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You Say Banana, I Say Bahnahnah: Culture, Semantics and Disease

2010/03/26

Our culture and our language are inextricable linked. We “see” what we have words to describe, and that for which we have words is often determined by the culture and environment in which we live … hence the Inuit’s many different words for different types of snow. Snow is important to the well-being of Inuits. Health is important to many of us. So how does our culture and language affect how we see disease and health care in this country?

I have recently returned from a trip to sub-Saharan Africa. I was there as part of a study on how developing countries have prepared or responded to an influenza pandemic. Should the world experience another serious pandemic like the one in 1918, the forecast is that the developing world, in particular, will be hit very hard and suffer from many secondary impacts to food and livelihood beyond the ravages of the disease itself. Fortunately, the current H1N1 virus, while meeting the technical requirements for a global pandemic, was mercifully mild in its overall mortality and morbidity. H1N1 did provide a real-life exercise of what might happen and how countries might respond to a more serious pandemic.

From my conversations with various people in this area, I took away three related insights into how language and cultural beliefs may shape how this particular country will respond (or not) to a future, severe influenza outbreak. Each of these observations has cultural roots; they represent logical conclusions given the environment and experience of the people. Together, they could lead to a failure to take any effective action in the event of a serious outbreak.

1) Malaria or flu? In one of the common local dialects, the word for malaria is the same as the word for what we know as influenza. As they see it, when you are feverish and sick to your stomach you must be suffering from malaria. As a result, people treat the illness as if it were malaria. Whether or not it could be influenza is just not seen.

2) Flu is a white man’s illness. Perhaps as a result of an inability to “see” flu as distinct from malaria, there is a general belief in the region that flu is a white man’s disease. This belief was challenged when H1N1 began to spread in Africa. The fact flu cases were reported locally was quite shocking to many. Will they see the threat of future flu pandemic as a real threat, or was H1N1 just some “fluke.?”

3) It’s only worth worrying about if it kills you. This last belief puts the final touch on the whole scenario. In a region where a serious illness is defined by Ebola, a disease you can frequently survive is not worth worrying about.

If we perceive a situation using the words we have to describe it, then what are the health issues that we struggle to describe because our beliefs have shaped our language and perception? In our developed society, are we too educated and well informed to fail to recognize health issues in an “objective” way? I doubt it. Not so long ago, we thought smoking was OK. Over time, we learned to re-perceive this behavior and adopted beliefs and language like “second-hand smoke.” More recently, we have become concerned about the relationship of health and diets — but, as Jamie Oliver recently found out, be careful about where you travel to if you advocate healthy eating.

When I listen to the health care debates in Congress, I hear two cultures with two different sets of meanings, two different understandings, and even a different vocabulary for many aspects of health care. In this debate, the different cultures of conservatives and liberals are creating very different “realities” through which to see the health care needs and responsibilities of this country. Is any “objective reality” possible?

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