Cross-cultural psychology of health and illness
Summary of the lectures and literature (book + articles)
2023-2024
Ilse van Meurs
Week 1: Course overview, research methods & Chapter 1 + 4
Culture culture is information people get from one another through social learning OR a dynamic group of
people sharing a similar context or environment. It can be seen as a set of implicit and explicit
guidelines acquired as members of a society
Health & Illness positive concept of health and negative concepts of disease / illness / sickness are defined
differently in different cultures → culture influences:
● what constitutes health or illness → culture specific illnesses
● what is thought to cause health or illness → personalistic views / mechanistic views (mostly
western)
● what should be done for health or against illness → habits in terms of seeking health care
& acceptable health care practices
Culture & culture can be thought of as a set of implicit and explicit guidelines / information that individuals
Enculturation acquire as members of a particular society or context, regarding 1) how to view the world, 2) how
to experience emotions, 3) how to behave in relation to other people, 4) supernatural forces or
gods, 5) the natural environment
● enculturation = culture provides a way of transmitting these guidelines to the next
generation
Culture = a lens through which the individual perceives and understands the world that he inhabits
and learns how to live with it (Helman, 2007)
Enculturation transmitting guidelines to the next generation
Facts about 1. cultures change over time: dynamic
culture 2. there is high variability in individuals in the same culture
3. there is no clear cutoff point (due to immigration etc) → cultural boundaries are unclear
4. culture also involves a method of enculturation (a way that the guidelines are transmitted
to the next generation)
5. mind & culture are inseparable: the brain is shaped by experiences shaped by culture
6. cultural ideas don’t necessarily evolve to address universal problems. Rather they result
from social learning. Cultural practices often outlive their usefulness
7. there are as many variations within cultures as between cultures
Cultural cultures can be distinguished according to 5 dimensions
dimensions 1. individualism - Collectivism
theory ● how independent is a culture?
(Hofstede 2001) ● example: US/western europe = individualistic, China = Collectivistic
2. uncertainty avoidance
Exam: list these ● how do people deal with uncertainty & ambiguity (something can be understood in
+ come up with multiple ways; has multiple meanings)
an example for ● example 1:
each ○ high uncertainty avoidance: low tolerance for uncertainty and risk-taking →
minimize the unknown through strict rules, regulations
○ low uncertainty avoidance: accept unstructured situations & changeable
environments and try to have as few rules as possible
● example 2: teacher doesn’t know the answer → low uncertainty avoidance students
, are more accepting than high uncertainty avoidance students
3. power distance
● how hierarchical is a culture?
● how big is the difference between top and bottom of society? is it easy to move up?
● example:
○ countries with low power distance → more equality between parents and
children; parents are more likely to accept if children talk back to authority.
○ countries with high power distance → parents expect kids to obey without
questioning their authority
4. long-term - short-term orientation
● connection with tradition, also economic orientation
● how traditionally minded is a culture? are they open to change things?
● example
○ societies with long-term orientations: focus on the future in a way that delays
short term success → invest in children’s education so they get better jobs
○ societies with short-term orientations: focus on the near future; delivering
short-term success → expect children to provide for the family as soon as
possible; start with work as fast as they can
5. masculinity / femininity
● how distinct are gender roles? distribution of classical male/female traits
● masculine society: values assertiveness, courage, strength and competition
● feminine society: values cooperation, nurturing and quality of life
● high femininity score
● example
○ country with high femininity score: traditionally feminine gender roles are
more important: better maternity leave policies + more affordable child care
○ country with low femininity score: traditional roles less important: more
women in leadership positions + higher rates of female entrepreneurship
The 3 levels of 1. primary / deepest level (roots; hidden, stable & resistant to change)
cultures ● rules that are known to all, obeyed by all
● but: implicit and generally out of awareness
2. secondary level (social norms)
● underlying shared beliefs & rules, known to the
insiders, but rarely shared with outsiders
3. tertiary level (visible to outsider)
● explicit manifest culture, visible to the outsider,
social rituals, traditional clothing, festive occasions
● easiest to change
Degrees of Human universality (all same) VS Cultural variability (all different)
universality whether a process is universal or cultural depends on its definition:
1. abstract definitions → lead to evidence supporting universality
Human 2. concrete definitions → lead to evidence supporting variability
universality VS 4 levels of universality of psychological processes
cultural 1. nonuniversal: does not exist in all cultures, only some
variability ● example: abacus reasoning = counting tool
2. existential universal: exists in all cultures but different
exam: identify functions / solves different problems, and is not equally
the level of accessible across all cultures
universality ● example: success = motivating, failure = demotivating
in the west, opposite = east
3. functional universal: exists in all cultures and are used to
solve the same problems, but are more accessible to people
, from some cultures than others
● example: costly punishment of others (some spend 28% of their earnings to punish
the unfair ones, others spend 90%)
● example: attraction to similarity, role of negative affect in depression
4. accessibility universal: no variation in cultures
● example: social facilitation
● example: basic understanding of physics
● extent of universality in psych processes = unclear; research limited to northern
american undergraduates
General General psychology / absolutist
psychology VS ● assumes the mind operates according to natural and universal laws that are independent
cultural from context and content → people are the same everywhere you go
psychology ○ example: universal emotions
○ context and content are seen as noise that limits us in conceptualizing the central
processing unit (CPU, the brain)
Cultural psychologists / relativists
● the mind is shaped by context and content. Our brains grows in response to what we do
and what we experience. They argue that to fully understand the mind, you have to
consider the content of what one is thinking about
○ cultural information leads to meaningful actions, thoughts and feelings
○ psychological phenomena only exist within the context of a culture
WEIRD Western, Educated, Industrialized, Rich, Democratic
2003-2007 (Henrich et al 2010)
- 96% psychology research is based on these countries, but it's only 16% of world population
- 70% of the participants are psychology undergraduates
- 99% of first authors come from Western universities
Evidence for evidence for WEIRD thinking has been shown by contrasting
WEIRD thinking 1. industrialized VS non industrialized societies
2. western VS non-western societies
3. americans VS other westerners
4. university educated Americans VS other americans
(Cross-)cultural aims to better understand the full distribution of human psychology, and the implications of
psychology cross-cultural variation → learning about cross-cultural variation helps us to interact in a
globalizing world, especially in multicultural societies
Socio-eco has cultural implications: interaction with culture, specifically important for health
nomic status → differences in health behaviors within western cultures (SLAN study Ireland 2007)
1. smoking: lower SES = likelihood of smoking, higher SES = attempts to quit
2. lower SES = higher alcohol consumption
3. higher SES = more balanced & healthy food
Determinants
of health as
used by WHO
(Dahlgren &
Whitehead
1991)
, Color-blind emphasizes common nature, and ignores cultural differences
approach ● research: even trivial distinctions between groups often lead to discrimination
Multicultural recognises that group identities are different (particularly minorities). Ignoring these differences
approach tends to lead to negative responses → this is the supported one!
Error of we perceive our own culture as the standard of comparison. The tendency to judge negatively
ethnocentrism by comparing them to your own culture
● narrowed perception / distortion of other countries
● example: people from Argentina might think the Netherlands and Finland are very similar
Research 1. describe: what is happening
methods 2. explain: why is it happening
3. predict: what will happen next
4. change behavior: how can we alter what happens
approaches: Quantitative + Qualitative
methodological equivalence: how easily can you apply measures across cultures? → extensive
piloting and validation
Measurement Reliability may refer to: reproducibility, replicability, precision
quality Validity may refer to: internal validity, external validity, construct validity, ecological validity
Central themes 1. universality of a specific trait → looking across groups - link to levels of universality
in cultural 2. influence of a specific trait on thinking and behavior → looking within multiple groups
research 3. studying a culture as a whole rather than individuals → looking at cultural messages
Questionnaire a process of forward and backward translation to achieve ‘equilibrium’
translation 1. 2 independent forward translations need to be resolved
2. back-translation needs to be resolved (native speaker translates back to see differences in
interpretation & meaning)
3. repeat if necessary
4. validate in new population
Study effects & 1. reference group effects = response to questions may depend on the group that one is
biases using for reference (ex: ‘i am tall’ statement → avoid subjective measures)
→ can be controlled by using objective and concrete measures; specific scenarios +
quantitative questions (ex: frequencies of behavior) + behavioral & psychological measures
2. deprivation effects = tendency for people to value what they would like or do not have
→ no clear solution for this, except interpret results witch caution
3. perseverance effect = holding on to your views in the face of conflicting evidence
4. self-fulfilling prophecy = expectations lead to thinking you see confirmatory evidence →
looking for evidence for your expectations
5. representativeness bias = incorrect categorizing based on inaccurate features
6. fundamental attribution error = overestimating
internal causes and underestimation situational causes
7. belief perseverance effect = holding on to your views
in the face of conflicting evidence
Experimental methods
● within culture: tend to share same response bias and
reference group (subjective measures work)
○ within-group: each participant is assigned to
all of the conditions / treatments
● between culture: tend to share different response
styles and reference groups (subjective measures do
