Public health workers consider the customs of people and communities, especially when they try to encourage the acceptance of health promotion and disease prevention programs or policies. Customs are more than aggregates of individual habits. They are regular, patterned, learned, and traditional ways of appearing or behaving in response to a given situation or occasion. Customs may be reflected in language, greetings, communications, religion, and certainly in health practices that distinguish one social group from another. The complexity of the study of customs was emphasized by the anthropologist Ruth Benedict, who noted in the 1930s that traditional customs the world over consist of a mass of detailed behaviors more varied than that which any one person could ever evolve individually.
Customs are derived from social norms, which are those rules or standards that guide, control, or regulate proper and acceptable behavior of a group. These norms define the shared expectations of a group and enable people to anticipate how others will interpret and respond to their words and actions if there is deviation from a custom. For example, if one has an infectious disease, typically the custom within the general community is to act in a manner to prevent infecting others. Failing that, the customary responses from others may range from ignoring the individual's behavior, verbally reprimanding, or even ostracizing him or her for threatening the health of other members.
A custom may exist at the level of a folkway or a more. Each of these concepts help demarcate the strength and importance of a custom held by a particular group relevant to a particular situation. The concept of folkways was developed by the American sociologist William Graham Sumner and his followers in the early 1900s. "The ways of the folk" arose and persisted over time as repetitive and accumulative patterns of expected behavior for responding to similar social situations or individual needs. They ultimately became incorporated into tradition and received some degree of formal recognition but were not considered of moral significance. Folkways may be reflected in the everyday habits and conventions people obey without giving much thought to the matter, for example, eating three meals a day, drinking alcohol but not to a state of drunkenness, or using the group's "right way" to cure disease. People who violate folkways may be labeled eccentrics and as a rule they are tolerated by the group.
When certain folkways become well established and are regarded by general agreement as highly important and obligatory, as evidenced by strong sentiments against deviation and by severe punishment for violation, they become mores. Mores are customs that represent the absolute truth to the particular group and are the norms people consider vital to their well being and to their most cherished values. They typically take the form of laws, for example, prohibitions against incest, drunk driving, and child abuse. In contrast to folkways, violations of mores by people or groups can provoke intense reactions ranging from being ostracized, beaten, jailed, exiled, or executed.
From the moment of birth, the customs into which the people are born shape their experiences and behavior. In many groups, health-related behavior may be custom bound and very normative—tradition sets the precedent and solves problems, whether by authority or by consensus. Individuals are required to learn about the specific customs that shape their health behavior and to perform what they have learned. In reality, however, by the time children can think independently, the health-related customs of the family group have become an intimate part of their personalities. They do not question these customs, which become deeply held and extremely difficult to change over time. For example, the manner of tobacco, alcohol, and drug use in some groups and communities have become customs or norms, even though such use carries major health risks. Any attempts to eliminate or modify or reverse behaviors so integrally tied to social customs often provokes hostile resistance to a new health program that intends to reduce health-related risks. Also, in many groups the custom is not to talk about certain sensitive topics, such as cancer or the sexual activities of adults or teenagers relevant to preventing pregnancy. For instance, in a particular ethnic group, the custom of its members may be to shun any discussion of cancer. The effect of this custom discourages individuals from initiating early screening behaviors that could save their lives.
Sometimes it is necessary to try to change or circumvent established customs in a community, particularly when this can bring modern health procedures for reducing particular health-related risks. Changing folkways and mores can be a very slow process, and it is not until their functional utility has disappeared that they may gradually change. New practices may then become embedded in the community as new values to be transmitted from one generation to the next. This requires public health workers to gradually adapt the customs and values of a community rather than trying to abruptly and totally change them.
Michael V. Kline
(see also: Acculturation; Assimilation; Benefits, Ethics, and Risks; Cultural Norms; Ethics of Public Health; Ethnicity and Health; Immigrants, Immigration )
Benedict, R. (1935). Patterns of Culture. Boston: Houghton Mifflin.
Huff, R. M., and Kline, M. V., eds. (1999). Promoting Health in Multicultural Populations. Thousands Oaks, CA: Sage Publications.
Kroeber, A. L. (1948). Anthropology. New York: Harcourt, Brace.
Sumner, W. G. (1906). Folkways. Boston: Ginn.
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