Culture, Structure, and Health

     The term “American Dream” mentioned in Benoit’s article (2005) attracted my attention. The idea of American Dream essentially claims that all human are equal, and everyone can succeed and live a happy life through hard work. However, I think actually the American Dream is not attainable for everyone due to the existing inequality rooted in class, gender, race, age, and religion. But the Dream reflects the ethos of the United States. In American’s culture, personhood is established through individual effort. A morality is playing a role here. Thus illness can be viewed as a moral fault that is resulted by failed self-improvement. It reminded me an interview we conducted. When I asked the participant what influenced her choice of Sugar Sweetened Beverage (SSB), she said she would feel guilty if she consumed SSB. She believed health problems would occur if she consumed too many. In her value system, health is a personal business. The narrative is rooted in the structure of meanings and roles. It is very different from Chinese culture. For example, compare the American Dream with the “Chinese Dream”, the American Dream pursues individual honor, whereas the Chinese Dream aims to achieve country prosperity. The Chinese Dream was created by Chinese dominant power, the Communist Party, who is intended to maintain dominance through control people to strive for community interest, rather than individual benefit. The Chinese Dream is a part of ideology that is instilled into the mind of Chinese people. Powerful actors have the ability to shape the contexts where problems locate and influence people’s behavior. Therefore, the ways in which people in different culture construct the disease meanings are distinct. There is an example in the book “postcolonial disorders”. Chinese provincial government viewed HIV throughout epidemiological categories that associated with group rather than individual risk behaviors to HIV. For instance, the Han, which is the dominant ethnic group in China, believes that the Tai ethnic group has a characteristic of sexual promiscuity, and it result to the Tai group members’ higher risk and susceptibility of sexually transmitted infections. Hence, this interpretation of sexual risk places blame in ethnic groups or marginalized communities. I am thinking whether this is the structure that produces violence through restricting resources to borderlands and “hard-to-reach populations”. In other words, this distinct characteristic of Tai ethnic group, even though it is “perceived” by the dominant group, becomes a source of discrimination, and suffering. Thus I think listening to cultures and the narratives of structural violence could identify resource needs and the cause of suffering in the community, in order to promote social change.

     With regard to the “hard-to-reach populations”, I also was thinking there is a wall between the “reachable populations” and the “hard-to-reach populations”. The reachable populations enjoy most of the basic resources, such as food, money, and materials, but in the meantime, hard-to-reach populations endure pain of inadequacy of resources. Why? It is because they are in the other side of the thick wall, no one sees their situation, and no one hears their voices as well. The wall is built by the structure, the culture, and all of these cause inequality in race, gender, and socio-economic status. Interestingly, I think it is like a vicious circle. Culture is a constructor of meanings, values, and roles within which the community exists, and it also can become a barrier of the existence of the community. The web of violence that is knitted by the structure is covering over the head of the “hard-to-reach populations”. They are suffering, struggling, striving, and hovering. They need support and direction, and their nature of suffering requires to be understood. As mentioned earlier, there is a circle. Cultural difference is a start of meaning making process, and a cause of inequality as well. To jump out of the circle, we need to put culture in the center, recognize the differences the structure leads to, identify effective methodology for resistance the structural violence and make efforts to achieve social change.
     However, how can the "silent" voices be heard? It is indeed a larger question as we discussed. Generally, I think the marginalization is caused by the (1) marginalized communities' ignorance, they have little motive to change their situation and they do not take active action; and (2) intentional discriminate or oppress result from political, economic and cultural factors; and (3)inappropriate or insensitive intervention, their voices are not heard. To change the marginalized community's situation, I assume that the ways may include resisting to discriminate, and develop programs that are sensitive to the experience of the marginalized community. Initially, I am thinking about some potential avenues. First, provide communicative platform for whom need to express their needs; Further, create ethical dialogue by sensitive and respectful identification, in order to urge more willingness among marginalized groups; Third, I think conducting a research itself is also a process of raising their awareness to shout their voices out. The projects can be empowering for the participants, because the research induces them to reflect on and evaluate their experiences.