk problems . . . decreased" (ctd. in Duffy, 1997, p. 152). Empirical examples are also provided in relation to family environment by Levy and Hawks (1996):
Family atmosphere may influence response to medications. Non-Western patients with schizophrenia were found to have more social support and better clinical outcomes than their Western counterparts. Patients whose family members expressed frequent criticism, hostility, and emotional over-involvement relapsed more frequently and required higher doses of medication.This suggests that family structures in Western nations like the US might also have an impact on physical illness, as social support is an important moderator of stress. ". . . African Americans experience greater stress from such events as a major personal injury or illness, a major change in work responsibilities, and a major change in living conditions than white Americans do," according to a 1989 study cited in Comer (1998), "Such differences probably reflect differences in the impact and meaning of such events in the lives of the persons in the two groups" (p. 355). The results confirm the influence of cultural groups on reality models, and thus what stressors are likely to enter into the equation of a psychosomatic response. A similar influence on psychosomaticism may be seen here:
. . . hypertension is twice as common among African Americans as among white Americans (Johnson et al., 1992). Although physiological factors may have much to do with this difference, some theorists propose that it is also linked to the dangerous environments in which so many African Americans live and to the unsatisfying jobs at which so many must work (Anderson et al., 1992). -Comer, 1998, p. 351.
There may be a physiological reason behind these health correlates. Beyond average levels of stress in the early stages of life may sensitize the stress hormone system of the hypothalamus (illustrated in human/ animal studies), so that one becomes hyper-responsive to stress throughout life (Marano, 1999, p. 72). This may imply that individuals who are perpetually discriminated against, or who live in poor, urban environments might be at a heightened risk to develop illnesses (pronounced by the fact that they may have inadequate access to health care). This would generally extend to populations considered minorities in the United States: race, ethnic, gender, sexual orientation, (dis)ability or otherwise. Acculturation becomes an increasingly important variable in the health of these individuals.
