Transcript cultural factors in health and disease

Socio- cultural factors in health and disease:
Cultural factors in health and disease:
All people, whether rural or urban, have their own beliefs and practices
concerning health and disease. It is now widely believed that cultural
factors are deeply involved in the affairs of man.
The customs and beliefs which reflect the cultural background of the
human are of three types regarding health and diseases:
1.Positive values: these are based on centuries of trial and error.
2.Useless.
3.Negative values.
Some of these cultural factors, hallowed by centuries of practice, have
stood in the way of implementing health programs and where a change
of behavior was involved, the resistance of people was maximum in
accepting new programs. Details information about these factors (
customs, cultural mores, habits and beliefs ) is still lacking.
The cultural factors involved the following:
I - Concept of etiology and cure:
Broadly speaking, the cause of disease, as understood by majority of
rural people, fall into 2 categories:
A- Supernatural causes:
1. Wrath of Gods and Goddesses: as e.g. small pox and chicken pox and
they considered the administration of drugs is harmful and cases should
not be notified.
2. Breach of taboo: venereal diseases thoughts by some people are due
to illicit sexual intercourse with woman of low caste, or a woman during
menstruation.
3. Past sins: as a cause of leprosy and tuberculosis.
4. Evil eyes: as a cause of disease and children are more prone to that
effect and usually they use charms to ward off their effects.
5. Spirit of ghost intrusion: as a cause of hysteria and epilepsy.
B- Physical causes:
1. The effect of weather: as exposure to sun in
summer lead to heat stroke.
2. Water: as impure water lead to certain diseases.
3. Impure blood: as a cause of skin diseases such
boils and scabies.
II – Environmental sanitation:
A- Disposal of human excreta: 98% of people in rural areas use open
field for defecation and considered harmless and they thought that
latrines of cities only because there were no fields for defecation.
B- Disposal of wastes: in front of houses and using animal dung as
manure and fuel.
C- Water supply: using wells as an area for meeting, bathing and
washing clothes and also for animal bath and water drinking. Some rivers
considered holy, where people go on pilgrimage to these rivers and
having a dip and brings water for other ( cholera and gastroenteritis).
D- Housing: In country side , there were damp houses, ill lighted , ill
ventilated, absence of separate latrines and bathrooms, no windows (for
security), animals and chicken inside the house.
III – Food habits:
As vegetarianism, some not eat onions due to religious
causes. Muslims abhor pork, Hindus abhor beef,
adulteration of milk, some thought that there is
certain food heat or cool the body, some not boil the
milk other wise their animal will not donated milk
again, Fasting of Muslims during Ramadan, alcohol
taboo by Muslims, Hindu women only eat from food
left by their husbands, and some people not eat until
taking a bath.
IV – Mother and child health:
The following various habits, customs in the field of MCH have
been classified as good, bad, unimportant and uncertain:
A- Good: as prolonged breast feeding, oil bath, exposure to
sun.
B- Bad: delivery by untrained dai, baby not breast feed during
the first 3 days after delivery, application of soil to umbilical
stump.
C- Unimportant: as punching of ears, nose and application of
oil or paste to anterior fontanels.
D- Uncertain: application of black soot to the eyes.
V – Personal hygiene:
Rituals: are set or series of acts usually involving religion or magic with
the sequence established by tradition.
A- Oral hygiene: some cultures are very concerned with this point, and at
country side some use twigs of neem tree for cleaning, ashes or charcoal.
B- Bathing: Bathing naked is taboo, some use regular baths, women after
menstruation and after a child birth must have a purified bath,
ceremonial and oil bath in India, after legal sexual intercourse in Muslims.
C- Shaving: at a country side by barber, using unsterilized instrument
which may lead to hepatitis.
D- Smoking: smoking Hubble-bubble may be social customs which may
lead to spread of T.B., smoking with burning end of cigar in mouth in
Andhra lead to oral ca. In addition to all bad effects of smoking.
E- Purdah: Muslims and some high caste Hindu women,
observe purdah, incidence of T.B. is found to be high among
Indian women using this style.
F- Sleeping: as sleeping on the ground because of poverty
leading to insect bites.
G – Bare feet: walking with bare feet leads to transmission
of hook-worms infestations.
H – Circumcisions: it is a religious sanction in Muslims and it
is found to be very beneficial.
VI – Sex and marriage:
Among Irish, there are taboos against digital exploration of
vagina, some religion consider menstruation as a time of
uncleanness when women are forbidden. Orthodox Jews are
forbidden to have sexual intercourse until seven days after
menstruation ceases, all these customs are important in family
planning.
Early marriage in India and in Muslims, carry a benefit of there
are no problems as unmarried mothers and of illegitimate
births as a case in western countries.
The problem of child marriages are fortunately disappearing all
over the world.
Monogamy: ( one male one female) is the usual type
of marriage.
Polygamy: ( one male with several females) found in
certain communities.
Polyandry: ( several males with one female) found
among Todas of Nilgiri hills and other areas in the
world which carry a high incidence of venereal
diseases.
Social factors in health and Disease:
The main causes of deaths in the past were infectious
diseases, now the main causes of deaths are
degenerative conditions of multiple etiology, which
have their origin in the ways we live in the society.
There are certain personal characteristics, certain life
events and certain social context, all these determine
social factors in etiology of such degenerative
conditions.
I – Personal characteristics: Which include the following:
A- Social identity: there are biological factors as age, sex, race and
heredity which are not modifiable and can determine susceptibility of a
man to certain diseases. Some other factors to certain degree are
modifiable as marital status, occupation, and religion all are associated
with different morbidity expectations.
B- Personal habits: Certain personal habits related to lifestyle which are
found to be strongly connected with certain diseases as
Smoking → lung cancer
Early promiscuity → cervical cancer
Fatty and calorie rich diets → coronary heart diseases
C- Psychological make-up:
Personality type A found to be associated with development of coronary
heart diseases independent of other factors.
Psychosomatic disorders thought to be due to reaction of someone to
external stresses because no organic reason could be found till now.
Asthma and peptic ulceration thought to be due to internal psychological
tensions.
II – Life Events:
A- Stress: Which may affect the susceptibility of someone to
certain diseases, as perforation of peptic ulcer diseases during
stress events as post operative patients, while stress is found
to do little ( if nothing) as a risk factor in coronary heart
diseases.
B- Social Discontinuities: Which require readjustment
irrespective whether the events being pleasant or unpleasant,
bereavement, loss of job, divorce and others all are found to
be associated with morbidity
These life events have been scored on a social readjustment
rating scale according to the amount of expected adjustment.
Social Readjustment Rating Scale
Life events
readjustment rating %
Death of spouse
100
Divorce
73
Marriage
50
Retirement
45
Change of residence
20
C- Geographical mobility:
It is found that the prevalence of physical
symptoms was strongly associated with the no. of
moves.
- Moves lead to state of incongruity and
inconsistency.
- In two important studies, it is found that, family
stresses associated with streptococci throat
infections, and females in working class found to be
more prone to have depressive illnesses than those
females in rural areas.
III – Social Context:
How the person lives , social class, culture, family etc , all lead
to certain susceptibility to specific diseases.
It is found that there was great ↓ in mortality rate in UK in
19th century ( the main cause of deaths was infectious
diseases), and great ↓ in infant mortality in UK also but, in
20th century, it is surprising that the major causes of these
upper 2 great advances are the following:
- Improved standard of living.
- Improved nutritional statuses.
- Better sanitary conditions.
While the minor causes were:
- Advances in medicine.
- Immunization.
Among the main elements of Social context are:
A- Economic factors:
- Unemployment: lead to increase in morbidity, mortality,
hospital admissions and suicide attempts.
- Very high employment: lead to increase mortality due to
stress, smoking and alcohol.
B- Social integration : as much as social integration increases
, the mortality will decrease, as well as psychological
diseases , this is the case in rural societies.
C- Urbanization: The overcrowding and high rise flats, all
lead to serious mental illnesses as known as New town
blues.