Regional Cultures & Health Outcomes: Implications for Consumer
Engagement.
Jackson Williams
Ezzati-Murrayy Mortalityy Map,
p, PLoS Medicine,, 2006,, 2008
(White Female Race/County Combination)
Academy Health June 2010
Lieske, 1993
Culture and Health




“Culture refers to the shared and learned
aspects
t off h
human cognition
iti and
d behavior
b h i that
th t
underlie our ability to interpret the world around
us and
d to
t ttake
k meaningful
i f l action.”
ti ” (Edb
(Edberg,
2007)
Diet
Behaviors ((e.g.,
g , smoking,
g, exercise))
Intangibles (e.g., social supports, timetimepreference)
Academy Health June 2010
T
Two
Methods
M th d off Analyzing
A l i Culture
C lt

Unit Analysis (e.g.,
(e g country,
country region)



Seven Countries Study (Keys)
Japanese--Americans study (Marmot & Syme)
Japanese
Syme)
C lt l Dimensions
Cultural
Di
i
Analysis
A l i



Social Capital (Putnam)
Traditional/Secular (Inglehart
(Inglehart))
Long--Term Orientation (Hofstede
Long
(Hofstede))
Academy Health June 2010
Matching Obesity Rates:
Homelands to Counterpart US States
Japan/Hawaii
Italy/New Jersey
Germany/Wisconsin
England/Indiana
Scotland/Tennessee
Dimensional Analysis: Social Capital
Academy Health June 2010
Dimensional Analysis: Traditional/Secular
Academy Health June 2010
Dimensional Analysis: Traditional/Secular
Academy Health June 2010
Dimensional Analysis: Long
Long--Term Orientation
Academy Health June 2010
There’s
There s Something Going On…
On
But: Limitations…




Culture is a soft concept, and analysis
relies heavily on authors in humanities
((Fischer,, Webb)) not sciences
Social science bias (vs., e.g., biology)
U i comparison
Unit
i
is
i not quantitative
i i
Regional medication adherence data
would help tease out consumer
engagement
Academy Health June 2010
Policy Implications:
Three Thought
g Paradigms
g



Public Health Positivism: Publish rankings
and demand improvements
P t d i
Postmodernism:
Take
T k cultures
lt
and
d
associated values as a given; celebrate
diversity
Di
Disparities:
ii
Is
I there
h
a “Scottish
“S
i h Effect”
Eff ” at
work in the U.S.?
Academy Health June 2010
Conclusions



S
Scorecards
d and
d rankings
ki
may unfairly
f il
stigmatize providers, public health
officials, and populations.
Given diversity of regional subcultures
subcultures,
best to formulate consumer engagement
policies at state le
level.
el
If p
provider payment
p y
is tied to consumer
engagement, will providers be deterred
from serving certain populations?
Academy Health June 2010