Epidemiology and Culture (review)

Culture is a little like dropping an Alka-Seltzer into a glass—you don't see it, but somehow it does something.

—Hans Magnus Enzensberger

When you think about the epidemiology of human health, statistics and quantitative methodology comes to mind. But after reading Epidemiology and Culture, by James A. Trostle, you will not be able to separate the thoughts of how culture influences all of epidemiology. This well-written book provides an excellent discussion of how culture influences epidemiologic research. It is an important book for anyone working in epidemiology of human health or interested in the sociocultural influences on the measurement of disease.

The author demonstrates the connection between patterns of disease and patterns of culture, explaining how researchers confront health challenges. He demonstrates his point using many examples of common epidemiologic issues that society has faced throughout time. His unique perspective as a medical anthropologist draws attention to the cultural aspects that affected these epidemiologic studies, from the research context to the implementation of changes and translation of the study into society. From the epidemiologic interventions after the cholera outbreak in South America in the 1990s, to the Framingham Heart Study, to the most recent outbreak of Severe Acute Respiratory Syndrome (SARS) in Canada and China in 2003, all are discussed with the cultural influences on the epidemiology studies brought to light.

Trostle argues that understanding this relationship will help us develop more appropriate health policies, better understand disease causation and treatment, and create more effective actions to enhance health and prevent disease. He describes the effect on culture on epidemiology as the anthropology of epidemiology. Although epidemiology is more statistical and quantitative, and anthropology is more textual and qualitative, the author sees them as working together. Traditionally, epidemiology studied problems within national borders and medical anthropology studied foreign cultures, but increasingly epidemiology is looking across borders and anthropology is looking within borders, so these fields are actually converging. Ultimately, both have the common objective of explaining the health of human populations.

Although some might think that this field is covered by social epidemiology, the emphasis here is on culture, over society. Nonetheless, Trostle argues it parallels social epidemiology by looking at the health effects of income, job stress, class, social support, occupation, and inequality as social epidemiologists would, but that it also allows scrutiny of international variability and the influence of categories and perceptions. He describes how culture itself can influence disease. Many diseases are influenced by where one is and whom one interacts with, what treatment people chose, and how diagnostic preferences of physicians from one culture to the next can influence national statistics.

In addition, Trostle points out that culture is always evolving; hence the diseases and problems continually change. As group norms change, people manipulate behavior for norms set by society and their culture. For example, at one time, many women had liver damage and muscle atrophy secondary to wearing corsets; today many women are experiencing problems secondary to breast implants, including scars, pain, and rupture. Our culture (and its values) is able to influence the diseases seen in our society, and we have to adapt to address them with culture in mind.

This book also reveals how measures used by epidemiologic research are influenced by culture. All measures are somewhat culture-bound and more arbitrary than researchers would prefer. When epidemiologists report data according to the categories of person, place, and time, all such data are influenced by culture. An example of person influenced by culture is race, and race categorization is getting more and more arbitrary and complex. The cultural pathways by which place influences health are exemplified by the way that disease seems to cluster in terms of neighborhoods. Neighborhood social environments influence many diseases, including cardiac mortality in women. Similarly, time is influenced by culture: time manipulation in the United States is associated with an increased rate of fatal car crashes each year after returning to Standard Time from Daylight Savings Time.

Ultimately, because culture plays a role...