Culture as a Determinant of Health and Well-being: Expanding the Concept of Cultural Capital

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Although local culture has been recognized as important in global health interventions, epidemiology, which is a key discipline evaluating such interventions, lacks conceptual frameworks and tools to measure cultural capital. This paper aims to identify challenges in adapting Bourdieu’s theory of cultural capital to public health and epidemiology, and to provide proposals to address them. Methods A theory adaptation approach, drawing on insights from public health, epidemiology, cultural anthropology, and related fields. Results and Discussion We identify five key challenges: 1. the epistemological divergence between Bourdieu’s focus on power structures and public health’s focus on health promotion; 2. the need to consider intervention-oriented cultural capital concept; 3. the need to assess cultural capital at the collective level; 4. the need for cultural capital concept that encompasses human nature beyond the social space; and 5. the unclear and inconsistent definitions of culture across research fields. For each challenge, we propose corresponding conceptual frameworks to facilitate the integration of cultural capital into public health and epidemiological research. Finally, we discuss the collective and existential properties of cultural and other forms of capital, arguing the liberating and constraining effects of capital (e.g., the risks of stereotyping specific subpopulations). Conclusion This study represents an initial step toward establishing cultural epidemiology as a field that quantitatively assesses the role of culture in shaping health and well-being. Future empirical research is needed to operationalize and apply these frameworks. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-638/v1", "name": "Culture as a Determinant of Health and Well-being:Expandingthe Concept..." } } ] } Home Browse Culture as a Determinant of Health and Well-being:Expandingthe Concept... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Habu H and Kondo N. Culture as a Determinant of Health and Well-being: Expanding the Concept of Cultural Capital [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :638 ( https://doi.org/10.12688/f1000research.166017.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Culture as a Determinant of Health and Well-being: Expanding the Concept of Cultural Capital [version 1; peer review: 1 approved with reservations, 1 not approved] Hiroshi Habu https://orcid.org/0000-0002-8061-9166 1 , Naoki Kondo 1 Hiroshi Habu https://orcid.org/0000-0002-8061-9166 1 , Naoki Kondo 1 PUBLISHED 30 Jun 2025 Author details Author details 1 Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Kyoto Prefecture, 606-8501, Japan Hiroshi Habu Roles: Conceptualization, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Naoki Kondo Roles: Conceptualization, Funding Acquisition, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Japan Institutional Gateway gateway. This article is included in the Sociology of Health gateway. Abstract Abstract Introduction Cultural capital, conceptualized by Bourdieu, is a form of individual capital facilitating social mobility. Although local culture has been recognized as important in global health interventions, epidemiology, which is a key discipline evaluating such interventions, lacks conceptual frameworks and tools to measure cultural capital. This paper aims to identify challenges in adapting Bourdieu’s theory of cultural capital to public health and epidemiology, and to provide proposals to address them. Methods A theory adaptation approach, drawing on insights from public health, epidemiology, cultural anthropology, and related fields. Results and Discussion We identify five key challenges: 1. the epistemological divergence between Bourdieu’s focus on power structures and public health’s focus on health promotion; 2. the need to consider intervention-oriented cultural capital concept; 3. the need to assess cultural capital at the collective level; 4. the need for cultural capital concept that encompasses human nature beyond the social space; and 5. the unclear and inconsistent definitions of culture across research fields. For each challenge, we propose corresponding conceptual frameworks to facilitate the integration of cultural capital into public health and epidemiological research. Finally, we discuss the collective and existential properties of cultural and other forms of capital, arguing the liberating and constraining effects of capital (e.g., the risks of stereotyping specific subpopulations). Conclusion This study represents an initial step toward establishing cultural epidemiology as a field that quantitatively assesses the role of culture in shaping health and well-being. Future empirical research is needed to operationalize and apply these frameworks. READ ALL READ LESS Keywords Cultural Capital, Cultural Epidemiology, Social Epidemiology, Cultural Determinants of Health, Social Determinants of Health, Cultural Well-being, Existential Well-being, Contextual Validity. Corresponding Author(s) Naoki Kondo ( [email protected] ) Close Corresponding author: Naoki Kondo Competing interests: No competing interests were disclosed. Grant information: This project was funded and supported by the World Health Organization (WHO) Regional Office for the Western Pacific (WPRO), but the outcomes reflect the deliberations of authors and research partners. This work was also supported by JST Grant Number JPMJPF2105. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Habu H and Kondo N. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Habu H and Kondo N. Culture as a Determinant of Health and Well-being: Expanding the Concept of Cultural Capital [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :638 ( https://doi.org/10.12688/f1000research.166017.1 ) First published: 30 Jun 2025, 14 :638 ( https://doi.org/10.12688/f1000research.166017.1 ) Latest published: 30 Jun 2025, 14 :638 ( https://doi.org/10.12688/f1000research.166017.1 ) Introduction Pierre Bourdieu proposed three forms of capital—social, economic, and cultural—in his discussion of the reproduction of social status. He emphasized that culture functions as a form of capital that confers advantage, and that it plays the most significant role in facilitating social mobility. 1 , 2 He categorized cultural capital into three forms: embodied (e.g., sensibilities and manners), objectified (e.g., cultural possessions such as paintings and books), and institutionalized (e.g., certifications and awards). Bourdieu considered that among these, embodied cultural capital plays a fundamental role in the reproduction of inequality and is less amenable to redistribution through intervention than economic capital. 3 Epidemiology is a foundational discipline for public health that aims to identify the determinants of health and establish effective methods to address health issues. 4 , 5 Social epidemiology, a subfield of epidemiology, has demonstrated that individual health is influenced by social factors beyond personal control, 6 and that socioeconomic status (SES)—as represented by education, income, and occupation—is a strong predictor of health outcomes. 7 Based on the findings of social epidemiology, culture, which Bourdieu identified as a form of capital that influences social status, is considered an important determinant of health. 8 , 9 In the field of global health, the importance of considering cultural factors within target populations during public health interventions has been widely recognized. 10 However, culture and cultural capital have not been formally conceptualized, and as a result, little progress has been made in elucidating the cultural determinants of health and understanding the roles of culture for both individual and population well-being, as well as assessing the impact of cultural considerations in public health interventions. 10 – 12 One notable methodological contribution from medical anthropology is the Explanatory Model Interview Catalogue (EMIC), developed by Mitchell G. Weiss, which provides an approach to understanding culturally shaped conceptions of illness. Unlike conventional biomedical classifications, the EMIC framework emphasizes illness as a subjective and cultural experience, assessing how individuals perceive, interpret, and respond to illness through both qualitative and quantitative methods. However, cultural influences on health extend beyond illness perception, including a broad range of factors such as personality traits, embodied daily habits, aesthetic sensibilities, and leisure practices. Therefore, cultural epidemiology needs to be developed to enable causal inferences regarding the effects of culture on health and well-being. This paper aims to identify and organize key challenges in applying Bourdieu’s concept of cultural capital to public health, epidemiology, and related fields such as medical care and welfare sciences, and to present proposals for addressing these challenges. Methods We adopted a theory adaptation approach to conceptual research, which involves changing the scope or perspective of an existing theory by informing it with other theories or perspectives. 13 We focused on Bourdieu’s concept of cultural capital and adopted it for application in the fields of public health and epidemiology, also drawing on insights from cultural anthropology as a discipline that specializes in the study of culture. In the preliminary stages of the conceptualization of this study, which convinced us of the need for this study, we identified several potential challenges in applying Bourdieu’s concept of cultural capital in public health and epidemiology. First, one fundamental divergence between the two domains lies in their primary focus: while Bourdieu was chiefly concerned with uncovering the structures of power and domination, public health is oriented toward improving health outcomes and fostering equitable environments. 14 Bourdieu’s cultural capital theory neither considers health as an explicit outcome nor was intended to be applied to interventions in people’s living environments or societies. Second, Bourdieu focuses on cultural capital as the individual-level factor, but public health emphasizes the importance of addressing collective, group-level, or macro-social determinants of health. 15 This discrepancy highlights the need for a theoretical update of cultural capital to accommodate group-level evaluation and interpretation. Third, Bourdieu did not clearly define culture, whereas public health researchers and practitioners have variably defined and operationalized it in their activities. On the basis of these preparatory considerations, we conducted a critical review of relevant literature to identify and organize key challenges in applying cultural capital to public health and epidemiology. In doing so, we sought to broaden Bourdieu’s original concept by incorporating perspectives from public health, epidemiology, cultural anthropology, and other related disciplines. We conducted a literature search using PubMed and other literature databases, including Web of Science, Google Scholar, and the Kyoto University library database. We also used bibliographic information obtained through consultation with experts. This selection process was further guided by purposive, iterative reading and citation tracking across disciplines. We prioritized works that offered conceptual innovation or identified theoretical limitations in existing applications of cultural concepts to public health and epidemiology. Through reading the collected literature and iterative discussion by multiple researchers, we organized and reconciled the core concepts of cultural capital in Bourdieu’s work, the objectives of Bourdieu’s sociology, and those of public health and epidemiology. We also identified similarities and differences, as well as key challenges in applying the concept of cultural capital to public health and epidemiology. Subsequently, we reviewed and discussed conceptual frameworks, ideas, and tools that could inform new proposals to address each challenge, and we developed a set of such proposals. Finally, we presented additional insights and items that emerged during these reviews and discussions. Results and discussion Challenges in implementing the concept of cultural capital in public health and epidemiology, and proposals to address them We identified five key challenges in applying Bourdieu’s concept of cultural capital to public health and epidemiology. These challenges stem from differences in research focus, disciplinary orientations, levels of assessment, underlying principles, and definitions of culture ( Table 1 ). We then formulated corresponding proposals to address each challenge. The following section describes these challenges and our proposal. Table 1. Five key differences between bourdieu’s cultural capital and public health, and features of extended cultural capital to bridge these gaps. Bourdieu’s cultural capital Public health Features of extended cultural capital 1. Research Focuses Structures of power and domination Improving people’s health Considering health as the outcome, with examination of various causal pathways, effect directions, and capital amounts 2. Orientations Explanatory-oriented Intervention-oriented Assuming intervention and considering contextual validity 3. Levels Individual-level Multilevel Multilevel, with assessment of Collective Cultural Capital 4. Principles Structured by exchange-based and governance-based principles Including existential field Based on three principles: exchange-based, governance-based, and existential. The existential principle can also serve as cultural well-being 5. Meanings of Culture Unclear Various ways depending on the researcher Classified by types of cultural meanings, into five dimensions of cultural capital, each divided into several domains Challenge 1: The Epistemological Divergence Between Bourdieu’s Focus on Power Structures and Public Health’s Focus on Health Promotion. Bourdieu conceptualized cultural capital as a positive force contributing to the attainment of a higher social status. In contrast, epidemiology, an important tool of public health, frames culture and cultural practices or structures as determinants of health. Following the conceptual causal models of epidemiology, culture and cultural practices can also affect health in a variety of ways and they do not always have positive effects on health under the specific macrosocial conditions (e.g., economic crisis) and subpopulations (e.g., corporate managers in Japan and South Korea). 16 – 19 For example, dietary customs and the use of pleasurable substances, which can be considered forms of embodied cultural capital within specific social groups, may lead to negative physical health outcomes. Behaviors such as smoking, alcohol consumption, and excessive salt intake are well-documented in the literature as detrimental to health and are widely recognized by the public. 20 – 23 Cigar smoking, which is favored by individuals in higher social strata, has been associated with an increased risk of oral cancer, acting as a mediator between social class and health. 24 Moreover, historical accounts suggest that in Japan’s Heian period in late 8 th to 12 th century, members of the aristocracy—who were known for their elegant and refined lifestyles—developed diabetes, likely as a result of their dietary habits. 25 Furthermore, the dose or duration of cultural exposure is also important. For example, when evaluating cultural activities such as sports or musical performance, the outcomes differ between someone who has participated for one year and someone who has been engaged for twenty years. 26 – 28 Based on the above, we propose a cultural capital framework for public health and epidemiology that considers its influence on health outcomes ( Figure 1 ). Specifically, we emphasize the need to examine cultural capital’s role in shaping various causal pathways, including its potential to function as a confounder, mediator, or effect modifier. 29 This framework takes into account both the extent of cultural exposure and the direction of its effects, which can have either positive or negative impacts on health depending on the social context. Figure 1. Possible roles of cultural capital in epidemiologic models. Panel a, Bourdieu was interested in how cultural capital influences social hierarchy. His cultural capital works in favor of the privileged classes. Panels b-e, in epidemiology, cultural capital can vary in quantity and operate in both positive and negative directions across different groups: b, cultural capital as an exposure can have both (i) direct and (ii) indirect effects on health, mediated through factors such as social hierarchy; c, cultural capital as a confounder; d, cultural capital as a mediator; and e, cultural capital as an effect modifier. Challenge 2: The Need to Consider an Intervention-Oriented Cultural Capital Concept While Bourdieu’s studies of cultural capital focused primarily on revealing social structures, public health aims to transform and develop equitable environments to promote health and wellbeing. Therefore, when the health effects of cultural capital are identified, it becomes essential to consider how such findings can be translated into appropriate public health interventions. Interventions involving cultural capital require ethical consideration. 10 However, epidemiology lacks conceptual frameworks for incorporating cultural contexts in the interpretation of research findings and designing interventions. To address this, we propose the concept of contextual validity , which consists of two dimensions ( Table 2 ). Table 2. Two types of contextual validity found when considering the concept of cultural capital in public health. Terms Definitions Contextual validity of the intervention A concept referring to the cultural acceptability and appropriateness of interventions across different communities and individuals Contextual validity of the outcome A concept referring to how meaningful or important the estimated health outcomes are for different communities and individuals First, in cases where the target is individual traits associated with embodied cultural capital—such as manners, sensibilities, or dispositions—it is clearly inappropriate to treat these traits in the same way for as distributable resources, such as income. Moreover, the interventions aiming to alter such traits risk generating stigma or undermining latent valid effects of existing culture-oriented practices. 30 , 31 Even when forms of cultural capital—such as access to museums or education—have demonstrated positive, generalizable, and transferable effects on health outcomes in a particular population, such interventions may still be culturally unacceptable to individuals or communities, or may risk undermining other locally valued cultural resources. 10 , 32 – 34 We refer to these considerations as contextual validity of intervention. Second, the meaningfulness of a targeted health outcome may vary across cultural contexts, and the interpretation of its effect may differ substantially. 10 , 35 – 37 We refer to these considerations as the contextual validity of outcome. For example, sexual relationship disorders were included in the World Health Organization’s International Classification of Diseases, 10th revision (ICD-10). However, in 2014, the WHO concluded that there was no justification for including these disorders as a category of mental illness, and they were excluded from ICD-11 in 2022. 38 , 39 As social values and historical contexts change, what was once considered a disease in a given culture may no longer be a valid target for medical intervention. Conversely, a contextually valid approach to cultural intervention could yield meaningful benefits. Understanding how individuals’ dispositions influence health outcomes or modify the effects of other determinants and interventions can inform the development of effective intervention programs. 40 , 41 For example, research on the mental health-improving app has shown that individuals’ traits strongly influence how they perceive and respond to different app features: e.g. conscientious individuals may prefer apps that offer relaxation audios, encouragement, and trusted information, while neurotic individuals might be more drawn to apps with relaxation exercises, social support, and clear privacy policies. 42 Recent developments in precision public health, particularly tailored interventions that often draw on behavioral economics and social marketing, may be more appropriately understood and contextualized by incorporating the concept of cultural capital. 43 , 44 Challenge 3: The Need to Assess Cultural Capital at the Collective Level Cultural capital studies, including those by Bourdieu, have primarily dealt with cultural capital as an individual-level factor. However, since culture is shared within groups, cultural capital may also function at the collective level. This underscores the need to conceptualize and assess cultural capital at the regional or group level—an approach that aligns with the contextual perspective in social epidemiology, which distinguishes between contextual and compositional effects when analyzing the social determinants of health. The contextual effects refer to the influence of structural characteristics specific to a group that goes beyond the distribution of individual attributes and the sum of individual unit effects (i.e., having emergent properties), while the compositional effects reflect health outcomes explained by individual-level risk factors. 45 Multilevel models, introduced by scholars in social epidemiology, aim primarily to distinguish between contextual and compositional effects. 45 , 46 Thus, we propose the concept of collective cultural capital as a structural determinant of health. Bourdieu uses the concept of champ to define the field in which the value of cultural capital is determined. This concept plays a central role in his theory. He argued that individuals are embedded in multiple fields rather than a single one. 1 However, he does not consider the field itself to which individuals belong as a form of capital that directly influences health and well-being. From a social epidemiology perspective, the field can be seen as a collective determinant of health. 47 – 50 Collective cultural capital is a concept that contributes to the valuation of the field. One caution when implementing the concept of collective cultural capital in quantitative research is to ensure a valid definition of the group. An inappropriate definition can lead to bias, which is recognized in health geography as the modifiable areal unit problem (MAUP). MAUP refers to the phenomenon in which estimates derived from different geographic units of aggregation may differ. 51 – 53 Challenge 4: The Need for a Cultural Capital Concept that Encompasses Human Nature beyond the Social Space A Proposal for Three Subtypes of Cultural Capital: Exchange-Based, Governance-Based, and Existential Bourdieu’s cultural capital concept presupposes a structure in which individuals are positioned within hierarchical relations—what he terms the social space—through their habitus. 1 , 2 According to Bourdieu, habitus is a system of dispositions that shapes individuals’ behavior. Through habitus , individuals are categorized by others within the social space and, in turn, categorize others. However, human life also encompasses realms beyond the social space, as cultural practices often give rise to spheres that transcend social hierarchy. For instance, in the Japanese tea ceremony, participants, regardless of social status, share a bowl of tea, emphasizing the value of building fair and simple relationships between individuals that transcend status and position. 54 Furthermore, the concept of the social space assumes that individuals’ actions are rooted in selfishness. However, studies across multiple disciplines including neuroscience and cognitive sciences have suggested that humans have inherent altruism, equality seeking, and sharing, and that these characteristics can be manifested in cultural acts. 55 – 58 David Graeber, a cultural anthropologist, also criticized the foundational assumption in Bourdieu’s model—that individuals act strategically to maximize personal gain—and argued that neither a purely egoistic nor a purely altruistic view can fully explain human behavior. 59 Graeber proposed three moral principles underlying economic relations: hierarchy, exchange, and communism. 60 The principle of exchange operates by stripping people of their unique contexts in existence, rendering them measurable and substitutable, e.g., slavery. 60 The principle of hierarchy is defined by dominant relationships based on fixed lines of superiority and obligatory giving. The principle of communism is based on non-exchangeability in existence, in contrast to slavery. Communism, in Graeber’s view, is not the Marxist doctrine of ownership of the means of production, but rather an everyday moral principle of mutual aid and unconditional giving. These principles coexist and intermingle in human life. The principles of exchange and hierarchy align with Bourdieu’s concept of the social space, but the principle of communism is not covered by Bourdieu’s framework. Applying Graeber’s three moral principles to Bourdieu’s theory of cultural capital, we classified cultural capital into three types: exchange-based cultural capital , governance-based cultural capital, and existential cultural capital. The former two are included in Bourdieu’s definition of cultural capital, and we propose existential cultural capital based on Graeber’s communism moral principle. Graeber illustrates the difference between these principles by contrasting examples such as marriage ceremonies and slavery. In certain social rituals, such as marriage ceremonies, the exchange of symbolic objects—e.g., ornaments and cloth—signifies the impossibility of equivalence, affirming that a person cannot be reduced to an equivalent value. In contrast, slavery, which regards people as equivalent to money or other commodities, is a phenomenon likely to happen in commercial economies. He distinguished between commercial economies, and human economies (gift economies), which aim to create, transform, and reconstitute human beings and human relationships. Anthropologist Hitoshi Imamura classified gift-giving into two types: pure gift , in which no return is expected from the recipient, 61 and reciprocal gift , in which a return is anticipated. Graeber’s principle of communism is based on relationships of gift-giving that do not involve reciprocity, such as immediate repayment or barter, which are characteristic of commercial economies. Like the tea ceremony example, many cultural activities follow the principle of communism often take precedence over those of exchange and hierarchy. Classifying forms of cultural capital based on these principles resonates with the arguments of the historian Yoshihiko Amino and the philosopher Hannah Arendt. Amino introduced the concept of muen , denoting “a liberated space free from private subjugation” in medieval Japan. This was a domain based on the existential principle, detached from the principles of exchange and governance. He wrote, “Literature, performance, art, religion—culture that moves the soul—is all born within the space of muen and sustained by the people of muen ”. 62 Similarly, as Hannah Arendt described as follows, the form of cultural capital used as a kind of currency should be classified as exchange-based cultural capital, while culture used for the attainment of social status can be understood as governance-based cultural capital. Cultural value, in contrast, can be understood as grounded in an existential principle—detached from both exchange and governance. Reflecting on the commodification of cultural goods, she identified an overtly utilitarian spirit—one that is unable to think about or evaluate things apart from their function or utility—as philistine. … cultural objects were first despised as useless by the philistine until the cultural philistine seized upon them as a currency by which he bought a higher position in society or acquired a higher degree of self-esteem—higher, that is, than in his own opinion he deserved either by nature or by birth. In this process, cultural values were treated like any other values, they were what values always have been, exchange values; and in passing from hand to hand they were worn down like old coins. … cultural and moral “values” were sold out together (pp. 200–201). 63 Culture as the outcome of epidemiologic study: Cultural (or Existential) Well-being Existential cultural capital can be understood as a determinant of health and wellbeing, but it can also be a component of wellbeing that may be treated as an outcome in epidemiologic study. We suggest calling this cultural well-being or existential well-being when utilizing the concept of existential cultural capital as an outcome in health research. The underlying principle of this form of capital, the unexchangeable nature of being, has historically embodied what is often referred to as humanism. For example, Inuit societies have developed everyday practices that prevent hierarchical relationships from arising through acts of giving, as a means of sustaining their humanity. 59 Similarly, traditions such as Buddhist non-discrimination and Christian philanthropy have emphasized domains of giving that transcend exchange and hierarchy. In Eastern philosophies, the idea of unexchangeable being goes beyond notions of individuality or being oneself. It encompasses an awareness found in Zen concepts such as ichi-go ichi-e (a once-in-a-lifetime encounter) and in mindfulness practices that emphasize the irreplaceability of each moment. 64 Some countries have legally guaranteed existential cultural capital as a right of citizens. The Constitution of Japan states “All people shall have the right to maintain the minimum standards of wholesome and cultured living”. 65 This protection of the right to a cultured living reflects an affirmation of human dignity through cultural expression. 65 , 66 This principle of unexchangeable being is inherently pluralistic and particular, and therefore resists standardization or homogenization. It may therefore be regarded as a foundation of dignity, which is a core principle in the ethics of care. 67 , 68 Care and art are the two social domains where this unexchangeable nature of being, or gift-like function, is most clearly expressed. 69 , 70 Arendt also noted that the etymological root of the word culture contains the meaning to care , as follows: Culture, word and concept, is Roman in origin. The word “culture” derives from colere —to cultivate, to dwell, to take care, to tend and preserve—and it relates primarily to the intercourse of man with nature in the sense of cultivating and tending nature until it becomes fit for human habitation. As such, it indicates an attitude of loving care and stands in sharp contrast to all efforts to subject nature to the domination of man. Hence it does not only apply to tilling the soil but can also designate the “cult” of the gods, the taking care of what properly belongs to them (p. 208). 63 She further connected culture to humanism through the Latin term cultura animi , which means cultivation of the soul , and explained: “This humanism is the result of the cultura animi , of an attitude that knows how to take care and preserve and admire the things of the world” (p. 222). 63 In this context, existential cultural capital can serve as a goal of public health in the form of cultural or existential well-being. Culture determines values, and values are concepts of the desirable. They shape our sense of how we ought to live and what is ultimately considered good , forming the existential foundation of well-being. 59 Moreover, the unexchangeable existence of cultural well-being arises from a web of countless relationships, which naturally includes connections with non-human beings, inanimate matter, and nature. However, the notion of society in the WHO’s definition of health, as well as the concept of social in social epidemiology, is generally confined to human social relationships, failing to account for non-human entities. Relationships with nature, in contrast, are central to various cultural traditions in Japan, including Shinto, Zen Buddhism, and Daoist philosophy, as well as the animistic worldviews held by indigenous peoples worldwide, all of which deeply inform their conceptions of well-being. 71 , 72 The concept of Buen Vivir , meaning the good life in Spanish, which was incorporated into the 2008 revised Ecuadorian constitution, is a translation of Sumak Kawsay in the Indigenous Kichwa language, signifying the fullness of life. While its adoption has been critiqued as a form of cognitive appropriation or mistranslation, the concept points to a mode of existence that emphasizes maintaining harmony with all elements of Pacha —nature and the cosmos. 73 Challenge 5: The Unclear and Inconsistent Definitions of Culture across Research Fields Bourdieu’s concept of cultural capital refers to “the capital that culture provides individuals to gain social advantage and higher status in society”. 1 However, definitions of culture remain ambiguous in both Bourdieu’s theory and public health research. In anthropology, traditional dichotomous understandings that separate humans from nature have been widely criticized. Instead, culture is increasingly understood as emerging from interactions and harmony between humans and nature, continuously evolving through the interweaving of multiple generations. 74 , 75 Through our literature review, we identified, based on this anthropological perspective, the potential multiple dimensions of culture, each containing several subdomains. Specifically, we classified these dimensions into five categories: Relationship , Referents , Principles , Forms , and Levels , and further subcategorized the domains within each as follows, making explicit the diverse meanings and dimensions of culture. This approach enhances the clarity and applicability of the concept of cultural capital in public health research ( Table 3 ). Table 3. The dimensions and domains of cultural capital found in the definitions of culture in various academic fields. Dimensions Domains 1. Relationship a. Internal b. Interpersonal c. Nature-related 2. Referents a. Totality of Human Activities b. Cultural Activities b-a. Arts b-b. Cultural Practices/Resources, and Cultivated Knowledge b-c. Leisure 3. Principles a. Exchange-Based b. Governance-based c. Existential 4. Forms a. Dispositional b. Behavioral c. Institutionalized d. Objectified 5. Levels a. Individual b. Collective Relationship We conceptualize a type of cultural capital that focuses on the relationship between humans and nature, as a way to evaluate cultural phenomena. We refer to this as nature-related cultural capital , which includes an individual’s sense of connection to nature and perceptions of it. Second, akin to Bourdieu’s focus on individual dispositions and accumulations, we identify internal cultural capital , such as educational background, habits, competencies, and possessions. Third, cultural capital may also reside in human relationships inherently, such as reciprocity, which is considered one form of social capital. 76 This type emphasizes the interpersonal dimension of culture and is referred to as interpersonal cultural capital. These categories are not mutually exclusive and in relation to each other, they will help us understand cultural capital better. For example, skills such as numerical ability may be more appropriately understood as internal forms of cultural capital, rather than as being embedded in interpersonal or human–nature relationships. In this sense, cultural capital can be classified according to the domain to which it primarily pertains within the dimension of relationship, which includes three domains: a. Internal ; b. Interpersonal ; and c. Nature-related. Referents Based on these relational foci, we then examine the objects or domains referred to by the term culture. As Monaghan and Just have noted, there are likely more anthropological definitions of culture than the number of anthropologists. 77 One of the most frequently cited definitions is by E.B. Tylor, who described culture (or civilization) as “that complex whole which includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits acquired by man as a member of society”. 78 On the other hand, 19th-century British poet and critic Matthew Arnold described culture as “the best which has been thought and said”, 79 referring to the works of literature, philosophy, classical music, and the fine arts. Although the concept of culture is inherently polysemous, it can broadly be categorized into two main meanings: culture as the totality of human activity , and cultural activities that express human spiritual refinement. 80 In the latter case, the boundary of what counts as cultural activity is socially constructed—defined by social conventions or authorized institutions. 81 , 82 Based on this distinction, the meaning of culture can be organized along the dimension of referents, which includes two domains: a. Totality of human activity ; and b. Cultural activities. Boundaries of cultural activities are determined socially or institutionally. In other words, what is recognized as a cultural resource varies depending on prevailing social norms. Cultural activities can be further classified into three subdomains: b-a. Art , which is often defined in an elusive and negotiated manner among participants who collectively determine its boundaries and quality; b-b. Cultural practices/resources and cultivated knowledge , including traditional performing arts and cultural heritage that may not be classified as art per se but are considered part of cultural activity; and b-c. Leisure , referring to activities that are difficult to classify strictly as art or cultural practices, such as gaming, sports, or gambling. Principles Building on the three cultural principles discussed in Section 4, each of the above classifications can be further divided into three domains within the dimension of principles, as follows: a. Exchange-based ; b. Governance-based ; and c. Existential. This dimension, principles , differs from the other dimensions, and is not directly observable through existing data. The development of a dedicated measurement scale is required to assess this dimension. Forms The form that culture takes can be understood using Bourdieu’s three forms of cultural capital: embodied, institutionalized, and objectified. 1 Embodied cultural capital can be further divided, drawing on Bourdieu’s notions of pratique and habitus. Pratique refers to the foundational behavior of everyday life, 83 while habitus is a system of enduring dispositions that orient individual behavior. 1 Thus, culture can be classified into the following four domains within the dimension of forms: a. Dispositional (values, attitudes, and personality traits that guide behavior, corresponds to the habitus aspect of embodied capital); b. Behavioral (habitual behaviors and cultural participation, corresponds to the pratique aspect of embodied capital); c. Institutionalized (formalized systems and structures, corresponds to institutionalized cultural capital and reflects strong governance-based principle); and d. Objectified (material resources such as artworks, buildings, and ornaments, corresponds to objectified cultural capital). Levels As discussed in Section 3, both individual cultural capital and its nested level, collective cultural capital, are assumed. Therefore, within the dimension of levels, culture can be classified into two domains: a. Individual ; and b. Collective . The field/context dependency of capital, and existential features of capital in human economy Bourdieu employed the term capital to draw attention to the concealed capital-like properties of culture. 1 Analogous to how capital in a commodity economy derives its value in relation to the market, Bourdieu argued that the value of cultural capital is determined by the field. He further defined capital as a form of social relation, a social force that exists only within, and derives its effects from, the field in which it is produced and reproduced. 1 Applying the idea of contextual effects assumed by social epidemiology, we hypothesize that the characteristics of the field additively or synergistically modify the outcomes of the individuals’ capitals belonging to the group. Based on Bourdieu’s concept and considering that the central aim of public health is to improve (human) health, we define capital in public health as a potential force that contributes to individual or collective health, which determined through its relationship with the field. As Bourdieu’s field theory emphasizes, capital is not an absolute potential, but one whose value is relationally defined. This aligns with Amartya Sen’s idea of capability. 84 , 85 A key feature of this view for capital is that even the inability to do something, or so-called negativity, can function positively within a particular field/context. In other words, depending on its relationship to the field, capital can function both positively and negatively. For example, assertiveness is valued in the American work environment, its value being determined by that field, but is often discouraged in East Asian culture. As a result, East Asians are disadvantaged in leadership attainment despite equal qualifications. 86 This field-dependent conception of capital corresponds to the epidemiological concept of effect modification, in which the field modifies the effect of capital on health outcomes among population subgroups. 19 , 87 Such a perspective offers a valuable framework for designing culturally grounded interventions in public health. However, while Bourdieu’s concept of capital is grounded in exchangeable and governance-based principles, based on equivalence or the expectation of return, capital in public health also incorporates the existential principle, grounded in unexchangeable being. This distinction aligns with Graeber’s differentiation between commercial and human economies. In commercial economies, capital is typically measured in monetary terms, reflecting the value of assets and transactions. In contrast, human economies are characterized by forms of gift that do not entail expectations of return; Graeber referred to the circulating money in such contexts as “social currency”. 60 Public health operates within both logics, and therefore capital in this field includes aspects not based on equivalence or exchangeability, resembling social currency in gift economies or even human existence itself. Just as one’s life experiences may be seen either as investments convertible into future returns or as irreplaceable sources of meaning and vitality that cannot be exchanged with other values or those of others, we propose that capital in public health includes forms of value derived from unexchangeable forces. The pitfalls of existential cultural capital: The risk of fixation and homogenization Graeber conceptualizes individuals as nodal beings, emerging from a web of unexchangeable relations rather than reducible to interchangeable entities. 60 In public health, this unexchangeable nature of being can be recognized across multiple levels of existence. As previously discussed, existential uniqueness may emerge at the individual level as well as within groups such as families, local communities, nation-states, or categories such as Japanese, New Yorker, or mother. However, once such a group is defined and studied or intervened, the collectivized view and evaluations of the group can create stereotypical and biased understandings. 88 , 89 Similar stereotyping and bias can occur when observing individuals: despite the multiplicity of selves that arise in relation to others, individuals are often reduced to a single, fixed self. The meaning of authenticity or being oneself shifts depending on whether it refers to a fixed inner identity or a dynamic, irreplaceable self that emerges between the self and the world. Even when measuring individuality , its meaning may vary across cultures. In Buddhist thought, fixed perceptions are regarded as attachment, while dynamic recognition is expressed as impermanence ( anicca ). 90 At every level of existence, the dignity that allows us to perceive dynamic singularity, the irreplaceable, is the core of existential cultural capital. However, we should remain cautious of its potential to become a trigger for discrimination or superficial understandings of others once this singularity is fixed. The idea that all beings are connected is fundamentally different from the idea that all beings are the same. While the use of the concept of existential cultural capital has risks, other types of principle-based cultural capital discussed in this paper, namely exchange-based cultural capital and governance-based cultural capital, also have the potential to either liberate or constrain individuals. Public health interventions should take these ambivalent characteristics into account. Exchange-based principles may strip away uniqueness and erode dignity by subjecting people to calculable equivalence; however, they also provide freedom, such as an equal opportunity for anyone to purchase a bottle of juice with the same 100 yen. Governance-based principles can lead to homogenization and the use of external force to maintain order, by governing bodies, even against one’s will. Yet they also offer the possibility of fairness through redistribution of financial and material resources. Likewise, existential principles, while representing a critical domain for existential well-being, also carry the risk of producing discrimination, prejudice based on stereotypes, or informal hierarchies. Even the act of gift-giving, central to existential cultural capital, can become burdensome when it implicitly entails an obligation to reciprocate. 60 Conclusion In this paper, we have sought to advance the application of Bourdieu’s concept of cultural capital within public health and related fields, including medical care, welfare, and health sciences. To this end, we first identified the key conceptual challenges arising from translating Bourdieu’s framework into public health contexts and then proposed corresponding adaptations of the cultural capital concept to address each challenge. We began by clarifying the epistemological divergence between Bourdieu’s original focus on structures of power and domination and public health’s aim of promoting health and well-being. We then introduced the notion of contextual validity and discussed ethical considerations for cultural interventions, emphasizing their potential risks, limitations, and benefits. Additionally, we extended the traditional individual-level orientation of cultural capital to encompass the collective level, such as communities or societies, by proposing the concept of collective cultural capital as a useful lens for public health research. We also introduced the concepts of existential cultural capital and cultural (or existential) well-being, grounded in the principle of unexchangeable being. These concepts offer a novel perspective that departs from exchange-based and hierarchical models of cultural capital, and suggest new ways to assess the relationship between culture and well-being in public health. We situated existential cultural capital as a form of capital that affirms human dignity, irreducibility, and the plural expressions of life, and as one that is closely tied to the domains of care and artistic practice. Finally, we proposed a classification framework for cultural capital types, with the aim of fostering a shared language for conducting cultural capital research in public health. We further conceptualized the field/context dependency of capital, and existential features of capital in the human economy, and suggested that the three principles, exchange-based, governance-based, and existential cultural capital, each carry ambivalent potential to both empower and constrain individuals. This work represents an initial step toward establishing cultural epidemiology as a field that quantitatively assesses the role of culture in shaping health and well-being. Given that the neglect of cultural factors in public health actions can lead to unwanted consequences, the concept of cultural well-being proposed in this study is essential to achieving the public health goal of creating a healthy society that leaves no one behind. 91 While medical anthropology has long explored the relationship between health and culture, there is a growing need to reorient epidemiology, which has traditionally emphasized quantitative assessment, to incorporate cultural perspectives. Moving forward, empirical research is needed to examine how cultural capital influences health and well-being, and how it can be meaningfully incorporated into policy interventions and community practices. The perspectives and typologies presented in this study aim to redefine culture as a central determinant of health, as well as the element of health, enabling both the quantitative assessment and practical application of culture in public health, and contributing to the future development of cultural epidemiology. Ethics statement This study does not involve human participants, personal data, or biological material. Therefore, ethical approval was not required. Assessment tool We did not use any proprietary instruments in this study. Author contributions Hiroshi Habu (HH) and Naoki Kondo (NK) contributed equally to this work. HH was responsible for conceptualization, investigation, methodology, project administration, visualization, writing – original draft preparation, review and editing. NK contributed to conceptualization, funding acquisition, supervision, and writing – review and editing. Data availability No data are associated with this article. This article is based on theoretical and conceptual analysis of the previously published literature cited in the manuscript. As no primary data were collected or generated, there are no datasets associated with this work that require sharing. Reporting guidelines This article is a theoretical discussion and does not report on empirical research. Therefore, no specific reporting guideline applies. Acknowledgements We would like to express our sincere gratitude to Professor Emi Kataoka and Dr. Tetsuji Yamamoto for their insightful lectures delivered during “A Series of Sessions on Considering Cultural Capital,” which we organized. Their contributions greatly deepened our understanding of cultural capital. This series of sessions was made possible through financial support from the Center for the Promotion of Interdisciplinary Education and Research, and the Research Administration Office, Kyoto University, as part of the “Cross–Sectoral Research Platform Development 2024” program. We are also deeply grateful for their generous support. Finally, we would like to thank Dr. Norihisa Arai for his valuable input on cultural anthropology. References 1. Bourdieu P: Distinction: a social critique of the judgement of taste. Nice R, translator. Cambridge (MA): Harvard University Press; 1984. (Original work published 1979). 2. Bourdieu P: The social space and the genesis of groups. Theory Soc. 1985; 14 (6): 723–744. Publisher Full Text 3. Bourdieu P: The forms of capital. Richardson J, editor. Handbook of theory and research for the sociology of education. Westport (CT): Greenwood; 1986; pp. 241–258. 4. 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Ekelund U, Tarp J, Steene-Johannessen J, et al. : Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. 2019; 366 : l4570. PubMed Abstract | Publisher Full Text | Free Full Text 28. Arem H, Moore SC, Patel A, et al. : Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA. Intern. Med. 2015; 175 (6): 959–967. PubMed Abstract | Publisher Full Text | Free Full Text 29. Hernán MA, Robins JM: Causal inference: what if. Boca Raton (FL): Chapman & Hall/CRC; 2020. 30. Corrigan PW: Lessons learned from unintended consequences about erasing the stigma of mental illness. World Psychiatry. 2016; 15 (1): 67–73. PubMed Abstract | Publisher Full Text | Free Full Text 31. Engel S, Susilo A: Shaming and sanitation in Indonesia: a return to colonial public health practices? Dev. Chang. 2014; 45 (1): 157–178. Publisher Full Text 32. Sobo EJ, Russell A: Contraception today: ethnographic lessons. Anthropol. Med. 1997; 4 (2): 125–130. Publisher Full Text 33. Ritzer G: The McDonaldization of society. Los Angeles (CA): Pine Forge Press; 2009. 34. Kleinman A, Benson P: Cultural barriers to care: inverting the problem. PLoS Med. 2006; 3 (10): e294. PubMed Abstract | Publisher Full Text | Free Full Text 35. Warwick DP: Culture and the management of family planning programs. Stud. Fam. Plan. 1988; 19 (1): 1–18. Publisher Full Text 36. Ikeda M, Okuno K, editors. Iryō jinruigaku no ressun: Yamai o meguru bunka o saguru [Lessons in medical anthropology: exploring cultures surrounding illness]. Tokyo: Gakuyō Shobō; 2007. Japanese. 37. OECD: Improving value in health care: measuring quality. Paris: OECD Publishing; 2010. 38. World Health Organization: WHO releases new International Classification of Diseases (ICD-11) [Internet]. Geneva: World Health Organization; 2019 [cited 2025 May 14]. Reference Source 39. Cochran SD, Drescher J, Kismödi E, et al. : Proposed declassification of disease categories related to sexual orientation in the International Statistical Classification of Diseases and Related Health Problems (ICD-11). Bull. World Health Organ. 2014 Sep 1; 92 (9): 672–679. PubMed Abstract | Publisher Full Text | Free Full Text 40. Bipp T, Kleingeld A: Goal-setting in practice: the effects of personality and perceptions of the goal-setting process on job satisfaction and goal commitment. Pers. Rev. 2011; 40 (3): 306–323. Publisher Full Text 41. Milyavskaya M, Ianakieva I, Foxen-Craft E, et al. : Inspired to get there: the effects of trait and goal inspiration on goal progress. Pers Individ Dif. 2012; 52 (1): 56–60. Publisher Full Text 42. Alqahtani F, Meier S, Orji R: Personality-based approach for tailoring persuasive mental health applications. User Model User-Adap Interact. 2022; 32 (2): 253–295. Publisher Full Text 43. Ueno K, Nishioka D, Kino S, et al. : A data-driven approach to detect support strategies for children living in households receiving public assistance in Japan: a mixed methods study to establish tailor-made health and welfare care. Int. J. Equity Health. 2025; 24 : 103. PubMed Abstract | Publisher Full Text | Free Full Text 44. Marteau TM, Hollands GJ, Fletcher PC: Changing human behavior to prevent disease: the importance of targeting automatic processes. Science. 2012; 337 (6101): 1492–1495. PubMed Abstract | Publisher Full Text 45. Subramanian SV, Lochner KA, Kawachi I: Neighborhood differences in social capital: a compositional artifact or a contextual construct? Health Place. 2003; 9 (1): 33–44. Publisher Full Text 46. Diez-Roux AV: Multilevel analysis in public health research. Annu. Rev. Public Health. 2000; 21 : 171–192. Publisher Full Text 47. Fancourt D, Steptoe A: Community group membership and multidimensional subjective well-being in older age. J. Epidemiol. Community Health. 2018; 72 (5): 376–382. PubMed Abstract | Publisher Full Text | Free Full Text 48. Zaitsu M, Kawachi I, Ashida T, et al. : Participation in community group activities among older adults: is diversity of group membership associated with better self-rated health? J. Epidemiol. 2018; 28 (11): 452–457. PubMed Abstract | Publisher Full Text | Free Full Text 49. Oldenburg R: The great good place: cafés, coffee shops, bookstores, bars, hair salons and other hangouts at the heart of a community. New York: Marlowe & Company; 1989. 50. Jeffres LW, Bracken CC, Jian G, et al. : The impact of third places on community quality of life. Appl. Res. Qual. Life. 2009; 4 (4): 333–345. Publisher Full Text 51. Parenteau MP, Sawada MC: The modifiable areal unit problem (MAUP) in the relationship between exposure to NO 2 and respiratory health. Int. J. Health Geogr. 2011; 10 : 58. PubMed Abstract | Publisher Full Text | Free Full Text 52. Clarke KC, Hegyi F, Yuan M, et al. : Sensitivity analysis in the context of regional safety modeling: identifying and assessing the modifiable areal unit problem. Accid. Anal. Prev. 2014; 66 : 62–71. Publisher Full Text 53. Duque JC, Laniado H, Polo A: S-maup: statistical test to measure the sensitivity to the modifiable areal unit problem. PLoS One. 2018; 13 (11): e0207377. PubMed Abstract | Publisher Full Text | Free Full Text 54. Rikyū S, Sōkei N, Kuwata T, editors. Tokyo: Iwanami Shoten; 1980. Japanese. 55. Tabibnia G, Satpute AB, Lieberman MD: The sunny side of fairness: preference for fairness activates reward circuitry (and disregarding unfairness activates self-control circuitry). Psychol. Sci. 2008 Apr; 19 (4): 339–347. PubMed Abstract | Publisher Full Text 56. Fehr E, Fischbacher U: The nature of human altruism. Nature. 2003 Oct 23; 425 (6960): 785–791. Publisher Full Text 57. Warneken F, Tomasello M: Altruistic helping in human infants and young chimpanzees. Science. 2006; 311 (5765): 1301–1303. PubMed Abstract | Publisher Full Text 58. Tomasello M: Why we cooperate. Cambridge (MA): MIT Press; 2009. 59. Graeber D: Toward an anthropological theory of value: the false coin of our own dreams. New York: Palgrave Macmillan; 2001. 60. Graeber D: Debt: the first 5,000 years. Brooklyn (NY): Melville House; 2011. 61. Imamura H: Shakaisei no tetsugaku [Philosophy of sociality]. Tokyo: Iwanami Shoten; 2007. Japanese. 62. Muen AY, Kugai R: Nihon chūsei no jiyū to heiwa [Freedom and peace in medieval Japan]. Tokyo: Heibonsha; 1978. Japanese. 63. Arendt H: Between past and future. London: Penguin Books; 2006. 64. Thich Nhat Hanh: The miracle of mindfulness: an introduction to the practice of meditation. Boston: Beacon Press; 1975. 65. Japan: Constitution of Japan. Tokyo: Government of Japan; 1946. 66. Saito Y: The legal nature of the right to life. J. Comp. Leg. Stud. 1996; 19 : 35–53. 67. Kadivar M, Mardani-Hamooleh M, Kouhnavard M: Concept analysis of human dignity in patient care: Rodgers’ evolutionary approach. J. Med. Ethics Hist. Med. 2018; 11 : 4. PubMed Abstract 68. Jones DA: Human dignity in healthcare: a virtue ethics approach. New Bioethics. 2015; 21 (1): 87–97. PubMed Abstract | Publisher Full Text 69. Saito Y: Aesthetics of care: practice in everyday life. London: Bloomsbury Academic; 1st ed. 2022. (Bloomsbury Aesthetics). 70. Thompson J: Care aesthetics: for artful care and careful art. London: Routledge; 1st ed. 2022. (Routledge Studies in Care Aesthetics). 71. Suzuki D: The Eastern way of seeing. Tokyo: Iwanami Shoten; 1963. Japanese. 72. Laozi, Te Ching T , Lau DC, translator. London: Penguin Classics; 1963. 73. Cuestas-Caza J: Sumak Kawsay is not Buen Vivir. Alternautas. 2022; 5 (1). Publisher Full Text 74. Ingold T: The perception of the environment: essays on livelihood, dwelling and skill. London: Routledge; 2000. 75. Ingold T: The rise and fall of generation now. Cambridge: Polity Press; 2023. 76. Putnam RD: Bowling alone: the collapse and revival of American community. New York: Simon & Schuster; 2000. 77. Monaghan J, Just P: Social and cultural anthropology: a very short introduction. Oxford: Oxford University Press; 2000. 78. Tylor EB: Primitive culture: researches into the development of mythology, philosophy, religion, art, and custom. London: John Murray; 1871. 79. Arnold M: Culture and anarchy: an essay in political and social criticism. London: Smith, Elder & Co.; 1869. 80. Agency for Cultural Affairs, Government of Japan: Basic policy on cultural administration (Fourth Basic Policy): Chapter 1. Fundamental approach to cultural administration. Tokyo: Agency for Cultural Affairs; 2025 [cited 2025 Apr 22]. Reference Source 81. Dickie G: Art and the aesthetic: an institutional analysis. Ithaca (NY): Cornell University Press; 1974. 82. Dickie G: The art circle: a theory of art. New York: Haven Publications; 1984. 83. Ishii Y: Difference and desire. Tokyo: Fujiwara Shoten; 1993. Japanese. 84. Sen A: Development as freedom. New York: Alfred A. Knopf; 1999. 85. Nussbaum MC: Creating capabilities: the human development approach. Cambridge (MA): Harvard University Press; 2011. 86. Cao J, Zhang S: A study on why foreign-born East Asians but not US-born East Asians are underrepresented in leadership attainment in the U.S. Sci. Rep. 2024; 14 : 9015. PubMed Abstract | Publisher Full Text | Free Full Text 87. Haseda M, Kondo N, Takagi D, et al. : Community social capital and inequality in depressive symptoms among older Japanese adults: a multilevel study. Health Place. 2018 Jul; 52 : 8–17. PubMed Abstract | Publisher Full Text | Free Full Text 88. Buchtel EE: Cultural sensitivity or cultural stereotyping? Positive and negative effects of a cultural psychology class. Int. J. Intercult. Relat. 2014; 38 : 133–141. Publisher Full Text 89. Allport GW: The nature of prejudice. Cambridge (MA): Addison-Wesley; 1954. 90. Rahula W: What the Buddha taught. New York: Grove Press; 1974. 91. WHO: Primary health care on the road to universal health coverage: 2019 monitoring report. Geneva: World Health Organization; 2019. Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 30 Jun 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Kyoto Prefecture, 606-8501, Japan Hiroshi Habu Roles: Conceptualization, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Naoki Kondo Roles: Conceptualization, Funding Acquisition, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This project was funded and supported by the World Health Organization (WHO) Regional Office for the Western Pacific (WPRO), but the outcomes reflect the deliberations of authors and research partners. This work was also supported by JST Grant Number JPMJPF2105. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 30 Jun 2025, 14:638 https://doi.org/10.12688/f1000research.166017.1 Copyright © 2025 Habu H and Kondo N. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Habu H and Kondo N. Culture as a Determinant of Health and Well-being: Expanding the Concept of Cultural Capital [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :638 ( https://doi.org/10.12688/f1000research.166017.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 30 Jun 2025 Views 0 Cite How to cite this report: van Meurs T. Reviewer Report For: Culture as a Determinant of Health and Well-being: Expanding the Concept of Cultural Capital [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :638 ( https://doi.org/10.5256/f1000research.182854.r399447 ) The direct URL for this report is: https://f1000research.com/articles/14-638/v1#referee-response-399447 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 27 Aug 2025 Tim van Meurs , Tilburg University, Tilburg, Netherlands Antilles Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.182854.r399447 This article attempts to expand Bourdieu's notion of cultural capital to fit the field of public health and epidemiology. In doing so, it takes a purely theory-based approach, basing the findings on prior research on the link between culture and ... Continue reading READ ALL This article attempts to expand Bourdieu's notion of cultural capital to fit the field of public health and epidemiology. In doing so, it takes a purely theory-based approach, basing the findings on prior research on the link between culture and health. While I appreciate the attempt to clarify how cultural capital should (can) be applied to research related to health, I do not think the authors succeed in doing so in this article. My main concern is how culture and cultural capital seem to be used by the authors rather interchangeably. Their definitions often seem to go beyond cultural capital, in which the capital part of cultural capital seems to be forgotten: many of the suggestions the authors 'expand' the concept beyond its usage as something that can be 'exchanged'. Drawing from anthropological research, they argue that exchangeability is not necessary for cultural capital, but I am not convinced by their argumentation here. A second main concern is two-fold. First, I am not convinced by the 'novelty' of the idea of a form of cultural capital that can be applied better to health and well-being. On the one hand, this is because I am of the opinion that the 'original' cultural capital is applicable enough for this (see amongst others the work of Thomas Abel and Joost Oude Groeniger), and on the other hand, similar attempts have been (successfully) made in the past already (see, e.g., Shim (2010)'s work on cultural health capital ). Second, the article does not make a convincing case for how this new form would work in practice. Many of the newly proposed concepts, like existential cultural capital and the three domains of relationship discussed in Table 3 remain vague and hardly applicable. As such, I do not see the added value this article has to the (admittedly limited) body of research on cultural capital and health. Some smaller issues: - At various times, the authors allude to cultural capital as an 'individual factor', at some point going so far as to suggest a contextual form is needed (challenge 3). While I can see how it can be defined as an individual factor (e.g., when it's operationalized in statistical models), this conceptualization seems to overlook how cultural capital is based on societal structures of how 'dominant culture' is defined. - Methodologically, the article is a bit unclear. It's a theoretical paper based on previous literature, yet it is far to incomplete to be considered a (systematic) literature review. Even if the authors' goal was not to paint a complete picture of the field, some core research of the cultural capital and health field is missing (e.g., abovementioned Abel, Shim, Oude Groeniger). Also more recent work about cultural capital itself could benefit the theoretical depth (e.g., Van der Waal et al., 2024). - There are some (commendable) remarks about equality and equal chances for all (e.g. Japanese tea ceremonies, "legally guaranteed existential cultural capital" (p. 7), or "a healthy society that leaves no one behind" (p. 11). I would argue that research on cultural capital exactly shows this is not the case . It shows that there is some (cultural) hierarchy in place in most societies that goes beyond e.g. economical inequalities. As such, I do not understand the attempt to create a form of cultural capital that is equal for all. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Sociology of stratification; cultural sociology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT van Meurs T. Reviewer Report For: Culture as a Determinant of Health and Well-being: Expanding the Concept of Cultural Capital [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :638 ( https://doi.org/10.5256/f1000research.182854.r399447 ) The direct URL for this report is: https://f1000research.com/articles/14-638/v1#referee-response-399447 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Searight HR. Reviewer Report For: Culture as a Determinant of Health and Well-being: Expanding the Concept of Cultural Capital [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :638 ( https://doi.org/10.5256/f1000research.182854.r396823 ) The direct URL for this report is: https://f1000research.com/articles/14-638/v1#referee-response-396823 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Aug 2025 H. Russell Searight , Lake Superior State University, Sault Ste. Marie, Michigan, USA Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.182854.r396823 First, many of the dimensions listed above—such as statistical analysis—are not applicable to this conceptual paper. The article aims to link a particular conceptual model, informed by Bourdieu’s perspective on cultural capital, to the field of epidemiology. The authors ... Continue reading READ ALL First, many of the dimensions listed above—such as statistical analysis—are not applicable to this conceptual paper. The article aims to link a particular conceptual model, informed by Bourdieu’s perspective on cultural capital, to the field of epidemiology. The authors argue that this framework may enhance our understanding of epidemiological processes. Certainly--the use of cultural capital is relevant and has found its way into social epidemiology (e.g--Abel, T. (2008) [Reference 1]) The authors reference previous work by Wieiss and the Explanatory Model Interview Catalogue, which emphasizes subjective and culturally specific understandings of health and illness and recognizes that specific "symptoms" have culturally specific meanings. As such, they may or may not be related to clinical syndromes depending upon their culturally specific meaning. The psychiatric anthropologists come on Arthur Kleinman also makes this case through his field research in mainland China. (See, for example, Ware, N. C., & Kleinman, A. (1992) [Reference 2]) The methodology of the current paper is described as a theory-driven literature review. The authors highlight key distinctions between Bourdieu's approaches and public health paradigms, particularly with regard to social epidemiology. In their discussion of five central challenges in applying Bordieu's model to epidemiology, the authors provide illustrative examples for the first two challenges. However, for challenges three through five, while providing examples drawn from cultural and religious traditions (e.g., Buddhism and Christianity) are included, the article would benefit from more direct applications to public health. and /or illustrations from cultural epidemiology The lack of concrete public health examples weakens the integration of the conceptual model with epidemiological practice. In the conclusion, the authors suggest that their model could foster a shared language for conducting culturally informed research in public health. However, due to the limited number of practical examples and the insufficient demonstration of integration with public health frameworks, the article does not present a compelling case for adoption by epidemiologists and public health professionals. As such, this paper represents a potentially useful beginning of a conceptual dialogue which will hopefully be expanded upon. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly References 1. Abel T: Cultural capital and social inequality in health. Journal of Epidemiology & Community Health . 2008; 62 (7). Publisher Full Text 2. Ware N, Kleinman A: Culture and somatic experience: the social course of illness in neurasthenia and chronic fatigue syndrome. Psychosomatic Medicine . 1992; 54 (5): 546-560 Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: social determinants oif health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Searight HR. Reviewer Report For: Culture as a Determinant of Health and Well-being: Expanding the Concept of Cultural Capital [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :638 ( https://doi.org/10.5256/f1000research.182854.r396823 ) The direct URL for this report is: https://f1000research.com/articles/14-638/v1#referee-response-396823 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 30 Jun 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 30 Jun 25 read read H. Russell Searight , Lake Superior State University, Sault Ste. Marie, USA Tim van Meurs , Tilburg University, Tilburg, Netherlands Antilles Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 van Meurs T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 27 Aug 2025 | for Version 1 Tim van Meurs , Tilburg University, Tilburg, Netherlands Antilles 0 Views copyright © 2025 van Meurs T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This article attempts to expand Bourdieu's notion of cultural capital to fit the field of public health and epidemiology. In doing so, it takes a purely theory-based approach, basing the findings on prior research on the link between culture and health. While I appreciate the attempt to clarify how cultural capital should (can) be applied to research related to health, I do not think the authors succeed in doing so in this article. My main concern is how culture and cultural capital seem to be used by the authors rather interchangeably. Their definitions often seem to go beyond cultural capital, in which the capital part of cultural capital seems to be forgotten: many of the suggestions the authors 'expand' the concept beyond its usage as something that can be 'exchanged'. Drawing from anthropological research, they argue that exchangeability is not necessary for cultural capital, but I am not convinced by their argumentation here. A second main concern is two-fold. First, I am not convinced by the 'novelty' of the idea of a form of cultural capital that can be applied better to health and well-being. On the one hand, this is because I am of the opinion that the 'original' cultural capital is applicable enough for this (see amongst others the work of Thomas Abel and Joost Oude Groeniger), and on the other hand, similar attempts have been (successfully) made in the past already (see, e.g., Shim (2010)'s work on cultural health capital ). Second, the article does not make a convincing case for how this new form would work in practice. Many of the newly proposed concepts, like existential cultural capital and the three domains of relationship discussed in Table 3 remain vague and hardly applicable. As such, I do not see the added value this article has to the (admittedly limited) body of research on cultural capital and health. Some smaller issues: - At various times, the authors allude to cultural capital as an 'individual factor', at some point going so far as to suggest a contextual form is needed (challenge 3). While I can see how it can be defined as an individual factor (e.g., when it's operationalized in statistical models), this conceptualization seems to overlook how cultural capital is based on societal structures of how 'dominant culture' is defined. - Methodologically, the article is a bit unclear. It's a theoretical paper based on previous literature, yet it is far to incomplete to be considered a (systematic) literature review. Even if the authors' goal was not to paint a complete picture of the field, some core research of the cultural capital and health field is missing (e.g., abovementioned Abel, Shim, Oude Groeniger). Also more recent work about cultural capital itself could benefit the theoretical depth (e.g., Van der Waal et al., 2024). - There are some (commendable) remarks about equality and equal chances for all (e.g. Japanese tea ceremonies, "legally guaranteed existential cultural capital" (p. 7), or "a healthy society that leaves no one behind" (p. 11). I would argue that research on cultural capital exactly shows this is not the case . It shows that there is some (cultural) hierarchy in place in most societies that goes beyond e.g. economical inequalities. As such, I do not understand the attempt to create a form of cultural capital that is equal for all. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Sociology of stratification; cultural sociology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) van Meurs T. Peer Review Report For: Culture as a Determinant of Health and Well-being: Expanding the Concept of Cultural Capital [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :638 ( https://doi.org/10.5256/f1000research.182854.r399447) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-638/v1#referee-response-399447 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Searight H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Aug 2025 | for Version 1 H. Russell Searight , Lake Superior State University, Sault Ste. Marie, Michigan, USA 0 Views copyright © 2025 Searight H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions First, many of the dimensions listed above—such as statistical analysis—are not applicable to this conceptual paper. The article aims to link a particular conceptual model, informed by Bourdieu’s perspective on cultural capital, to the field of epidemiology. The authors argue that this framework may enhance our understanding of epidemiological processes. Certainly--the use of cultural capital is relevant and has found its way into social epidemiology (e.g--Abel, T. (2008) [Reference 1]) The authors reference previous work by Wieiss and the Explanatory Model Interview Catalogue, which emphasizes subjective and culturally specific understandings of health and illness and recognizes that specific "symptoms" have culturally specific meanings. As such, they may or may not be related to clinical syndromes depending upon their culturally specific meaning. The psychiatric anthropologists come on Arthur Kleinman also makes this case through his field research in mainland China. (See, for example, Ware, N. C., & Kleinman, A. (1992) [Reference 2]) The methodology of the current paper is described as a theory-driven literature review. The authors highlight key distinctions between Bourdieu's approaches and public health paradigms, particularly with regard to social epidemiology. In their discussion of five central challenges in applying Bordieu's model to epidemiology, the authors provide illustrative examples for the first two challenges. However, for challenges three through five, while providing examples drawn from cultural and religious traditions (e.g., Buddhism and Christianity) are included, the article would benefit from more direct applications to public health. and /or illustrations from cultural epidemiology The lack of concrete public health examples weakens the integration of the conceptual model with epidemiological practice. In the conclusion, the authors suggest that their model could foster a shared language for conducting culturally informed research in public health. However, due to the limited number of practical examples and the insufficient demonstration of integration with public health frameworks, the article does not present a compelling case for adoption by epidemiologists and public health professionals. As such, this paper represents a potentially useful beginning of a conceptual dialogue which will hopefully be expanded upon. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly References 1. Abel T: Cultural capital and social inequality in health. Journal of Epidemiology & Community Health . 2008; 62 (7). Publisher Full Text 2. Ware N, Kleinman A: Culture and somatic experience: the social course of illness in neurasthenia and chronic fatigue syndrome. Psychosomatic Medicine . 1992; 54 (5): 546-560 Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise social determinants oif health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Searight HR. Peer Review Report For: Culture as a Determinant of Health and Well-being: Expanding the Concept of Cultural Capital [version 1; peer review: 1 approved with reservations, 1 not approved] . F1000Research 2025, 14 :638 ( https://doi.org/10.5256/f1000research.182854.r396823) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-638/v1#referee-response-396823 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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