Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
Acknowledgements
Book Review
Book Reviews
Classics In Indian Medicine
Clinical Case Report
Clinical Case Reports
Clinical Research Methods
Clinico-pathological Conference
Conferences
Correspondence
Editorial
Eminent Indians in Medicine
Errata
Erratum
Everyday Practice
Film Review
History of Medicine
HOW TO DO IT
Images In Medicine
Indian Medical Institutions
Letter from Bristol
Letter from Chennai
Letter From Ganiyari
Letter from Glasgow
Letter from London
Letter From Mumbai
Letter From Nepal
Masala
Medical Education
Medical Ethics
Medicine and Society
News From Here And There
Notices
Obituaries
Obituary
Original Article
Original Articles
Review Article
Selected Summaries
Selected Summary
Short Report
Short Reports
Speaking for Myself
Speaking for Ourselve
Speaking for Ourselves
Students@nmji
View/Download PDF

Translate this page into:

Editorial
34 (
4
); 193-196
doi:
10.25259/NMJI_846_21

Covid-19 Through a Cultural Looking Glass

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

To cite: Sharan P. Covid-19 through a cultural looking glass. Natl Med J India 2021;34:193–6.

The Covid-19 pandemic is global in terms of its spread, restrictions on personal freedoms and economic crises.1 However, striking differences have been observed in mortality, rates of transmission, policies, and beliefs and behavioural responses, in relation to Covid-19 in different societies and groups. The interplay between a cultural context and the experience and behaviours related to Covid-19 are thus germane to its understanding as it is a disease spread by social contact and managed at least in part through social interventions.

Friedler states that we are in many ways the architects of our own pandemics. According to her, wet markets that represent heightened risk for novel pathogen behaviours and host crossovers due to their capacity to link sociocultural and eco-biological networks act as biocultural hubs.2 These markets exist because of their cultural value (e.g. valued social interaction, beliefs that local products are healthy, cultural value of traditional medicines derived from wild animal products). The timing of the Covid-19 outbreaks appears to have intimate cultural links, e.g. the Spring Festival in Wuhan, China and the festival season in India acted as super-spreader events.2,3

Societal differences in terms of individualism–collectivism, ‘tight–loose’ orientation and relational mobility

Individualistic cultural contexts tend to prioritize an independent construal of self, individual freedom and fulfilment of personal goals; on the other hand, collectivistic societies prioritize group ties and responsibilities. In the context of the pandemic, governments in individualistic societies might be hesitant to promulgate compulsory measures (e.g. lockdown, wearing of masks) and citizens might be less accustomed to following mandatory health advisory. In a study comparing data from 98 countries, collectivism was associated with fewer cases of Covid-19 and fewer deaths per million people, although the country’s economic status played a stronger role in predicting those variables.4 The promotion of collectivism and the action for the common good has been advocated as a strategy for public health messaging because it increases engagement with official recommendations.5

Individualism and collectivism also influence people’s conceptualization of health and illness. Western biomedical models, based on analytical thinking, frame illnesses as intrusions into bodily systems; while holistic medical systems such as Ayurveda consider illness as an imbalance within the individual’s system existing in a broader environmental context.6 In consonance, even while supporting vaccinations, Ayurvedic physicians have proposed interventions to support global bodily functions (e.g. strengthening immune and respiratory systems) to prevent infection and manage the disease.7

Tightness–looseness, a measure of the strictness of societal rules, may also be related to the formal and informal enforcement of and adherence to restrictive measures. In a study on datasets from 54 countries, Cao et al. found that reported cases and deaths per million inhabitants were positively associated with greater looseness.8 It should be remembered that all communities negotiate social norms to strike a balance between freedom and constraint. Tight rules regarding social distancing are critical, yet looseness within these constraints might help in the development of creative solutions to contain the pandemic and help people feel connected.9 Thus, different strategies might be needed in different cultural contexts.

Relational mobility denotes the degree to which interpersonal relationships are fixed or voluntary in each group or society. High relational mobility (with greater propensity for making new social connections) might increase the chances of spread of Covid-19 within the sociocultural groups. Salvador et al. found that relational mobility was correlated with the rise in the number of Covid-19 cases and deaths across 39 countries.10 Further, geographical mobility of relationally mobile groups could potentially spread the virus across geographical areas.

Intersection of culture and marginalization

Social amplification impacts risk perception within groups and can create grounds for social contagion of beliefs and behaviours in crisis situations. Disease threat is often associated with higher levels of ethnocentrism and greater intolerance and punitive attitudes toward outgroups. Some stigmatized groups may even face dehumanization (e.g. stereotyped as dirty and carriers of disease and pestilence) based on processes embedded in larger-scale, institutional discrimination.11

The Covid-19 pandemic has caused or worsened and exposed discrimination against minorities in several ways: prejudice and aggression (e.g. ethnic Asian people); over-representation in frontline and essential services; over-representation in displaced and incarcerated communities; and structural disadvantage in treatment access and vaccine distribution.11 This, in combination with pre-existing discriminatory health inequities, has led to disproportionate detrimental impacts of Covid-19 in minority communities.12

In India, people from northeastern states with more phenotypically east Asian features have been discriminated against and attacked.13 Conspiratorial rumours blaming Indian Muslims for the spread of coronavirus were propagated.14,15 Marginalized groups (e.g. various castes and tribes) were already vulnerable because of pre-existing economic and employment disparities and health inequities. Higher levels of frontline exposure, poverty, homelessness, displacement, overcrowding, food and water insecurity, and lack of access and unaffordability of resources made their situation worse.16 Increased rates of depression, anxiety, trauma and other mental health issues have been reported in marginalized communities compared to other groups.14 A prominent phenomenon observed during the lockdown in India was the long march of migrant workers from cities to their native places.17,18 The dehumanization of these migrants (e.g. they were sprayed with chemical disinfectants and denied even minimal support) and the hardships suffered by them during their journeys might have left them with worse mental and bodily scars than the threat of the virus itself.19

Intersectionalities between cultural and other sociodemographic categories such as gender, age and social class affect the rates of transmission and morbidity due to a disease. Unexpectedly, the levels of stress reported by younger people in several countries were consistently higher than those reported by older adults despite higher social isolation implemented on the latter.20 Globally, more men than women have died of Covid-19 disease. While this may be related to biological differences (e.g. immune responses and smoking patterns), behavioural factors may also play a role. Use of niqabs or burkas by Muslim women might work as a protective factor against contamination, while preferences for facial hair in men might act as a risk factor for contamination. Gender segregation and differing levels of involvement in various societal spheres (e.g. almost 70% of frontline health and social care providers globally are women) might also influence the likelihood of exposure.21 In addition, quarantine measures pose more risks for women, children, elderly and people with disabilities to experience abuse.2,9 Chronological patterns of transmission of the virus (greater spread in richer sections initially and in poorer sections later) and case fatality due to Covid-19 (often due to comorbid conditions) were related to social class.22

The disparities in access to healthcare and treatment are reflected in the distribution of the Covid-19 vaccines. Many rich countries negotiated private deals with pharmaceutical companies for early access to several vaccines outside the WHO’s Covid-19 Vaccine Global Access Facility (COVAX); hence, the equitable distribution of vaccines between countries and within a given nation to disadvantaged marginalized groups continues to be a matter of concern.23

Common threats can create opportunities to reduce sectarian prejudices. Coordinated efforts across individuals, communities and governments to fight the spread of disease can send signals of cooperation and shared values. Since communities may differ in levels of trust in social institutions (including the healthcare system), there is a need for targeted (culturally sensitive) public health information and for partnerships between public health authorities and organizations trusted by minority/marginalized communities.9 Airhihenbuwa et al. have proposed a cultural model of public health messaging that has three domains: cultural identity, relationships and expectations, and cultural empowerment.24

Political polarization and conspiracy theories

Affective polarization can privilege partisan beliefs (e.g. through self-selection of polarized news sources or partisan ‘echo chambers’) and decrease trust in public health information, so different segments of the population may arrive at different conclusions about threat perception and appropriate actions.9 In the USA, certain news channels recommended precautionary measures against the transmission of Covid-19, while others downplayed the severity of the pandemic in 2020. This impacted their viewers’ risk perception, adoption of preventive behaviours, and infection and fatality rates.25 By highlighting an overarching identity, politicians, the media and opinion leaders can help reduce political division around various issues. Since misperceptions underlie polarization, combating misinformation that could generate partisan reasoning and inaccurate beliefs could help.9

People are likely to accept conspiracy theories about events that have serious consequences. Regarding the Covid-19 pandemic, some conspiracy theories concerned the origins of the SARS-CoV-2 virus (e.g. it is a bioweapon created to wage wars), while others focused on prevention and cure (e.g. medical treatment should not be trusted and alternative remedies should be used).9 Belief in conspiracy theories is associated with vaccine hesitancy, prejudice and hostility towards outgroups. The emergence of Covid-19 added to the pre-existing trend of propagation of anti-vaccination rumours through social media. Propagators manipulated information and fabricated facts to promote incredulity toward experts and polarization against purported common enemies (e.g. government or scientific community) depending on local, shared beliefs.26 Giving people factual information through trusted voices can combat belief in conspiracy theories and fake news.9

The individual in the cultural context

Individual attitudes and beliefs are influenced by cultural factors and motivate behaviours that affect the risks of contagion and impact of the disease. Collective narcissism is an individual trait that is grounded in broader political polarization and nationalist ideology. It involves a strong sense of identification with one’s own perceived group, feelings of collective entitlement, unrealistic beliefs about the ingroup, and outgroup hostility in reaction to perceived threat.27 Collective narcissism was positively associated with dissemination of conspiracy theories related to Covid-19; and negatively correlated with preventive behaviours such as washing hands and staying home.28,29

The cultural context also plays a role in individual adjustment and well-being. Collective optimism (a shared optimism about a group) was found to favour the espousal of effective coping strategies such as positive reappraisal during the Covid-19 crisis.30

Conclusions

The impact of every disease is contingent on how individuals, groups and societies understand it, experience it and respond to it. It is evident that dynamics of privilege and marginalization interact with cultural beliefs to influence subjective experiences of diseases and their outcomes. Understanding these dynamics can help in better communication and promotion of protective measures, help people cope with their current realities, and promote inequity repair and solidarity with marginalized communities.

Finally, the Covid-19 pandemic marks the beginning of a major cultural–historical change. Lusardi and Tomelleri have called the pandemic a cultural break point—a watershed between the relatively unreflective social configuration that was in place earlier and the one to come—with the consciousness that complexity of knowledge and global interdependency require collective awareness, political participation and shared responsibility.1

References

  1. , . The juggernaut of modernity collapses. The crisis of social planification in the postCOVID-19 era. Front Sociol. 2020;5:611885.
    [CrossRef] [PubMed] [Google Scholar]
  2. . Sociocultural, behavioural and political factors shaping the COVID-19 pandemic: The need for a biocultural approach to understanding pandemics and (re)emerging pathogens. Global Public Health. 2021;16:17-35.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , . Plausibility of a third wave of COVID-19 in India: A mathematical modelling-based analysis. Indian J Med Res. 2021;153:522-32.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , . Culture, COVID-19, and collectivism: A paradox of American exceptionalism? Pers Individ Dif. 2021;178:110853.
    [CrossRef] [Google Scholar]
  5. , , , , , , et al. How fear and collectivism influence public's preventive intention towards COVID-19 infection: A study based on big data from the social media. BMC Public Health. 2020;20:1-9.
    [CrossRef] [PubMed] [Google Scholar]
  6. . Ayurveda: A distinctive approach to health and disease. Curr Sci. 2010;98:908-14.
    [Google Scholar]
  7. . Ayurveda and COVID-19: Where psychoneuroimmunology and the meaning response meet. Brain Behav Immun. 2020;87:8.
    [CrossRef] [PubMed] [Google Scholar]
  8. , , . Do national cultures matter in the containment of COVID-19? Int J Sociol Soc Policy. 2020;40:939-61.
    [CrossRef] [Google Scholar]
  9. , , , , , , et al. Using social and behavioural science to support COVID-19 pandemic response. Nature Human Behav. 2020;4:460-71.
    [CrossRef] [PubMed] [Google Scholar]
  10. , , , , . Relational mobility predicts faster spread of COVID-19: A 39-country study. Psychol Sci. 2020;31:1237-44.
    [CrossRef] [PubMed] [Google Scholar]
  11. , , . The social lives of infectious diseases: Why culture matters to COVID-19? Front Psychol. 2021;12:648086.
    [CrossRef] [PubMed] [Google Scholar]
  12. . Enough: COVID-19, structural racism, police brutality, plutocracy, climate change-and time for health justice, democratic governance, and an equitable, sustainable future. Am J Public Health. 2020;110:1620-23.
    [CrossRef] [PubMed] [Google Scholar]
  13. . From 'Chinky' to 'Coronavirus': Racism against Northeast Indians during the COVID-19 pandemic. Asian Ethnicity. 2020;22:353-73.
    [CrossRef] [Google Scholar]
  14. . Disparities, desperation, and divisiveness: Coping with COVID-19 in India. Psychol Trauma: Theory Res Pract Policy. 2020;12:582-84.
    [CrossRef] [PubMed] [Google Scholar]
  15. . Hindu-Muslim relations in times of Coronavirus. Studia. 2020;2:77-91.
    [CrossRef] [Google Scholar]
  16. , . A vulnerability index for the management of and response to the COVID-19 epidemic in India: An ecological study. Lancet Global Health. 2020;8:e1142-e1151.
    [CrossRef] [Google Scholar]
  17. . Migrant in my own country: The long march of migrant workers in India during the COVID-19 pandemic 2020-Failure of postcolonial governments to decolonize Bihar and rebuild Indian civilization after 1947. J Family Med Prim Care. 2020;9:5087-91.
    [CrossRef] [PubMed] [Google Scholar]
  18. , . Social policy, COVID-19 and impoverished migrants: Challenges and prospects in locked down India. Int J Commun Soc Dev. 2020;2:152-72.
    [CrossRef] [Google Scholar]
  19. , , , , , , et al. Neglect of low-income migrants in COVID-19 Response. . Available at https://blogs.bmj.com/bmj/2020/05/29/neglect-oflow-income-migrants-in-covid-19-response/ (accessed on 7 Aug 2021)
    [Google Scholar]
  20. , , . Who is the most stressed during the COVID-19 pandemic? Data from 26 countries and areas. In: Appl Psychol Health. Vol 12. . p. :946-66.
    [CrossRef] [PubMed] [Google Scholar]
  21. , . COVID-19: Cultural predictors of gender differences in global prevalence patterns. Front Public Health. 2020;8:174.
    [CrossRef] [PubMed] [Google Scholar]
  22. , . COVID-19: Exposing and amplifying inequalities. J Epidemiol Community Health. 2020;74:681-2.
    [CrossRef] [PubMed] [Google Scholar]
  23. . After a COVID-19 vaccine: Collaboration or competition? Health Aff. 2020;39:1856-60.
    [CrossRef] [PubMed] [Google Scholar]
  24. , , , , , , et al. Culture matters in communicating the global response to COVID-19. Prev Chronic Dis. 2020;7:200245.
    [CrossRef] [PubMed] [Google Scholar]
  25. , , , , , , et al. Partisan differences in physical distancing are linked to health outcomes during the COVID-19 pandemic. Nat Hum Behav. 2020;4:1186-97.
    [CrossRef] [PubMed] [Google Scholar]
  26. . Pseudoscience and COVID-19-we've had enough already. 2020 Available at 10.1038/d41586-020-01266-z (accessed on 7 Aug 2021)
    [CrossRef] [Google Scholar]
  27. , , , . We will rescue Italy, but we dislike the European Union: Collective narcissism and the COVID-19 threat. 2021136843022110029.
    [CrossRef] [Google Scholar]
  28. , , , . Collective narcissism predicts the belief and dissemination of conspiracy theories during the COVID-19 pandemic. PsyArXiv 10.3123.4/osf.io/4c6av. [Preprint]. 2021. Available at 10.31234/osf.io/4c6av (accessed on 7 Aug 2021)
    [CrossRef] [Google Scholar]
  29. , , , , , . Adaptive and maladaptive behavior during the COVID-19 pandemic: The roles of dark triad traits, collective narcissism, and health beliefs. Pers Individ Dif. 2020;167:110232.
    [CrossRef] [PubMed] [Google Scholar]
  30. , , . Trait optimism and work from home adjustment in the COVID-19 pandemic: Considering the mediating role of situational optimism and the moderating role of cultural optimism. Sustainability. 2020;12:9773.
    [CrossRef] [Google Scholar]
Show Sections