Paradoxical
Patterns within a Single American Culture of Oral Health Care Reflect Different
Quality of Life Standards Community Dentistry and Oral Epidemiology
W. Penn Handwerker
and
Objective: This study
describes the culture of oral health access and delivery in
Methods: We conducted a
mixed method ethnography that integrated narratives from one set of diverse
research participants (n=39) with structured interviews from a different set of
diverse participants (n=288). Principal components analysis tested the
construct validity of culture, and correspondence analysis clarified
significant forms of intracultural variation.
Results: The population
studied shares a single cultural understanding organized around the assumption
that oral health constitutes a cosmetic not a disease category.
Intracultural variation in quality of life standards corresponds with a history
of poor oral health.
Conclusions: Oral health prevention behaviors reflect cultural norms that bear on
appearance and quality of life.
Intracultural variation in quality of life standards, however, produces an
apparent paradox, that the use of oral health services increases with access
but may decrease with objective need. Improved oral
health may require social marketing that targets people disenfranchised within
the global market economy, and their employers, which stresses the socially
enhancing objective of healthy teeth and gums.
A Theory of Frames and Violence
W. Penn Handwerker
Rational
choice theories, which provide powerful explanations in the social and
behavioral sciences, assume that the weighted average of preferences and the
likelihood of their realization explain why people choose one thing over
another. Because they cannot explain
preferences, however, rational choice deterrence theories, which start from the
premise that strength deters violence and weakness elicits it, inconsistently
identify deterrents and do not tell us what makes a threat credible. Empirical tests thus may provide only
ambiguous support, and policies based on these theories may not work well. Here I argue that strength deters violence
and weakness elicits it because selection favors choices framed as gains
between equals and as losses as inequalities grow. Deterrents consist of evolutionarily
significant consequences for violent acts, but their credibility (and effects)
should vary with the likelihood that people frame choices as gains or losses. Analysis of a pooled cross-sectional
time-series for the