Generally speaking, the influence of culture (in this broad sense) on health and well-being has been seen as distal and diffuse, pervasive but unspecified. Yet it seems plausible, if not self-evident, that cultural characteristics such as materialism or individualism can have as important an impact on psychosocial factors such as social support and personal control as socioeconomic inequality—perhaps even more important.
However, the neglect of culture is surprising in some respects, but not others. It is surprising given that some of the earlier social epidemiological research pointed to its significance. It is unsurprising in that cultures tend to be “transparent” or “invisible” to those living within them because they comprise deeply internalized assumptions and beliefs, making their effects hard to discern. As Corin says, cultural influences are always easier to identify in unfamiliar societies. Our own cultures appear to constitute a natural order that is not itself an object of study. This impression, she says, is an “unsupported ethnocentric illusion”.
Another reason for underestimating the role of culture is the extent to which its impacts are “refracted” through a host of other, more specific influences, including a person’s personal circumstances and temperament (this is also true of other distal determinants of health). In other words, changes that affect everyone can, nevertheless, affect people differently and contribute to specific problems that only some experience.
A third explanation is that culture is a much debated and contested subject, defined and used in many different ways in different disciplines and even within the same discipline. Culture, as I use the term here, refers to the language and accumulated knowledge, beliefs, assumptions, and values that are passed between individuals, groups, and generations; a system of meanings and symbols that shape how people see the world and their place in it and give meaning to personal and collective experience; or, more simply, as the knowledge we must possess to function adequately in society.
In discussing the effects of modern Western culture on health, I do not mean to suggest that culture exerts a uniform effect on everyone, regardless of gender, class, and ethnicity; or that individuals passively absorb cultural influences, rather than interacting actively with them. It follows that, just as inequality can be studied at both population and individual levels so too can culture.
The psychological and sociological literatures suggest powerful effects of culture on psychological well-being. Take materialism, by which I mean attaching importance or priority to money and possessions (and so broadly equate here with consumerism), and which underpins consumption-based economies. Many psychological studies have shown that materialism is associated, not with happiness, but with dissatisfaction, depression, anxiety, anger, isolation, and alienation. Human needs for security and safety, competence and self-worth, connectedness to others, and autonomy and authenticity are relatively unsatisfied when materialistic values predominate.
People for whom “extrinsic goals” such as fame, fortune, and glamour are a priority in life experience more anxiety and depression and lower overall well-being than people oriented towards “intrinsic goals” of close relationships, self-knowledge and personal growth, and contributing to the community. People with extrinsic goals tend to have shorter relationships with friends and lovers, and relationships characterized more by jealousy and less by trust and caring.
As materialism reaches increasingly beyond the acquisition of things to the enhancement of the person, the goal of marketing becomes not only to make us dissatisfied with what we have, but also with who we are. As it seeks evermore ways to colonize our consciousness, the market both fosters and exploits the restless, insatiable expectation that there must be more to life. In short, the more materialistic we are, the poorer our quality of life.
Individualism, by which I mean placing the individual at the center of a framework of values, norms, and beliefs and celebrating personal freedom and choice, is another cultural quality with profound significance for well-being, but here the evidence is contradictory. Well-being is associated with several qualities that individualistic societies should encourage, notably personal control and self-esteem; individualism is, after all, supposed to be about freeing us to live the lives we want. Historically, individualization has been a progressive force, loosening the chains of religious dogma, class oppression, and gender and ethnic discrimination, and so associated with a liberation of human potential.
However, just as the reality of commitment differs from the ideal, so the reality of freedom differs from its ideal, especially when it is taken too far or is misinterpreted. Sociologists note that individualization has transformed identity from a “given” into “task”; it has replaced determination of social standing with, in Bauman’s words, “compulsive and obligatory self-determination”. The individualized life is a fate, not a choice; we cannot choose not to play the game.
This process has had a range of consequences: a heightened sense of risk, uncertainty, and insecurity; a lack of clear frames of reference; a rise in personal expectations, coupled with a perception that the onus of success lies with the individual, despite the continuing importance of social disadvantage and privilege; and a surfeit or excess of freedom and choice, which is experienced as a threat or tyranny. To cite Bauman again, there is “a nasty fly of impotence in the ointment of freedom”, an impotence that is all the more upsetting in view of the empowerment that freedom was expected to deliver.
An important means by which individualism and materialism affect well-being is through their influence on values. Values are a core component of culture, a property of societies and their people and institutions, as well as of individuals. Like culture more broadly, values have been underestimated in health research because their effects are hard to measure: they are abstract, generic, pervasive, flexible, and internalized (just the sort of “rules” complex adaptive systems like human societies need). Values provide the framework for deciding what is important, true, right, and good, and have a central role in defining relationships and meanings, and so in determining well-being.

Question 1: Why has culture been ignored? Answer this question in about 80 words. (5 points)
Question 2: How does culture affect people? Answer this question in about 80 words. (5 points)