Cultural Trauma as a Driver of Health Disparities

A recent article published in the Social Science & Medicine journal explores the relationship between cultural trauma and health disparities. This work expands on research among marginalized communities who have been denied access to protective resources and have experienced forced relocation, cultural loss, and other destructive forces at the hands of dominant colonialist groups. The authors, public health sociologists Andrew Subica and Bruce Link, describe cultural trauma through the lens of a “resource deprivation/loss and social disadvantage perspective.”

A number of researchers have pointed to the need for culturally attuned understandings of how trauma can affect issues like health outcomes and healing, along the lines of things like racial trauma and trauma associated with colonialism.

Related, some research suggests that turning to mobilize community resources and modes of healing can reduce the risk of PTSD.

The current article seeks to explain the relationship between cultural trauma and health disparities within a framework that connects existing research on the effects on cultural trauma with a theoretical model “linking cultural trauma to health disparities from a resource deprivation/loss and social disadvantage perspective.”

The authors define culture as:

In explaining cultural trauma specifically, they state that it is an “overwhelming and often ongoing physical or psychological assault or stressor perpetuated by an oppressive dominant group on the culture of a group of people sharing a specific shared identity/affiliation (e.g., race/ethnicity, nationality, religion).”

They differentiate cultural trauma from interpersonal trauma by pointing out that interpersonal trauma results from an assault by a person on an individual’s health. In contrast, cultural trauma involves an assault “by a dominant group on an individual’s culture.”

This can range from force, threats of force, and oppressive policies which target marginalized populations with the purpose of “advancing” the dominant group’s interests—access to resources/labor, status/reputation, and more.

They note that cultural trauma may intersect with interpersonal trauma, as in the case of genocide and hate crimes aimed at members of minority groups. However, they argue that a cultural trauma lens allows for thinking about how these aggressions can generate “lasting disparities” down the line, even if people in a community were not the original recipients of these traumatizing events.

Using “fundamental cause theory,” the authors note that health disparities can persist for generations because of a community’s lack of access to resources aiding in protecting health and avoiding disease.

To qualify as a “fundamental cause,” three conditions must be met. The first:

• “It must impact multiple health outcomes in a population through multiple risk factors.”

The authors describe many indigenous American communities as falling under this description since their traumatic displacement and cultural loss continue to result in health disparities such as heart disease, suicidality, and alcohol use disorders.

The authors are careful to note, however, that cultures are also flexible and frequently resilient, such that we should avoid simplistic and perhaps stereotypical depictions of any marginalized community.

The second condition for qualifying as a fundamental cause:

• “The proposed factor must embody access to flexible resources (e.g., knowledge, money, power, prestige, beneficial social connections, freedom).”

Here the authors describe cultural traumas related to processes of discriminatory housing practices, barred access to intergenerational wealth accumulation, and more exhibited among some African American communities.

The third condition:

• “The proposed factor’s production of health disparities must be reinforced over time through multiple replaceable mechanisms.”

As an example, the authors explain that continuing through overt cultural traumas related to slavery, Jim Crow laws, and lynching, African American communities still experience discrimination through practices of mass incarceration, housing discrimination, and police violence.

The authors move on to describe three “essential cultural resources for health.” These are “cultural modes, institutions, and lands.”

Cultural modes are the shared norms, languages, cultural practices, and more that define any culture. These norms and practices are required for individuals of that culture to navigate the world and fulfill their needs successfully.

The disruption of these modes—for example, through colonialism and discrimination—can lead to several detrimental health effects. For example, healthy cultural modes are known to protect against anxiety and loss of self-esteem. In addition, the “devaluing/destruction of cultural modes by a dominant group” can lead to survivors of this destruction experiencing elevated rates of suicide, depression, substance abuse, chronic grief, and PTSD susceptibility.

Regarding institutions, research shows that “when individuals are afforded positive status within their cultural institutions, institutions protect against stress and support health.” These institutions range from “family, economic, legal, educational, religious, political, and health systems.”

When a community’s relationship to these institutions is one of devaluation, stress and health issues can result.

As an example, Aboriginal communities faced with forced relocation and erosion of cultural modes can experience deepened “poverty, unemployment, and ensuing health disparities such as tuberculosis, substance use, obesity, and early mortality.”

Forces such as physical dislocation through force, genocide, and disease – as well as “discriminatory policies that strip groups of existing cultural lands (i.e., material resources) while blocking access to future lands and other flexible resources” – can produce massive amounts of stress that impacts mental and physical health in the long term.

Moreover, fundamental cause theory argues that these kinds of discrimination and displacement must be “replaceable over time.” The authors explain:

They follow up by stating that what these “replaceable mechanisms” achieve is an ongoing “reinvigorated hierarchy” whereby dominant groups can keep marginalized groups disenfranchised over generations.

Discussing the mechanisms of cultural trauma transmission, the authors describe several direct and indirect modes.

“Cultural resource loss” and “cultural wounding” are two mechanisms of direct cultural trauma transmission. Cultural resource loss refers to the damage done by devaluing a culture’s modes, institutions, and lands. This denies people protective resources like cultural/ethnic pride, culturally grounded modes of coping and healing strategies, and supportive social systems like community and family networks.

Cultural wounding refers to the psychological and spiritual loss experienced under these conditions of oppression. There can be a “deep psychological injury” or a “soul wound” resulting from these discriminatory forces. It is “physically and emotionally destructive, manifesting in problems such as depression, anxiety, shared posttraumatic stress, and substance use” that can lead to “adverse health outcomes” such as diabetes, suicide, and cancer.

The authors note that these wounds can be felt across generations, “impacting offspring through exposure to daily reminders of the cultural trauma.”

For indirect mechanisms, the authors state that processes of stigmatization and decreased access to flexible resources are additional destructive social forces that can lead to health disparities.

For stigmatization, this can manifest as dominant groups othering marginalized groups through language and media images, for example, the use of language such as “immigrants,” “refugees,” “queer,” or “terrorists.” This contrasts with their “appropriate” designation as, for example, “Latin-Americans, sexual minorities, Muslims.”

Decreased access to flexible resources such as money, power, and status are also discussed. For example, the culturally traumatic denial of same-sex couples to inclusion in the institution of marriage denied millions of people access to employer-sponsored health insurance and partner-inherited wealth.

Many of these destructive cultural forces are passed down intergenerationally, such that Holocaust survivors, refugees, Indigenous populations, and other groups can experience secondary traumatization through passed-down trauma narratives, among other processes of intergenerational transmission such as epigenetic biological vulnerabilities.

These biological vulnerabilities can increase susceptibility to physical maladies such as depression, metabolic syndrome, and cardiovascular disease.

Among the positive interventions noted by the authors are efforts to mobilize community-based resources for healing and policy-based changes aimed at restoring the dignity and flexible resources of marginalized groups.

The authors conclude:

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Subica, A. M., & Link, B. G. (2022). Cultural trauma as a fundamental cause of health disparities. Social Science & Medicine, 292. (Link)