The oppositional cultures and urbanity in Oklahoma health care

Abstract

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.