Commentary: ‘Culture’, cultural explanations and causality

Eckersley provides a thought-provoking synthesis of a wide range of findings. Many will probably remain unconvinced. Showing evidence of changes over time in population averages of psychosocial factors such as anxiety, depression, and sense of control does not lead to the conclusion that cultural changes are responsible. As he notes, changes in culture may be the byproducts, rather than the determinants, of changing rates of mental distress. There are other non-cultural explanations with which to compete. However, the stark spatial and social patterning of all health behaviours is consistent with the possibility that cultural software is a contributor. Currently, epidemiologists lack even basic knowledge about cultural trends. The measurement of those trends will have to move beyond aggregating survey responses if we are to proceed. More importantly, social epidemiologists will be required to abandon either/or explanatory frameworks when considering the role of cultural factors relative to material deprivation. Envisioning how culture and material conditions interact synergistically will prove difficult for epidemiology, but may yield significant improvements in our ability to account for population patterns of health.