WHAT’S YOUR RESEARCH ABOUT?
We studied people’s ideas of and explanations for health in diverse urban neighborhoods, i.e. areas of a town or city that are home to people from a very wide range of backgrounds and communities. Specifically, we did our research in the Tannenbusch district of Bonn and the Mülheim district of Cologne.
HOW DID YOU GO ABOUT IT?
We applied what’s known as “mixed-methods research” in our project, meaning that we used a range of different approaches. The findings we’ve just published come from the first phase of the project, where we conducted in-depth interviews with migrants.
WHAT’S BEEN YOUR MOST IMPORTANT FINDING?
First, many people believe things that aren’t fully compatible with the biomedical understanding of health. This presents a major health communication challenge for everyone involved in healthcare. It’s also important to make medical professionals aware that people might have some completely different ideas about health and illness—and might thus be skeptical about the treatments being proposed to them. Second, everyone we spoke to essentially had their own idea of health and illness, which was influenced by some very different notions. A few of the interviewees, for instance, mixed religious explanations with shamanic concepts and biomedicine.
WHAT DIFFERENT VIEWS OF HEALTH AND ILLNESS CAN YOU DISTINGUISH BETWEEN?
There are essentially four groups, each of which explains health and illness in a different way. The first stresses supernatural forces such as gods and spirits, while the second combines these kinds of influences with their own behavior, such as exercising or avoiding stress. The third sees health as a balance—either a spiritual or physical one—that’s influenced by concepts like Ayurveda or Traditional Chinese Medicine. These are all about the balance between hot and cold or the body and its environment. The fourth group draws its ideas primarily from Western biomedicine. Often, however, people adopt several perspectives at the same time, a phenomenon known as medical diversity. This diversity shapes an individual’s understanding of health and influences what treatments they might prefer and will choose in different situations.
DO YOU HAVE ANY EXAMPLES TO ILLUSTRATE THIS?
Somebody we spoke to said that her husband fell ill because she hadn’t worn a headscarf, provoking God’s anger. This weighed heavily on her, because she felt guilty. Someone else, a young woman, told us about an eye infection that her mother had called the work of evil spirits. She said that a shamanic ritual by a “healer” had led her to make a full recovery. Experiences like this make it clear that people don’t always turn to the Western health system first of all.
WHAT WAS THE BIGGEST CHALLENGE?
It’s hard to make contact with people, because many don’t have time, aren’t interested or are afraid. This means it takes a lot of time and effort to produce basic knowledge in this little-studied field.
CAN YOUR RESULTS BE APPLIED TO OTHER PARTS OF THE WORLD?
That’s a tricky question; there are likely to be more types out there. You could probably take the findings that people’s views on health are highly diverse and originate from different cultural backgrounds and that they construct their own preconceptions and transfer them to other projects.
DO YOU HAVE ANY SPECIFIC RECOMMENDATIONS?
Differing understandings of health can disrupt doctor-patient communication and hamper access to medical care, so there needs to be awareness-raising among medical staff, and a basic knowledge of this diversity of health-related views has to be made part of their training. Building on this, training courses in communication should be developed in order to improve patient outreach. Diversity is particularly relevant in prevention measures, because many vaccination drives presuppose a biomedical understanding of the concept. Strategies like deploying vaccine ambassadors could be expanded. A diverse mix of medical staff should also be encouraged to share their knowledge, support their colleagues and adapt explanations in a culturally sensitive way in order to get more patients treated.
WHAT COMES NEXT?
The results we’ve obtained so far come from phase one. We’re currently analyzing a household survey on the prevalence of various ideas about health and running workshops on our results and access to health services. In the medium term, we’re planning a follow-up project on the translocal use of health services, e.g. in migrants’ home regions.
WHERE HAVE YOUR FINDINGS BEEN PUBLISHED?
Kevin Becker, Frauke Kraas, Carsten Butsch: “Migrants’ and immigrants’ understandings of health and disease. Medical diversity in two diverse urban neighbourhoods,” in: “Social Science & Medicine,” DOI: https://doi.org/10.1016/j.socscimed.2025.118851
WHERE CAN I FIND OUT MORE?
Adjunct Professor Carsten Butsch, Sustainable Futures Transdisciplinary Research Area, Department of Geography at the University of Bonn, email: butschc@uni-bonn.de, phone: +49 228-733917
