Cultural and social factors

affecting health &

disease

Dr.R.Srinath
I yr P.G
Dept. of Community
Medicine
Overview
 Introduction
 Culture
 Acculturation
 Cultural factors in health & disease
 Society
 Social groups
 Social classification
 Social class
 Social factors in health & disease
 Social defence
Introduction:
 Health cannot be isolated from its social context.

 Social & cultural factors have much influence on

the health.
 Direct bearing on the incidence, course and
outcome of various disease worldwide.

 Major role in influencing the nutrition,

immunisation, health seeking behaviour,
sanitation, family planning & child rearing.
Culture
Definition:
‘socially acquired learned behaviour’

 Etymology:
cultura(Latin) - growing

 culture is the central concept around which the

cultural anthropology has grown
Components
 Customs
 Tradition
 Beliefs
 Informal laws
 Moral concepts
 Art
 Literature
 Religion
Characteristics
 Not an innate. Learned through socialisation.
 Communicated from generations to generations.
 Ideas & patterns are accepted by the society.
 Total heritage, which links to the past.
 Fulfills the ethical & social needs of the society.
 Binds the individual to the society.
 3 parts- learning, sharing, transmitting.
 Culture traits
 Smallest unit of the culture.
 Trait is the repeated, irreducible
unit of learned behaviour.
 Eg.; vanakkam
 shaking hands
 blessings from the elderly
 growing beard
 Culture complex
 Clusters of many culture traits
 Ex.; religious complex
 folding hands
 idol worship
 animal sacrifice
 divine songs
 Cultural pattern
 Cultural pattern consists of
group of cultural complexes.
 Ex.; Indian cultural pattern
 Joint family
 Caste system
 Spritualism
 Gandhism
 Culture is the distinct characteristic of a nation.
 It depicts the nation’s mentality.
 Japanese proverb:
If one can do it, you can do it.
If none can do it, u must do it!!!
 Culture is the distinct characteristic of a nation.
 It depicts the nation’s mentality.
 Japanese proverb:
If one can do it, you can do it.
If none can do it, u must do it!!!
 Indian version:
If one can do it, let him do it.
If none can do it, then leave it!!!
Culture transfer
 Within the society:
Done by family, kinship, social
institutions (schools, religious centers)

 Between societies:
Acculturation
Acculturation
 Acculturation is defined as the process by
which the cultural traits invented in one
society are diffused directly or indirectly to
other societies.

 As the spread is always both ways &

reciprocal, it is called cultural diffusion.
Acculturation…
Influencing factors:
 Trade & commerce
 Military conquest
 Education
 Religious propogation
 Migration
 Industrialisation
• Benefits • Demerits
 Allopathic medicine  Drug abuse
 Technology  Broken family
 Communication  Poor socialisation
 Transport
 Education
Cultural factors in health & disease
 Concept of etiology & cure
 Environmental sanitation
 Food habits
 Mother & child health
 Personal hygiene
 Sex & marriage
Concept of etiology & cure
SUPER NATURAL CAUSES:
 Wrath of Gods
 Breach of taboos
 Past sins
 Evil eye
 Ghost intrusion
Concept of etiology & cure
PHYSICAL CAUSES:
 The effect of weather
 Water
 Impure blood
Environmental sanitation:
 Open field defaecation
 Dumping solid wastes near
households
 Bathing, washing, cleaning animals in
the drinking water source.
 Using step wells
 Drinking raw water from rivers
 Poorly ventilated kitchens
 ill-lighted rooms
 Food habits:
 Food habits have a deep
psychological roots.
 Influenced by local conditions,
religious customs & beliefs.
 Vegetarianism- a place of high honour
in Hindu society.
 Muslims taboos pork & alcohol.
 Hindus avoid beef.
 Food habits:
 Hot foods: meat, fish, eggs, jaggery
 Cold foods: curd, milk, fruits.
 Religious fastings.
 Alcohol feasts during rituals.
 Hindu women take the foods left over
by their husband
 Food fads- nutrition deficiencies
 Mother & child health
 Marriage is universal in indian society.
 Family is incomplete without a male
child.
 GOOD: breast feeding, oil bath,
exposure to sun
 BAD: unsafe delivery by dais,
forbidding nutritious diet,
avoiding colostrum, cowdung on

cord, branding the skin.

 UNCERTAIN: applying kajals, ear
 Personal hygiene
 Oral hygiene:
Good: tooth brush, Neem twigs
Bad: ash, charcoal.
 Oil bathing
 Rural women- turmeric paste
 Shaving- unsterilised blades by barbers
 Smoking with burning end on mouth.
 Purdah- vit.D deficiency, T.B.
 Bare feet- hookworm infestations
 Sleep on the ground
 Sex & marriage
 In certain societies, women during
menstruation are forbidden to worship
& to even enter into the house.
 Customs -major role in family planning
 Early marriage- high fertility rate & poor
maternal health.
 Resistance by the men for vasectomy.
 Monogamy
 Polygamy
 Polyandry
society
Society is the group of individuals
drawn together by a common bond
of nearness and who act together
for the achievement of certain
common goals
Social groups
 Collection of human beings who are
brought into social relationship with
one another.
 Characteristics:
 Unity- sense
 We-feeling
 Common interest
 Reciprocal attachment
 Deep inter-relation
Social groups- classification
1. Sanderson classification:
Based on the structure-
 Involuntary (family)
 Voluntary (military)
 Delegate (parliament)
Social groups- classification
2. Gidding classification

 Genetic group- family

 Congregate- politics, work place
Social groups- classification
3.Miller classification:

 Horizontal group- nation

 Vertical group- economy
Social groups- classification
4. George Hasen classification:
Based on their relations with the
other groups-
 Uni-social
 Pseudo-social
 Anti-social
 Pro-social
Social groups- classification
5. Cooley classification:
 Primary groups:- small size, face-
face relationship, physical
proximity, shared interest.
Ex. Family, friends
 Secondary groups:- large size,
formal, impersonal, goal oriented.
Ex.- politics, industry.
 Types of social groups
Temporary groups:
1.Crowd- Motivated by a common interest.
Lacks leadership & organization.
2. Mob- Has a leader.
More emotional & unstable.
Lacks internal organization
3. Herd – Crowd with a leader.
Follows the leader’s order
 Types of social groups
Permanent groups:
1.Band- ex; gypsies
2.Village- basic unit. Self reliant.
3.Towns & cities- heterogenous group.
4.State- stabilised & formalised social
group.
Social classification
Society is mostly classified on the
basis of-
 Caste
 Income
 Occupation
 Purchasing power
 Education
 Rural & urban
Occupational classification
I- professional occupation
II- intermediate occupation
III N- non-manual skilled
III M- manual skilled
IV- partly skilled
V - unskilled
Socio-economic status scale
1. Hollingshed scale
2. Kuppusamy’s scale
3. Prasad’s classification
4. Pareek’s method
5. Standard of living index
6. Wealth index
 Prasad’s classification
Pgggg jj uujER CAPITA INCOME MjODIFIED WITH CONVERSION FACTOR CLASS
Per capita income Modified with
32 class
conversion 32
>100 >3200 upper

50-99 1600-3199 Upper middle

30-49 960-1599 Lower middle

15-29 480-959 Upper lower

<15 <480 Lower

Pareek’s classification
 Caste
 Occupation of the head of the family
 Education of the head of the family
 Level of social participation of the head of
the family
 Land holding
 Housing
 Farm power
 Material possessions
 Type of family
…Pareek’s classification
> 90 : upper class
75-90 : higher middle
60-75 : middle
45-60 : lower middle
30-45 : lower class
< 30 : below poverty line
Standard of living index
 Used in NFHS-II (1998-99)
 Based on household ownership of
assets & provisions.
 Ex.; house type, toilet, fuel, durable
goods etc.
 GRADE S.E SCALE
0-14 low
15-29 medium
25-67 high
Wealth index
 Used in NFHS III
 Index of economic status of households
 Datas- household goods, modes of
transport, agricultural land & farm
animals, health insurance, bank account.
 Divided into 5 groups.
Wealth index- TAMILNADU (2005-06)

 Lowest - 10.6%
 Second - 15.6%
 Middle - 29.9%
 Fourth - 24.4%
 Highest - 19.5%
Social class & health
Upper class:
 Longer life expectancy
 Less mortality
 Better nutritional status
 Small sized family
 Better health seeking behaviour
 Disease- diabetes, hypertension,
psychiatric illness, coronary heart disease
Social class & health
Lower class:
 Shorter life expectancy
 Poor nutritional status
 More prone for infections
 Large family size
 Poor health seeking behaviour
 Higher mortality rates
Social factors in health & disease
 Economy
 Education
 Occupation
 Unemployment
 sex
 Political system
 Urbanisation
 Social stigma
 K.A.P
Economy & health
 MERITS
 Better technology in medical care
 Low mortality
 Higher life expectancy
 Better quality of life
 Better health seeking behaviour
 DEMERITS
 Diseases- CHD, diabetes, obesity,
hypertension
Education & health
 Education compensates the effect of poverty
on health.
 Ex. Kerala India
per capita income 27000 rs 28000rs
IMR 15 58
female literacy rate 87.8% 54.16%
 World map of illiteracy closely correlates with
the world maps of poverty and IMR
WORLD POVERTY MAP
Occupation & health
 Merits:
 better health seeking behaviour
 Better nutrition and health

 Demerits:
 Occupational hazards
Unemployment & health

 Psychological illness

 Poor Socialisation

 Status damage
Sex & health
• Male children given higher priority
than the female children.
• Many health problems of female does
not receive medical attention /
unreported.
• In an Indian society, family is
incomplete without the birth of a male
child.
Political system
 It is the main obstacle in implementing
healthcare in many countries.
 Determines- resource allocation, manpower
policy, choice of technology, degree to which
health services are available & accessible to
different segments of society.
 India- 3% GNP on health & family welfare
 WHO goal- 5% of GNP
Urbanisation & health
 Behavioural changes- alienation, anomie,
aspirations
 Better health seeking behaviour
 Low birth rate, mortality rate
 Pollution
 Social evils and constraints
 Psycho-somatic illness- pcod, peptic ulcer,
ulerative colitis,
hypertension
Social stigma
 Many diseases are considered as social
stigma due to the way of its presentation

 Ex; leprosy, elephantiasis

 Venereal diseases- hiding/ late reporting

Knowledge, attitude & practices
 Poor sanitary knowledge

 Attitude towards many infectious diseases

ex.; tuberculosis, leprosy

 Practices- cow dung on umblical cord, purdah

system, avoiding collustrum
Role of social development on health

 Decrease in the load of the disease

 Improvement in the healthcare

 Demographic effects
Role of health on social development

 Increase in the productivity

 Reduction in the medical/ sick expenditure

 Reduction in the dependent population

(disabled/ handicap)
 Social defence
 Multifaceted approach covering the preventive, therapeutic
&rehabilitative service for the protection of society from
antisocial, criminal & deviant conduct of man.
 Developmental approach:
people-friendly govt., socio-economic development,
employment generation, de-centralisation of powers,
recreation, rehabillitation
 Educational approach:
health education, public awareness prog., counselling,
 Legal approach:
basic compulsory education, pollution controls, slum clearance
Summary
 References
1. Parks text book of SPM, K.Park,20th edition
2. Text book of medical sociology- T.Karunakaran
3. Textbook of PSM- MC.Gupta, BK Mahajan, 3rd edition
4. Sociology and healthcare- John bond, Senga bond,3rd edition
5. Community medicine and Recent advances- suryakantha, 2nd edi
6. An Introduction to sociology- vidya bhushan, 43rd edition
7. Foundations of community medicine- Dhaar, Robbani, 2nd edition
8. Textbook of community medicine- BP Paride, AP Kulkarni,3rd edi
9. Textbook of community medicine for AFMC,2nd edition
10. Textbook of PSM- Bhaskara rao.T,1st edition
Thank you