People do not live in a vacuum. They are the product of a whole universe of beliefs and cultural values. These beliefs may run counter to the health advice they might receive. A great deal of health promotion activities and patient-centric research, if conducted properly, needs to involve a firm understanding of the health beliefs shared by the target population. Considering a patient’s values transforms them from a two-dimensional research subject into a three-dimensional living, breathing being.

These are beliefs and perceptions held by people about their health and go to the core of their health-seeking behaviours, lifestyle attitudes, clinical care and influence their trust in healthcare professionals. They also mould health practices. They shape how people live their lives: how they express pain, experience symptoms, ask for help, accept change or adhere to treatment regimens. This is the seam that runs through all aspects of an individual’s life and are rooted deeply in an individual’s cultural norms.

Not all health beliefs and practices are harmful or in conflict with medicine. Drug developers sometimes look at folk beliefs and “old wives’ tales” about remedies and try to medicalise them. The evidence of this can be seen in attempts to make medical use of cannabis plants. Seaweed extracts have recently become an area for drug development for their anticancer and antimicrobial properties and could form part of a new generation of antibiotics and cancer treatments. Psilocybin mushrooms are being seriously considered for the treatment of depression, addiction, OCD and anxiety. Herbal drugstores have sold stinging nettle seeds as a natural, mild amphetamine for many years. All of these firmly have their origins in folk health beliefs. And these run deep through time. Before antibiotics, herbal and fungal remedies to treat infections and wounds have always been with us: Ötzi, the 5000-year old iceman, had birch fungus in his digestive system and traces of a form of penicillin were found in the remains of our cousins, the Neanderthals.

Some beliefs influenced medical thought. In early Chinese medicine, the body was envisaged as a reflection of how the Chinese Empire operated: bodily fluids seen as imperial waterways, organs were imagined as officials who directed the fluids. Modern descriptions of anatomy and explanations of disease are replete with metaphors such as this (musculus, arterial wall, amniotic bag, banjo string), which, in turn, have their origins in how people imagine health and the body. 

From the vantage point of the 21st century, we can see how some beliefs have been obscured by time and dispelled by new evidence: the demon possessions in the Bible were probably only descriptions of seizures, the three stages of pregnancy in Ancient Rome seem bizarre to us now, as does the Incan practice of trepanation to treat mental illness. The belief in 18th century Italy that malaria was caused by bad air (mal’aria) from swamps or that, during the ‘Scramble for Africa’ era, malaria could be caught from Africans, rather than mosquitos, are plain foolish (and offensive) now. Perhaps in centuries to come, beliefs we hold dear now may be greeted with similar ridicule.

 Other contemporary health beliefs seem to be idiosyncratic or motivated by contrarianism. Examples include US President Trump’s ‘finite battery of the life force’ theory, a conviction that is perhaps shared by no one else, or the serious belief by some groups that smoking does not cause cancer (or that the Earth is flat, or that there is a Reptilian elite, or that Paul McCartney died in the 60s, etc.). This is where we edge towards health beliefs causing harm to oneself and to others.

Then there are beliefs about perceptions of risk that really do cause harm. These include workers in Chernobyl believing that vodka was an effective antidote to radiation exposure. Another example is the reported practice in the Caribbean of engaging in sex with a virgin can cure a person of sexually transmitted diseases.

Worse still is when governments reinforce and institutionalise local beliefs. AIDs denialism under the Mbeki government in South Africa, where beetroot and garlic were promoted as serious treatments for HIV/AIDS. Ugandan President Museveni who promoted abstinence as the best preventive measure against HIV infection and withdrew the provision of free contraception is another example. In both countries, there was a significant increase in new HIV/AIDs cases. There are many instances where health beliefs become serious obstacles to fighting pandemics. This is currently the case in the Kivu regions of the Democratic Republic of Congo, where some people refuse to believe that Ebola exists, even when confronted with symptoms. Why bother seeking treatment for a disease that does not exist?

There are health beliefs that are shaped by religious convictions, such as the denial of blood transfusions amongst Jehovah’s Witness or Bob Marley’s refusal, on religious grounds, to amputate to stop the spread of cancer. Then, there are beliefs relating to health where boundaries between culture and religion have been blurred over time: male circumcision is an example of this. What came first? Was the cultural practice encoded into the religious or vice versa?

One of the areas we are most interested in is health beliefs in multicultural contexts: how do health services manage in large multicultural centres where there are multiple, competing and sometimes colliding health beliefs? How do front-line staff in the UK National Health Service deal with this? How are differing cultural beliefs about health accommodated and what happens when they cause harm? Are there culturally-based health beliefs that are dismissed out-of-hand and there any that are taken seriously when counselling patients? If so, is it a numbers game?

In multicultural societies, how do health promotion activities take shape? What happens when a set of health beliefs shared by one community run contrary to good medical practice, or are in conflict of the mores of the mainstream culture? There are degrees of beliefs and practices within specific cultures and how they are addressed depends on the threat to individual and group well-being: cooking with ghee is one thing, albeit harmful, female genital mutilation is another. How does a primary school in Leeds, for example, deal with evidence of female genital mutilation in its midst? Does it turn a blind eye, accepting it as a legitimate cultural practice for some groups of people? Or does it address the issue by education or does it inform the police immediately? What safeguarding procedures and educational materials are already in place? How effective are they? We are interested in how these and similar issues are addressed via health promotion activities.

This article introduces this section of the blog and will present and discuss health promotion activities, as well as examples of health beliefs and practices from around the world.

By Mark Gibson, Health Communication Specialist

17th September 2019, United Kingdom

References:

• Clark R, A dose of AI, Fit for the future: medicine’s new frontier, The Spectator, 27th April 2019

• Let the magic into the daylight, The Economist, June 8th 2019

• Noble-Wilford J, Lessons in Iceman’s Prehistoric Medicine Kit, The New York Times, December 8th 1998 [retrieved from: https://www.nytimes.com/1998/12/08/science/lessons-in-iceman-s-prehistoric-medicine-kit.html]

• Barras C, Neanderthals may have medicated with penicillin and painkillers, New Scientist, 8th March 2017

• Lo V, Stanley-Baker M, Chinese Medicine, A Global History of Medicine, ed. Jackson M, OUP, 2018

• Davisson L, Leon I, Metaphors in English, French and Spanish Medical Written Discourse, Elsevier Encyclopedia of Language and Linguistics. 2nd edition, ed. by Brown K, Elsevier 2005.

• Matyszak P, 24 hours in Ancient Rome, Michael O’Mara Books Limited, London, 2017

• Jones PA, Word Drops. A Sprinkling of Linguistic Curiosities, Elliott and Thompson Limited, London, 2015

• Schumaker L, History of Medicine in Sub-Saharan Africa, A Global History of Medicine, ed. Jackson M, OUP, 2018

• Cilizza C, It's time to revisit Donald Trump's 'battery' theory of life force, CNN, February 8th 2019 [retrieved from: https://edition.cnn.com/2019/02/08/politics/donald-trump-exercise-health-physical/index.html]

• Maia V, Chernobyl, onde vivem os fantasmas e floresce o turismo, Visão, 25 January 2018

• Gray G, Fighting for life in a time of AIDS denial, New Scientist, 25 March 2017

• Vinck P, et al., Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey, The Lancet, Volume 19, Issue 5, P529-536, 1st May, 2019 [retrieved from https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30063-5/fulltext]

• Safeguarding Procedures. Female Genital Mutilation, Leeds City Council, December 2015 [retrieved from https://leedschildcare.proceduresonline.com/chapters/p_fgm.html]

© 2019 Mark Gibson, protected under British Copyright Law 1988.