Culture, Behavior, and Health

“Culture” is widely invoked as an explanatory framework—often rather vaguely constructed—for the behavioral choices of people and organizations, including in relation to health. Often, though, it is invoked as if a kind of historicized instruction manual, rooted in past precedent and scaffolding current beliefs and preferences—an inherited blueprint of values and norms defining or delimiting present behavior and prospective choice. But culture is dynamic, and culture and behavior are interactive. What people do becomes, over time and in the social aggregate, what they believe is to be done, what is right to do, and, ultimately, “what we do.” Pierre Bourdieu captures this interactivity, this historically embedded active process in his ideas of habitus and praxis. In a world in which diverse identity groups are coming into increasing contact under processes of globalization, escalating population mobility, movement and migration, the premise of “culture” as a defining framework for a people’s beliefs, preferences, choices, and behaviors becomes increasingly complex and contestable. Pressurized by competition for increasingly scarce resources—for example, in public goods and services—the role of culture in shaping social values may be better understood as a medium of engagement, in which normative behavioral prescriptions may be asserted, sometimes powerfully, but also subjected to challenge and change. Health—as a spectrum of ideas of wellness and illness, of infectious and noncommunicable conditions, of social determinants, and modes of clinical care—offers a particularly rich field of objective conditions and subjective interpretations in which to explore in more concrete detail the way culture operates. This chapter will discuss ways in which “culture” is defined and understood, using illustrative examples from the fields of infectious disease and immunization, noncommunicable diseases and diet, and their relation to behavior and health.