Societal and Cultural Attitudes to Gout: An Important Consideration in the Successful Management of Gout among Maori in Aotearoa New Zealand

Although there has been a steady increase in the number of literature reviews on the epidemiology, pathophysiology, diagnosis and treatment of gout there has not been a similar output on the societal and cultural aspects, following the pivotal work of Porter and Rousseau, Gout: The Patrician Malady, which chronicled the socio-political aspects of gout from antiquity to the 1930s. Several excellent reviews which do discuss these issues include the history of gout from 2640BC up to the present, and a historical perspective on gout in women, but a survey of magazine articles and newspapers provides a useful additional perspective on social and cultural attitudes surrounding gout over the past century. Despite advances in management, there are notable similarities between the impact of gout in society today, and in the past, including family and whanau life, employment, sport and recreation, and political activities. One notable difference is that the over-nourished nineteenth century sufferers of gout from the opulent aristocracy, have been replaced in the twenty first century by patients who are frequently from deprived communities. This article will review these aspects, including a discussion on societal and cultural impacts of gout on Maori, the indigenous population of New Zealand. Political and economic influences, such as the adverse effects of colonisation, compound an emerging genetic predisposition to hyperuricemia and gout in Maori. A response to a gout diagnosis arising from a sense of embarrassment (whakama), contrasting with the social elevation once accorded to gout, may also delay effective treatment. Other cultural factors influencing gout management include the perceptions of health and illness by both providers and recipients of health services, and the congruence of these perceptions, as demonstrated in our preliminary studies, though further research is required. The prioritisation of healthcare costs versus other priorities by the patients, as well as the appeal of alternatives to conventional medication may also have an impact. Unless such sociocultural factors are recognised and negotiated with the patient, family and whanau, in an atmosphere of mutual trust, the success of secondary prevention of chronic disease by either self management or the use of prescribed medications may well be thwarted, no matter how effective these might have been in randomised controlled clinical trials.