IzBen C. Williams, MD, MPH
Instructor
Lecture # 16
THE FAMILY,
CULTURE,
AND
ILLNESS BEHAVIOR
The Family
I. Overview of the family
Definitions:
Family: Contextually, three major definitions of
family are currently used.
Structural
b. Functional
c. Transactional
a.
The interpersonal relationships in families play a
significant role in the health of family members
The Family
I. Overview of the family
Definitions:
a. Structural:
 Extended family: Broadly, the family is a group of people
related by blood, adoption, or marriage. This definition as
biologic and socio-legal relevance
 Nuclear family: family lives together
 Family of orientation (origin): the nuclear family in which
an individual has the status of child
 Family of procreation: the nuclear family in which an
individual has the status of parent
The Family
I. Overview of the family
Definitions:
b. Functional:

A family is a psychosocial system that consists of
an adult and one or more other individuals
(children, adults, or both) who have a commitment
to mutual need fulfillment and nurturance. This
definition emphasizes normative function, and is
identical to the concept of a social support system
The Family
I. Overview of the family
Definitions:
c. Transactional
 The family is a group of individuals who share
affection and loyalty, a history and a future, and a
sense of home. This definition emphasizes
emotional and experiential bonds that arise from
recurrent face-to-face interactions.
The Family
I. Overview of the family
Definitions:
Culture:
The behaviors and belief characteristics of a particular
social, ethnic, or age group:
Illness:
unhealthy condition; poor health; indisposition; sickness
The Family
II. Demographics and current trends (USA)
A. Marriage and children….
i. 90% of the US population lives with relatives
ii. Marriage remains extremely popular. (95% of the
population marries at some time. 80% of those who
divorce, remarry). A good marriage is an important
predictor of health. Married individuals are found
consistently to be in better health than single
individuals of similar age.
The Family
Demographics and current trends (USA)
Marriage and children….
Marriage most likely fosters better health by….
ii.
a.
b.
c.
d.
Providing a more stable life-style
Increasing everyday social contact and decreasing
loneliness and increasing self esteem
Allowing the individual to develop a consensus of the
world
Providing a forum to discuss problems and receive
feedback
The Family
Demographics and current trends (USA)
B. Divorce and single-parent families….
 Divorce rate remains high, almost 50%. Factors
associated with divorce include
Short courtship
 Marriage at a young age
 Lack of family support
 Premarital pregnancy
 Differences in religious and socioeconomic
backgrounds

The Family
Demographics and current trends (USA)
 Divorce and single-parent families….
 Divorced men are more likely to remarry than are divorced
women
 Physicians have a higher divorce rate than other professions
 Single-parent families
 Have lower incomes and less social support and hence
increased risk of physical and mental illness
 However the fastest growing population of single mothers is
educated professional women, although many
unmarried mothers belong to the low socioeconomic group
The Family
Demographics and current trends (USA)
 Children in single-parent families
 Most single parent families (about 90%) are headed by
women
 The number of single parent families is increasing rapidly.
It now stands at >20% of families
 The percentage of children living in single parent families
varies widely, by ethnic group
 Parental discord, more so than divorce, increases the risk of
delinquent and aggressive behavior
The Family
Demographics and current trends (USA)
 Child custody
 After divorce, the types of custody that may be granted by
the courts include joint, split, and sole custody; fathers are
increasingly being granted joint or sole custody
 In sole custody, the child the child lives with one parent
while the other has visitation rights. Until quite recently,
sole custody was the most common type of custody
arrangement after divorce.
The Family
Demographics and current trends (USA)
 Child custody
 In joint residential custody, which has recently become
more popular the child spends some time living with each
parent
 In split custody each parent has custody of at least one
child
Transition
.
Culture & Illness Behavior
Culture in the United States
A. Characteristics
 The USA has a population of approximately 320 million,
made up of many minority subcultures as well as a
large white middle class which is the major cultural
influence.
 Although many subcultures have formed the American
subculture, the culture seems to possess certain
characteristics of its own.
Culture & Illness Behavior
Culture in the United States
A. Characteristics
 ……………certain characteristics of its own:
 Financial and personal independence are valued at
all ages, especially in the elderly. Most elderly
Americans spend their last years living on their own.
20% live with family members; 5% live in nursing
homes
 Emphasis is placed on personal hygiene and cleanliness
 The nuclear family with few children is valued
Culture & Illness Behavior
Culture in the United States
B. Culture and Illness
 white ethnic groups are not homogeneous (ie., their
members have different backgrounds and different
reasons for emigrating) and groups often have
characteristic ways of dealing with illness.
 Although the major psychiatric disorders such as
schizophrenia and depression are seen to about the same
extent in all cultures, the sorts of behavior considered
abnormal may differ considerably by culture
Culture & Illness Behavior
Culture in the United States
B. Culture and Illness
 While differences in presentation of symptoms may be
the result of individual characteristics of a patient, they
may also be influenced by the characteristics of the
particular ethnic group.
 A patients belief system has much to do with compliance
and response to treatment. Physicians must have
respect for, and work in the context of, such beliefs in
order to help patients.
Culture & Illness Behavior
Culture in the United States
B. Culture and Illness
 Respect and work in context of such beliefs in order to
help patients. For eg.:
 If patient thinks a particular food is good for a disorder, as
long as there is no danger …… let him eat
 Be prepared to involve the witch doctor or other outside
influence if necessary for appeasing the patient’s belief
 People may seek health care from their traditional/folk or
religious. Do not disparage; rather, include it in the
treatment plan.
Culture & Illness Behavior
Culture in the United States
C. Culture Shock
 Culture shock is a strong emotional response, which
may involve psychiatric symptoms related to geographic
relocation and the need to adapt to unfamiliar social and
cultural surroundings.
 Culture shock is reduced when groups of immigrants of a
particular culture live in the same geographic area
Culture & Illness Behavior
Culture in the United States
C. Culture Shock
 Young immigrant men appear to be at higher risk for
culture shock, including symptoms such as paranoia and
depression, than other sex and age groups. This is true in
part because
 Young men lose the most status on leaving their culture of
origin
 Young men often must get out into the new culture and
earn a living, hence greater exposure and greater risk
Culture & Illness Behavior
IV. Minority Subcultures - USA
A. African Americans
 There are approximately 40 million African Americans
(12.5% of the total population)
 The average income of African American families is only
about half that of white families. This lower income is
associated with decreased access to health care services,
which leads to increased health risks
Culture & Illness Behavior
IV. Minority Subcultures - USA
A. African Americans
 Compared to white Americans, African Americans have
Shorter life expectancies
 Higher rates of NCDs, prostate cancer, AIDS (African
American men and women respectively are 15 time and 5
times more likely to have AIDS than are white men and
women)
 Higher death rates from heart disease and from most forms
of cancer

Culture & Illness Behavior
IV. Minority Subcultures - USA
A. African Americans
 Religion and strong extended family networks play a major
role in social and personal support among many African
Americans. This may in part explain why the overall suicide
rate is lower among African Americans than among white
Americans
 However, suicide in African American teenagers, once
uncommon, has more than doubled in the last twenty years.
It is now the third leading cause of death in this group, with
homicides being first, and accidents second. In white
teenagers, its accidents/homicides/suicide
Culture & Illness Behavior
IV. Minority Subcultures - USA
B. Hispanic/Latino Americans
1. Overview
With 41 million people, Hispanic Americans are now the
largest minority group
b. As a group, Latinos place great value on the nuclear family and
on nuclear families with many children
c. Respect for the elderly is important. Younger people are
expected to care for elderly family members, to protect elderly
relatives from negative medical diagnoses, and often, to make
medical decisions concerning the care of elderly relatives
a.
Culture & Illness Behavior
IV. Minority Subcultures - USA
B. Hispanic/Latino Americans
1. Overview
d. Among the Latinos, “hot” and “cold” influences are
believed to relate to illness
e. Latino women are less likely to get mammograms and
more likely to have cervical cancer than are white or
African American women
Culture & Illness Behavior
IV. Minority Subcultures - USA
B. Hispanic/Latino Americans
2. Two thirds of Latinos, especially those in the Southwest,
are of Mexican origin
3. The second largest group of Latinos is of Puerto Rican
origin (3 million people). Most live in the
Northeastern states.
4. Over 1 million Latinos are of Cuban origin and live
primarily in the Southeast, especially in Florida.
Culture & Illness Behavior
IV. Minority Subcultures - USA
C. Asian Americans
1. There are more than 11 million Asian Americans. The
largest groups are the Chinese (2.6 million), Filipino (2
million), Asian Indian (1.9 million)
2. Other Asian American groups include Korean (1.1
million), Vietnamese (1.2 million), Japanese (.9
million)
3. Although many groups are assimilated, ethnic
differences may still result in different responses to
illness among Asian American groups
Culture & Illness Behavior
IV. Minority Subcultures - USA
C. Asian Americans
4. Characteristics of these cultures include the following;
As in Latino cultures adult Asian American children show
strong respect for, and are expected to care for their
elderly parents, protect elderly relatives from negative
medical diagnoses and make medical decisions about
elderly relatives’ care
b. Patients may express emotional pain as physical illness
a.
Culture & Illness Behavior
IV. Minority Subcultures - USA
C. Asian Americans
4. Characteristics of these cultures include the following;
In some Asian American groups, the abdominalthoracic area rather than the brain is thought to be the
spiritual core of the person. Thus the concept of brain
death and resulting organ transplant is generally not
accepted
d. Folk remedies include coining (a coin is rubbed on the
affected area; the resulting bruises are believed to aid the
patient). Injuries resulting from such ‘remedy practices’
may be mistaken by medical personnel for abuse
c.
Culture & Illness Behavior
IV. Minority Subcultures - USA
D. Native American Indians and Eskimos
There are about 2.7 million Native Americans in the US
Native Americans have their own program of medical care
under the direction of the Indian Health Service of the
federal government
3. The distinction between mental and physical illness may be
blurred; engaging in forbidden behavior and witchcraft are
thought to result in illness
4. In general, native Americans have low incomes and high
rates of alcoholism and suicide, particularly among teenagers
1.
2.
Culture & Illness Behavior
IV. Minority Subcultures - USA
E. Americans of European Descent
Anglo Americans are those originating in English-speaking
European countries, mostly from Ireland
I.
i.
ii.
Anglo Americans in general are less emotional, more stoic, and
less vocal about pain and illness than members of groups of
Mediterranean origin (eg Jews, Greeks, Italian)
Therefore, Anglo Americans may become very ill before seeking
treatment while people of Mediterranean origin may be
considered complainers and ignored when they are in fact quite
ill
Culture & Illness Behavior
IV. Minority Subcultures - USA
E. Americans of European Descent
II. Americans of Middle Eastern/North African Descent
i.
ii.
iii.
People of Middle Eastern or North African origin, who
speak dialects of the Arabic language are often referred
to as Arabs.
Some Middle Eastern people are Christian or Jewish; most
follow the Muslim religion
People who follow the Muslim religion value female
modesty and purity. Female patients may wish to remain
as covered as possible in the examination room. They
often prefer to have a female physician, or to be examined
with their husband present. Honor your patients wishes.