CHAM SOC SirC KHOE TLT GOC NHIN NHAN HOC VAN HOA LE VAN KHAM* Sire khoe dugc coi la trung tam ciia qua trinh phat trien ngucri vi "siic khoe la von quy nhit cua nguoi" Trang thai khoe manh cua mSi nguoi dugc hieu voi nhieu y nghTa khac nhau, tir don thuan la tinh trang khong bi mic benh cho den tinh trang hoan toan khoe manh, dugc gpi la siic khoe ly tuong Tinh trang siic khoe ly tuong dugc To chuc Y te the gioi dinh nghTa la "trang thai hoan toan thoai mai ve the chat, tinh than va xa hpi ma khong chi gidi ban viec khong mic benh" (T6 churc Y te thi gioi, 1948) Tir dinh nghTa co the thay rang, "siic khoe" ciia moi ca nhan hay moi cpng ding bj chi phoi boi cac yeu to ve nguoi, he thong y te va cac hinh thirc chua benh, moi truang tu nhien, moi truong kinh te, xS hoi, chinh tri va van hoa tai cpng dong, dja phuang hay quoc gia ma hp sinh song Nhiing yeu to tuong tac voi nhau, tac dpng len sue khoe tren phuang dien the chat, tinh than va xa hpi, dong thai hinh nen cac hanh vi cham soc siic khoe Yeu to v3n hoa, kinh te - xa hpi cham soc sire khoe Xet duoi phuong dien van hoa, y hpc mang sac thai van hoa cua moi quoc gia, moi dia phuang hay timg dan tgc Vi vay, thuat ngii "van hoa y hpc" (cultural medicine) la thuat ngG thuong xuyen dugc sir dung cac nghien ciiu ve y te hay site khoe dat bli canh ciia cac nen van hoa va cac dac trung xa hoi Ve siic khoe, nguoi Viet Nam tir lau d3 co cau "an dugc, ngii dugc la tien" Theo do, nhiing nguoi "an dugc" thi hien kha nang hap thu nang lugng hay dinh duong cao nho cac he co quan co the dam bao tot cac chiic nang, dong thai chi dau ve kha nang boat dpng the lire manh me Tuong tu, ngucri "ngu dugc" bieu thi trang thai thoai mai ve tinh than, khong co nhiing tac dpng ve tam ly, xa hoi, hay nhung lo lang ve siic khoe Iam anh huong den giic ngii Nhu vay, co the noi rang tir xua, nguoi da quan tam tai siic khoe vl ca hai mat thi chit va tinh than gin lien voi cac yeu to ve sinh hpc va xa hSi Moi nguoi ling xir voi van de siic khoe tren co so niem tin, nhan thiic, dieu kien kinh * ThS Bic ST.; V^ B4o hiem y te Bo Y te Nghiin cdti Con ngui* so 5(68) 2013 2Q Chdm soc siic khoe ti - xa hpi, su sin co cua cac loai hinh y hpc (Tay y, Dong y, Y hpc dan gian) va nhung trai nghiem ciia ban than gin liSn voi b6i canh van hoa noi hp dang sinh song Mpt trpng nhung khai niem vi van hoa dupe nhiiu nha nghien ciiu nhan hpc tiep can la khai niem cua Edward Taylor Theo ong, "Van hoa la mpt t6ng the tri thiie, tin nguong, nghe thuat, luat le, dao diic, phong tuc va tit ca nhung kha nang tiem tang va nhiing tap quan ma nguoi co dupe voi tu each la vien xa hpi" (Edward Taylor, 1887) Tu khai niem nay, chiing ta thiy van hoa cung la mpt nhOng co che thich nghi cua nguoi d6i voi moi trucmg nguoi dang song va nguoi da su dung van hoa de lam thay d6i hoan canh, co viec giii gin sue khoe va tim kiem dich vu y te Cling vcri van hoa, kinh ti - xa hpi cp tac dpng true tiip d6i voi cac van de y ti, dac biet la viec tiep cSn co so y te ciia moi nguoi co nhu cau kham chiia benh Hien van t6n tai nhung khac biet va bit binh ding v^ thuc trang cham soc siic khoe giOa nuoc giau va nuoc ngheo, giira nguoi giau va nguoi ngheo, giiia thi va n6ng thon, giiia dong bang va mien niii Co nhieu nghien ciiu da chi ring, cac nuoc thu nhap thap va trung binh phai doi mat vai ti le tii vong va tan tat cao hon so voi nhiing nuoc phat trien tren the gioi Cimg voi la sir thien lech tiep c^n dich vu cham soc siic khoe voi viSc tap trung nhieu nguon luc cho dieu tri benh, dat trpng tam vao dich vu y te tai benh vien voi cac ky thuat cao hon la cac boat dpng ve phpng benh tat va nang cap siic khoe Khpng nhiing the, viec cham sec siic khpe nhan dan khong phai Iiic nap va dau ciing dupe xem nhu la mpt phan quan trpng su phat triSn chung ciia xS hpi va chua dupe dat long the cac moi quan he kinh ti, xa hpi va van hpa di cp thai dp va chien lupc ling xu phu hop Mot so ly thuyet nhan hoc van hoa su- dung nghien cmi ve cham soc siic khoe 2.1 Ly thuyet giai thich van hoa (Interpretive Theory of Culture) Giai thich van hoa nhan hpc dupe Clifford Geertz (1973) ii cap dSn nhu la mpt each tijp can ly thuySt giai thich van hoa Theo Geertz, "van hoa la mpt mang y nghia nguoi det ra" g6m he thong cac biiu tuong mang y nghia van hoa quy dinh Tiep eta giai thich van hoa nghien ciiu nhan hpc y ti - von la mpt phan nganh cua nhan hpc van hpa, la each phien giai y nghia ciia hanh vi, cua each thiic ling xu voi tinh ttang benh tat, kS ca viec chira tri theo quan diim cua nguoi ban dia, tiic la nguoi cupc (emic view) Geertz cung nhan dinh ring giai thich y nghia cua cac bi6u tuong la mpt cpng viec khc khan, vi y nghia cua bilu tuong gin liSn voi hoan canh sit dung cac bieu tuong va nguoi tao dung r6i gan cho cac biSu tuong Do vSy, ong cho rang viec quan trpng nhat cua cac nha nhan hpc la cin su mp ta that su sau sic vi bin 30 Nghien ctiu Con ngudi s6 5(58) 2013 Le Vdn Kham canh dien cac sir kien van hoa de tir phien giai tot ban y nghia cua cac hien tugng xay Moi hanh dpng, cu chi, loi noi, ngon tit dugc su dung mot boi canh cu the se mang mot y nghTa van hoa tugng trung nhat dinh doi vcri nguoi thupc ve nSn van boa Ciing theo each tiep can giai thich van hoa, su bien dien ciia benh tat dugc nguoi benh va thay thuoc nhan biet thong qua su phien giai y nghTa cua cac dau hieu b$nb tat Su phien giai y nghTa xay sir tuong tac vcri thuc hanh sinh hgc, thuc hanh xa hoi va y nghia dugc phien giai boi cac quy dinh thupc \h van hoa Bang chung cho thay, v6i cung mot hien tugng benh, cac phan nganh chuyen mon khac cua y hpc CO the dua nhiing li giai khac Vi the, giai thich ve nguy co sue khoe, thuyet van hoa cho rang nhiing each thiic ma moi ca nhan thuc hien co lien he chat che voi boi canh xa hpi ma nguai dang sinh song va tham gia Tuong tu nhu Eward Taylor, Kessing (1987) cho rang "van hoa bao gom cac he tu tuong ciing dugc chia se, la he thong cac khai niem, nhiing quy dinh va y nghTa lam nen tang cho cupc song va dugc the hien qua loi song ciia moi nguai" (Kessing, 1987) Nhu vay, nhung thugc tinh cua van hoa dugc cac vien cua mpt xa hpi hay cpng dong cu the cung chia se voi va co gia tri nhu mpt khai niem trung tam de giai thich li cua nhung hanh vi ma moi ca nhan thuc hien Trong ITnh vuc sue khoe, quan niem, nhan thiic ve nguy co benh tat va each thirc ma moi nguoi lira chpn de phong ngira hay ung voi benh tat co can nguyen tir ban chat van hda va sir chi phoi ciia van hoa toi each ling xir voi benh tat ciia nguoi timg hoan canh cu the ve kinh te - xa hpi Dieu thuc su co lien he sau sac voi moi quan tam cua ban than moi nguoi va each phien giai y nghTa ciia cac phuang thiic ling ay Mo binh giai thich la co so ly luan trung tam ciia each tiep can giai thich Mo hinh giai thich tim hieu niem tin ciia nguoi ve nguyen nhan dau 6m ciing nhu ly cua cac hanh vi bao ve siic khoe hay chiia tri nhim doi voi tinh trang dau 6m M6 hinh dugc A Kleinman gidi thieu nhu mpt m6 hinh li luan cho nhan hpc y te cong trinh "Patient and Healer in the Context of Culture" Klemman cung nhin manh ring, moi khu vuc van boa co mpt m6 hinh giai thich rieng cho benh tat noi chung va cho timg truang hgp 6m dau noi rieng Mo binh giai thich gom cac to: 1) Tri thiic va niSm tin ve dau hieu ciia benh the hien qua cac dau hieu nhan biet, each thuc gpi ten va phan loai; 2) Tri thiic va niem tin ve thai gian va each thiic phat benh; 3) Tri thiic va nilm tin vh cac nguyen nhan gay benh; 4) Tri thuc va niem tin ve su tiln triln cua benh, vl sir phat trien va miic dp tram trgng cua cac dau hieu qua timg giai doan; 5) Tri thiic Ngfiien cuu Con ngUHf so 5(68) 2013 Chdm soc sice khoe va nilm tin vl each thiic phong ngira va dieu trj (Akleinman, 1980) Tren co so tilp can giai thich van boa va irng dung mo hinh giai thich, nghien cuu ve cham soc site khoe cho phep cac nha nhan hpc ma rpng pham vi va doi tugng nghien ciru, tu van hoa tgc nguoi cho din cac tilu nhom van hoa mot xS hoi Nhihig tieu nhom van hoa co tbI la nhiing nguoi cimg mot ting lop xa hoi, mpt nhom nghe nghiep hay mpt nhom lua tuoi, tre em hoac nguoi gia 2.2 Ly thuyet ve vdn xa hoi Ngan hang Thi gioi (WB) (2001) da dua nhan dinh ring "Mot nhiing dong gop chinh cua Y xa hpi hpc la xac dinh dugc v6n xa hoi nhu la mot nhiing yeu t6 quylt dinh siic khoe Nhilu nghien ciiu da chi m6i lien he giiia v6n xa hpi va sire khoe Theo do, vin'xa hpi co thi tac dpng true tilp hoac gian tiep din siic khoe th6ng qua cac chinh sach" (WB, 2001) Co nhilu each dat vin dl va giai ngbia ve v6n xa hpi Theo Jame Coleman (1988), v6n xa hpi bao gom nhiing dac trung cua doi s6ng nhu mang luoi xa hpi {social network), cac chuan muc (norms) va sir tin cay xa hpi (social trust) - la nhiing yeu tl giiip cho cac vien co the hanh dpng ciing mot each co hieu qua nhim dat toi muc tieu chung Cung quan diem voi Coleman, Robert Putnam (1993) cung cho rSng von xa h6i la nhiing gia tri dac trung ciia to chiic xa hpi nhu cac mang luoi xa hpi, cac chuSn muc va su tin cay xa hpi - va nhiing dac trung d6 t£io dieu kien cho su phii hgp va hgp tac vi Ipi ich bo tuong Noi each khac, v6n xa hpi chinh la cac moi quan he co anh huong den kha nang giai quyet van de cua nguoi V6n xa hpi dam bao cho s\r gan ket ciia xa hpi thong qua cac mang luoi, sir tin tuong va trao d6i giiia cac ca nhan, cac nhom xa hpi (Robert Putnam, 1993) Theo Portes (2000), v6n xa hpi la kha nang tiep can cac nguon luc ciia ca nhan thong qua cac mli quan he co chit lugng mang luoi ma hp la vien Dinh nghia nhin manh din cac mli quan he xE hpi cua ca nhan va nhiing moi quan he giiip ca nhan giai quylt cac vin dl cupc s6ng, dac biet ITnh vuc sue khoe (A.Porters, 2000) Von xS hpi dugc hieu nhu mot thii tai san ca nhan, ding thai la tai san chung ciia mot cpng dong Voi cip dp ca nhan, v6n xa hpi xem nhu mpt tai san ca nhan tilp can goc nhin ve mang luoi xa hoi Do la cac chuin muc ngi tai Iam cho mpi nguoi thiy CO nghTa vu va muon thuc hanh nghTa vu theo each dung nhit Them vao dd, sir doan ket CO thi Iam mgi nguoi co y mu6n giiip nguoi khac V6n xa hpi cung la mpt thupc tinh tap the tiep can ve phuang dien c6 kit xa hpi Theo d6, nilm tin tao chit xiic tdc cho hanh dgng tap the Mot moi truong dugc dac trung bai su tin cay la dilu ki$n dl ho 32 NgtiiSn eOu Con nguOls65(68) 2013 Le Vdn Kham trg cho cac boat dpng cua m6i ca nhan hay cpng dong vi mot muc tieu cu the nao Cac dinh nghTa tren day ve von xa hpi deu de cap den cac moi quan he xa hpi co chat lugng ciia ca nhan va cac moi quan he c6 anh huang den kha nang giai quyet van de ciia ca nhan Vl mat hinh thiic, v6n xS hoi gim loai (Kimberiy L., Ichiro K., Bruce P.K., 1999): Mpt la "Sir gan ket" (bonding), tiic la moi quan he giira cac vien gia dinh, hang xom, ban be, dong nghiep Moi quan he la phuong tien truyen dat nhiing chuan muc ve hanh vi va cac gia tri van boa, dong thai anh huong den doi song moi ca nhan va quan he cua hp xa hpi Von xa hpi gin kit co vai tro rit quan trpng viec truyen dat thong tin, hinh cac chuan muc va kiem soat su lech chuan ve siic khoe, kien tao sir ho trg lan va bao ve nhung ngucri dl bi tin thuong Loai v6n xa hpi ciing co vai tro nhu nguon ho trg chinh vl kinh tl va an sinh xa hpi cho cac vien Loai von xa hoi thii hai dugc gpi la "Cau noi" (bridging) the bien mli quan he giGa cac nhom khac xa hpi Nhiing cau noi mang lai Igi Ich thilt thuc cho sy phat trien kinh te - xa hpi Xet tren khia canh siic khoe, v6n xa hpi "ciu n6i" dong vai tro quan trpng viec truyen dat thong tin, cung cap dich vu, kilm soat hanh vi bit Igi cho siic khoe va tang cuong cac chuan muc lien quan den siic khoe, y tl Ngoai ra, cac m6i quan he loai h6 trg cho viec tang cuong thuc hien cac hanh vi chung v6 siic khoe nhu kham siic khoe dinh ky doi voi nguoi gia, kham thai phu nii hay tiem chiing cho tre em Hinh thuc thii ba ciia von xa hpi la su lien ket (linking) Loai hinh dl cap din ban chat va su ma rpng m6i quan he dpc giiia cac nhom xa hpi co kha nang va cac nhom kh6ng co kha nang tiep can vai cac nguon lire Moi quan he giiia nha nuoc va cpng dong se dugc hoan thien hem thong qua von xa hpi lien ket Xet tren khia canh siic khoe, m6i lien ket dpc tao dieu kien cho sir hinh nhiing phan ling can thi^t d6i voi tinh trang siic khoe va quan ly nguy co riii ro d6i vai siic khoe Them vao do, mot dilu dl nhan thay la sy phan hoi tir cong dong, tii nhiing nguoi chiu tac dpng ciia chinh sach y tl rit quan trgng, giiip he th5ng cung ung dich vu y te va chinh sach y tl di diing huang phii hgp vai nhu cau thuc te cua cpng dong, cua timg nhom d6i tugng m6i khong gian xa hpi cu the 2.3 Ly thuyit phi phdn (critical theory) nhan hocy ti Nin tang ciia tiep can phe phan dugc hinh va phat trien tir hpc thuylt kinh tl chinh tri hpc ciia K Marx va Angghen ve chii nghTa tu ban Nhiing iuan dilm chinh ciia Ngtti6n ciiu Con ngu&so5(68} 2013 -i-i Chdm soc sue khde kuih ti - chinh trj hpc th6 hien cac pham Ut vi: su phan ting Uong xa hpi, sir bat binh ding vi quyin luc ciing nhu viec tiip can va kiim soat ngu6n lire giira cac tang lop xa hoi, van hoa thupc thuong ting xa hpi va dupe cac nhom thdng tri tri nhSm phuc vu cho loi ich ciia hp Nhimg bit cong chinh la ngudn goc va dpng luc cho su dau tianh giiia cac ting lop di lam thay dii xa hpi (B Malinpwski, 1994) Nhan hoc phe phan tiep can din su bit binh ding giira cac ciu mic xa hpi va su diu tranh giai quyit cac mau thuan Khi phan tich vi linh vuc sire khoe, nhan hpc phe phan dat cac van de c6t loi lien quan din bit cong bing xuit phat tir bit binh ding vi quyin kiim soat dii vol nguin luc xa hpi nhu: Ai la nguoi co quyen lire doi voi cac the che y hpc va quyen luc dupe biiu hien nhu thi nao? Mau thuan chu yeu la gi va viec giai quyet mau thuSn bit dau tir dau? Tang lop yeu the xa hpi dau tranh nhu the nao va tac dpng ciia no den su van hanh ciia he thong y te sao? Tir nhihig van de nen tang nay, cac cau hoi ve bat cong bing cham soc siic khoe thuong la: 1) Lieu co tinh trang bat cong v^ sire khoe va cham soc sire khoe khong? Bat cong bang co lien quan nhu thi nao voi bit binh dang ve quyen luc? 2) Bit cong bang y te lien quan nhu thi nao toi bii canh kinh te - chinh tri noi chung? Lieu nhung bat binh dang xa hpi nhu bit binh dang ve gioi, ve thu nhap va tiep can nguon luc co phai la nguyen nhSn cua bit cong bang cham soc siic khoe hay khong? va 3) Bat binh dang xa h6i co anh huong den hanh vi cham soc sue khoe khong? Cach thirc ma cac phin khac xa hpi mo ta, dien dat ve sire khoe thi nao? Su bat binh dang ve siic khoe va cham soc sire khoe bieu hien su khac biet vi cac chi so siic khoe, hanh vi cham soc sire khoe va sir dung dich vu y ti tir cip dp cpng ding den quoc gia va toan ciu Theo quan diim cua tiip can phe phan, nhirng bit cong ITnh vuc y ti chi co thi dupe giai quyit co sir thay dii vi tuong quan quyin luc, tang CO hpi cho nhom yeu thi tiip can duoc dich vu y ti thong qua cac chinh sach tai chinh cho y te phii hpp nhu lap quy kham chua benh miln phi hpac bap hiim y ti Tuong tu, mpt nhiing phuong thiic di giam bat binh ding giira nguoi benh va thiy thuoc la thuc hien cung cap th5ng tin diy du, ling nghe va ton trpng y kiin ciia ngucii benh Nhin chung, vcri each tiip can phe phan nay, cac vin di cham spc sire khoe phai dupe giai quyit bing nhiing dii moi manh me va sau sic thpng qua viec cai each he thong y te, tien toi mpt he thing cung ring dich vu y ti cpng bing hon 2.4 Ly thuyit cau true - chuc nang Bronislaw K Malinowski (1884-1942) - nguoi dat nin mong cho cac tiip can chiic nang cho rang, so di mpt sp thiit chi xa hpi, thiit chi van hpa cd thi tin tai qua thai 34 NgliiSn ciiu Con ngudi s65(68) 2013 Le Vdn Khdm gian la vi chiing co cbitc nang dap ling nhirng nhu cau nhat dinh ciia nguoi (Brown A.R, 1952) Vi vay, nghien ciiu cac thilt che xa hpi van hoa hien hiiu khong chi nham xac dinh va mo ta cac thilt chi ma quan trpng la tim cac chuc nang rieng ciia chiing Theo ong, thilt chi la nhiing each tbiic chung va tuong dii on dinh dl tl cbiic cac boat dpng cua nguai xa hpi huong din viec thoa man nhiing nhu cau co ban cua xa hpi Nhung dac trung chung nhit ciia mpi thiet che bao g6m: dieu le (charter), sir tham gia cua ca nhan, chuan muc, ca so vat chit, hogt dpng va chiic nang Doi voi Malinowski, cap dp cau true (xa hpi) c6 yeu ciu co ban mang tinh quat, la: san xuat va phan phoi vat pham tieu dimg, kiem soat va dieu chinh hanh vi, giao due (xa hpi hoa), to chuc va dieu hanh cac quan he quyen luc Nhiing yeu cau dugc dap ling bai nhiing thilt chi tuong irng (B Malinowski, 1994) Khac voi Malinowski, Radcliff Brown (1952) co quan diem ring chiic nang ciia cac thiet che xa hpi khong phai la de dap iing nhu cau ciia nguoi, ma la de tri sir t6n tai cau tnic ciia chiing tong the cau tnic ciia mpt be thong xa hpi Vai each tiep c^n Brown nhdn manh tai chiic nang tri cau tnic cua cac thiet che xa hOi nen dugc ggi la each tiep can "cau tnic chiic nang" (A.R Brown, 1952) Brown cho rang, mpt dieu kien can thiet cho sir ton tai cua mot xa hpi la su lien ket toi thilu cac t6 cua no va sir lien ket dugc tri bai cac chirc nang lien quan den nhung qua trinh tri sir lien ket can thiet Trong mot xa hoi, cac dac trung cau tnic co the dugc xem la nhung dac trung g6p phan vao viec tri su lien ket Do do, phan tich chiic nang doi vai mot hien tugng xa hpi chinh la tim kiem xem no co dong g6p gi vao viec tri lien ket ciia xa hpi hoac each thitc tri su doan ket xa hpi Tiep tuc each tiep can cau tnic chiic nang, Talcott Parson (1951) nghien ciiu ve chii nghTa cau tnic chiic nang da lap luan rang, mot xa hpi dugc xem nhu mot to chiic mang luoi vl sy hgp tac giua cac nhom boat dpng mpt trat ty nhat dinh, nhim tri mpt he thing can bang va boa hgp Noi each khac, xa hpi gi6ng nhu cac bg phan ciia mpt to chiic, la sy hoa hgp va can bang cua mpt he cac thiet che co sy tuong tac Ian tao nen m6t he thong hanh dpng Cung theo Parson, mpt nhiing he thong hanh dpng la he van hoa Van hoa dugc xem nhu mpt he thong co tinh khuon mau va trat tu vl cac bieu tugng - la doi tugng cua su dinh huong hanh dpng ciia nguoi Dilu co nghTa la cac gia tri van hoa quyet dinh cac chuan muc ciia xa hpi (Talcott Parson, 1951) Theo thuylt chiic nang hay cau true chirc nang, sy t6n tai hoac mat di cua cac thilt chi xa hoi la chiing co tri dugc chiic nang dap ling nhu cau nguai hay NgtilSn cuu Con ngUd!so5(68} 2013 -ir Chdm soc sue khoe tri ciu tnic trpng ting thi ciu tnic xa hpi hay khpng Tren phuong diSn ve cac van dS siic khpe va y ti hien nay, su tin tai cua mpt he thong y te voi nhieu loai hinh, nhieu nguyen ly thuc hanh chOa tri khac (con gpi la he thing y te da nguyen) nhu Tay y, Dong y, Y hpc dan gian chinh la boi nhu ciu cham soc sire khoe cua nguoi Nhu cau ay phan anh quan diim, niim tin cua m6i nguoi va dieu kien kinh tB - xa hpi cua hp Tuong tu, viec doi cua mpt co che, chinh sach ve cham soc sire khoe cpng dpng tam vi mo hay su xuat hien ciia nhihig nhom lien ket, nhiing mpi quan he mang luoi xa hpi ciia cpn nguoi dupe xem nhu la nhiing hinh thirc tri su on dinh xa hpi, ciing vcri nhiing chuan muc van hoa tao nen hanh vi iing xir ciia nguoi truoc viec phong benh, chira benh va tang cuong sire khoe Ket luan Van hoa dinh hinh cho nguoi each cam nhan ve the gioi xung quanh, trai nghiem ve nhimg gi xay ra, each iing xir giiia nguoi voi nguoi, nguoi vol xa hpi, ngucri voi tu nhien Do van hoa cung dinh hinh cho nguoi cam nhan vi sir khoe manh, dau 6m hay benh tat, ve each ung hay each to chiic di ching lai benh tat va ve each trao truyen lai cho the he mai sau kien thirc, kinh nghiem lien quan din siic khoe Vi cham soc siic khoe dupe coi la mpt hien tupng van hoa nen each thiic giii gin sire khoe, phong tranh benh tat va viec chuan bi cac diiu kien di phong benh tat xay ra, ciing nhu tim kiem phuong phap chila tri co lien quan true tiip din bii canh van hoa, xa hpi, kinh te va trai nghiem ban than mpi nguoi Ben canh cac phuong phap nghien ciiu siic khoe theo huong y hpc va y ti cong cpng, phupng phap tiip can nhan hpc van hca/nhSn hpc y ti la mpt nhiing each tiip can mod Cach tiep can giup viec nhin nhan cac vin di sire khoe, cham lo sire khoe phii hop voi boi canh van hoa dac thii cua timg khu vuc, ciia moi quic gia hay mii vimg mien ciia quic gia Tren thi gioi, co nhiiu ly thuyit vi nhan hoc van hoa dupe iing dung rpng rai trpng nghien cim vi cham SPC siic khoe nhu thuyit giai thich van hoa, thuyet vi von xa hpi va thuyit ciu tnic chiic nang Thuyet giai thich van hoa la mat ly thuyit tuong dii dac thii ciia nhSn hpc y ti Su hien dien ciia benh tat va each chira tri duac nguoi benh va thiy thu6c nhan biit thong qua sy phien giai y nghTa cua cac diu hieu dau 6m, benh tat dat su tuong tac giira chuyen m6n vi y khoa, vi van hoa va xa hpi Viec phien giai cac y nghia, each giai thich ve nguyen nhan va diu hieu ciia dau 6m khac theo each van hoa quy dinh se dan den nhihig thuc hanh khac vi cham lo sire khoe va kham chOa benh cua cac nhom xa hpi khac L/ng dung thuyit cp thi giai thich cac hanh vi chiia benh 36 Ngftien ciiu Con ngudi $65(68) 2013 Le Vdn Khdm bao gom ca tu dieu tri, tilp can cac co so y t l nha nuoc hay tu nhan, co so Dong y hay Tay y va each thiic phong benh theo each van hoa quy dinh Ciing voi thuyet giai thich van hoa, ly thuylt v l von xa hpi giiip cac nha nghien ciiu bo sung vai tro cua cac moi quan be xa hpi cua moi ca nhan giai quyet cac van d^ lien quan den sue khoe bao g i m tilp can cac nguIn luc thong qua hgp tac giiia cac ca nhan mpt cpng dong, cac gia tri ma cpng dong coi trpng ciing nhu kha nang va dpng luc de chia se trach nhiem nham vugt qua nhiing kho khan cua cupc song Ly thuyet co y nghTa quan trpng nhin nhan cac ylu to tuong tac cua cac ca nhan xa hpi doi vai hanh vi cham lo sue khoe, dac biet giai thich cac hanh vi siic khoe cua cac ca nhan la nhiing nguoi it nhieu bi phu thugc nhu tre em va nguoi gia Ngoai ra, thuyet cau tnic - chirc nang va thuyet phe phan lai nhin nhan hanh vi cham !o siic khoe theo mot each tong the chii khong don thuan ca nhan nguai benh D6i voi tiep can ph^ phan, cac yeu to vT mo bao g i m phan tang xa hpi, cac giai cip, bit binh dang v l quyen lyc, ve tiep can va kiem soat ngu6n luc dugc xem xet Cdch tiep can giiip nha nghien ciiu phan tich va chi nguIn g6c xa hpi ciia nhung bit binh ding cham soc siic khoe va cho rang cac van de sue khoe chi co the dugc giai quyet cac van de bat cong bang xa hpi n6i chung va y te noi rieng dugc cai thien Doi voi thuyet cau tnic - chiic nang, thiet che xa hpi, chinh sach, he thong y te co tac dpng den nhu cau, quan diem, niem tin cua moi nguoi va dieu kien kinh te - xa hpi cua hp viec cham soc siic khoe Vi$c ket hgp cac ly thuyet tren day nghien curu v l siic khoe se co dong gop quan trgng doi voi moi dia phuong, moi qu6c gia viec xay dung va van hanh hieu qua cac chinh sach ve siic khoe cpng d6ng noi chung, cung nhu voi nhung d i i tupng thu huang la nhom doi tugng cu dan de ton thuong noi rieng, d i n g thai phat huy dugc gia tri tiem nang cua nhiing nhom lien ket, nhiing moi quan he xa hpi v6n dugc hirih tren n^n tang van hoa Tai lieu t h a m k h a o To chirc Y tl thi gioi (1948) Taylor E.B (1887), "Primitive Culture: Reseach into the Development of Mythology", Beaglehole R, Bonnita R (1997), Public health at the crossroads, Cambrige Keesing R (1981), "Cultural Anthropology A Contemporary Perspective", New York, Philosophy, Religion, Language, Art, and Customs, New York, Henry Holt & Co University Press Holt, Rinehart & Winston NghiSn ciiu Con nguiH s65(68) 2013 -i"] Chdm soc sifc khoe Kleinman A.M (1980), "Patient and Healer in the Context of Culnire", Berkeley, University of California Press Ngan hang Thi giai (World Bank) (2001), "Attacking poverty" World Development Report 2000/2001, World Bank, Washington/New York Putnam R.D (1993), "Making the democracy work: Civic traditions in modem Italy", Porters, A (2000), "Social capital its origins and applications in modem sociology", In Princeton: Princeton University Press Knowledge and social capital, Eric, L Lesser editor, Princeton University Press Kimberiy L., Ichiro K., Bruce P.K., (1999), "Social capital: a guide to its measurement" Health and place 5, pp 259-270 PERGAMON,]999 10 Malinowski, B (1944), "A Scientific Theory of Culture and Others Essays", Chapel Hill, N Carolina: The University of North Carolina Press 11 Brown A.R (1952), Structure and Function in Primitive Society 12 Parsons Talcott (1951), "Structural Functionallsm, Neofunctlonalism, and Conflict Theory", In Socilogical Theory, George Ritzer, Mac Graw Hill International Editions, 2000, pp 229-270 HgtiiSn ciiu Con ngutif s6 5(68) 2013