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Map Illinois for As Bullinger observed If disease, as anthropological research suggests, is so very much culture-bound, how could quality of life be culture free?’ Conceptually, the meaning of health and illness has been shown to be affected by cultural norms and experiences of health, illness and health care, as well as by different belief systems, such as the Chinese belief in the need to maintain a balance between yin and yang, or as in some tribal beliefs in the supernatural. We described many such different beliefs in the opening chapter. Cultural differences also affect how QoL can be assessed see the section on measuring quality of life, below. n Aspects of the illness and quality of life It is quite common for QoL not to be predicted by objectively determined severity of illness and associated symptoms. Furthermore, among carers, it has also been shown that the severity of symptoms or disability of the caredfor does not inevitably reduce carer QoL. We return to this issue in Chapter . The finding that symptom severity or extent of disability does not consistently predict QoL highlights the subjective nature of this concept, and it should come as no surprise to readers that QoL judgements, as with stress and illness discussed in previous chapters, are influenced by individual differences in the appraisal of, and subsequent coping with, ill health. Map Illinois 2016.