A conceptual framework

The entire way of life of a community (i.e., its culture), including social and economic conditions, form a major category of factors that, along with biological and environmental components, determines the nature, scope, and distribution of health problems in that community. The culture of a community determines the health behaviour of the community and of its individual members, and the cultural response of the community to the health problems it confronts determines its health practices. All these elements form an interacting subsystem within the overall cultural system.

The health behaviour of the individual is closely linked to the way he or she perceives various health problems: what they actually mean to him or her, on the one hand, and, on the other, his or her access to various relevant institutions. For example, when a poverty-stricken agricultural labourer consults the village medicine-man for problems associated with his wife's pregnancy, he is not necessarily a prisoner of his ‘traditional culture’: he may lack the financial means for seeking the help of the specialist obstetrician in the nearby town.

This complex whole embracing the cultural perception and meaning of health problems and the health behaviour of individuals within the context of the available and accessible health institutions is termed health culture. Like any other cultural entity, health culture undergoes change. Endogenous innovations, cultural diffusion, and purposive interventions from without all bring change to the health culture of a community.