The oppositional cultures and urbanity in Oklahoma health care

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Howard F. Stein


This paper studies rurality and urbanity (in the state of Oklahoma, and elsewhere) as bona fide cultural realities, and explores the consequences of rural/urban cultural differences and conflict for health care in rural settings. The methodology of exploring multiple viewpoints (borrowed from anthropology, as the emic/etic distinction), and the statuses and power associated with these perspectives, is fruitful in elucidating many long-standing issues in rural health care: access, isolation, boundaries, units of measurement, sense of place, stigma, identity, etc. From twenty-three years as a clinically applied psychodynamically-
oriented medical anthropologist in rural and urban Oklahoma settings, the author provides numerous vignettes to illustrate the methodological and theoretical points made. The paper concludes that a powerful barrier to improved rural health care is the reciprocal stereotyping between rural and urban cultures, a binary opposition, that prevents accurate assessment of needs and realities.

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