How culture affects even health care policy

health — By Bob Riel on July 27, 2009 at 7:10 am

One of the big debates going on in Washington and around the U.S. these days, of course, revolves around the nation’s health care programs. I’m no policy wonk, so I’m not going to wade into a debate about issues here, but rather point out that even health care is related to national culture and values. Jacob Weisberg described this connection in a recent issue of Newsweek. A good chunk of his column is devoted to exploring the pros and cons of our current system, but he also does a nice job of showing how culture and health care are related.

In his new book The Healing of America, the journalist T. R. Reid employs a clever device for surveying the world’s health systems: he takes an old shoulder injury to various countries. In the United States, a top orthopedist recommends joint-replacement surgery, costing tens of thousands of dollars. In France and Germany, doctors steer him instead toward a regime of physical therapy. In Britain, they tell him to go home. In India, he is treated, quite effectively, with herbs, massage, and meditation…

He’s right that we can learn much from practices elsewhere. But the lesson I took away from his book was somewhat different: health-care systems are not just policy choices, but expressions of national character and values. The alternatives he describes work not just because they’re well designed but because they reflect the expectations and traditions of their societies.

All advanced, wealthy countries have health systems that are more egalitarian and cost-effective than ours. Each also has its quirks, which reinforce familiar stereotypes. Britain, land of the stiff upper lip, provides what to us seems shockingly minimalist treatment…The Japanese, on the other hand, love doctors and visit them, on average, 14.5 times per year, three times the U.S. rate. They do this in an orderly, ritualized way, usually bringing a bottle of sake or cash in an envelope as a gratuity.

Interesting stuff. And if you want to know more details about culture and health care in the U.S., check out his piece.