Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 - PowerPoint Presentation

1. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 1Role of cultural, social, economic, and demographic factors in Health & DiseaseProf. Jasim N. Al-AsadiM.B.Ch.B, M.Sc., Ph. D. (Community Medicine)2018- 2019

2. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 2What is Culture?Definition: the sum total of the way of living; includes values, beliefs, standards, language, thinking patterns, behavioral norms, communications styles, etc. Guides decisions and actions of a group through time. People develop preferences, notions of expected behavior, beliefs, knowledge and symbols (non – material aspects of culture ), they also produce building, cars …etc (material aspects of culture ).

3. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 3Culture is the content of social relationship between individuals in some related aggregate. A relationship that has a perceptual degree of regularity and permanence and in which behavior is controlled by laws and customs.

4. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 4OR : the way people behave. It is the particular manner in which people behave. Behavior includes ' collective activities' of individual, physical or mental, overt or hidden. Culture, therefore includes all types of learned pattern of behavior e. g. language, attitude, skills, values system & ethical judgment.

5. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 5The Definition of Health Across CulturesA state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity”-World Health OrganizationU.S. view of health is guided by the biomedical model, where disease is viewed as a result from a specific cause in the body (pathogen).Consequently, treatment in the U.S. is focused on making a treatment within a person.

6. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 6Definition of Health in Other CulturesChina and Greece-view health not only as the absence of negative states but also the presence of positive ones.China’ notion of health is based on religion and philosophy, with special emphasis on Yin and Yang (dark-bright or negative-positive energies); balance is health. yin is characterized as an inward energy that is feminine, still, dark, and negative. On the other hand, yang is characterized as outward energy, masculine, hot, bright, and positive. An imbalance can be caused by foods, social relationships, the weather, or supernatural forces.Maintaining balance involves mind, body, spirit and the natural environment

7. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 7One of the characters of every culture is the constant changes in individual’s life. The non-material parts of culture lay behind the material. This is referred to as cultural lag . People of varied beliefs & knowledge systems interpret the material innovation differently, react to it in unique way & often their own solutions to problems it has caused. This can lead to value conflicts. The more heterogeneous the society the more likely is that such disagreements will occur.

8. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 8Culture & health related behaviors :People vary in obvious physical matter – there is genetic diversity which is expressed in individual variation within population & in the racial variation between population .Race vs culture health related behavior: Basic characteristics are transmitted to individuals through "genes " and “sexual reproduction”, but also, individuals incorporate experience that mould it to a new form.

9. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 91. Constitution has some influence on the speed & manner of the process of learning & on the acquisition of culture . Examples: Motor activity: Black African infants have greater motor activity than white ones in the first 72 hours of life - Intrinsic (skeletal maturity) - Extrinsic (mothers handling babies freely may stimulate motor activity) The difference may be ascribed to cultural diversity; African Women & European mothers have dissimilar attitudes & behavior toward their newborn children.

10. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 102-Adult responses to social situations which include medical situation, are influenced by the manner in which they were reared & educated & by the mode of life peculiar to their society & don't correspond with intrinsic racial characteristics. All men feel & think, but the manner in which they express even the deepest and most universal emotion is culturally determined . e.g. response to shock or mutilation or injury by black & white (blacks manifest less somatic reaction when express to trauma than the whites, the threshold of pain is different between different groups. The reactions of blacks to mutilation were related to general attitudes toward pain –culture discourage the experience of pain .

11. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 113- African women's response to the lower abdominal pain of acute Gonococcal salpingitis may seem exaggerated →anxiety about sterility & the uterus. In tribal societies where child bearing dominate the life of women. In child birth, the same women will be stoical, i.e. she can tolerate child birth pain better. "Reactions to disease & pain are thus bound up with whole systems of beliefs & values that influence people to respond distractively when exposed to similar situations.

12. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 124- Indian soldiers had lower rates of mental break down than British soldiers, and their distress was not evoked by the same things. Doctor & patient even when reared in the same society, can have equally divergent cultural values & responses & each is likely to interpret the other's behavior in terms of his own values and beliefs.

13. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 13Categorization of health related human behavior:1- Deliberate consciously health related kinds of behavior – by individual or group that serve to promote or maintain health. e.g. - Immunization - Healthy diet (low fat ) - Practicing exercise

14. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 142- Deliberate behavior that contributes to ill health or mortality e.g. Smoking .3- Non-deliberate behavior which is not perceived to be health related but nevertheless influence the health of individual, group or population. Favorable either by enhancing or maintaining level of health. e.g. - Exercise for leisure - Vegetarian, or eating more vegetables and fruits

15. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 154- Non – deliberate behavior that contributes to ill health or mortality. A behavior carried out unintentionally which leads to disease or mortality . e.g. - Swimming in river → schistosomiasis - Fatty diet → CHDEach of these divisions can be looked out to take in account one of two :-

16. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 161-Behaviour of, and, as defined by those in the community or other people at risk . 2- Behavior of, and, as defined by outsider including those concerned with control, prevention, health promotion & treatment who can not be a member of the community .

17. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 17Thus, there is a need to understand why and not only how people behave in certain way in disease situation and how people interpret the causes of sickness and disease.How people respond to sickness or birth of a handicapped baby?

18. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 18Values & Causation of sickness : (closed system of thought ):Why some individuals get illness & not other? Some attributed illness to: 1- Witchcraft 2- Will of God 3- Luck or destiny 4- Materialism and determinism 5- Theory of probabilityMaterialism: is the philosophical theory is the matter is the fundamental substance in nature, and that all things, including mental aspects and consciousness, are results of material interactions (e.g. he biochemistry of the human brain and nervous system)Determinism is the philosophical theory that all events, including moral choices, are completely determined by previously existing causes. It is often contrasted with free will.

19. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 19II: Socioeconomic factors :1- Social stratification : The social rewards of each society, i.e. economic advantage, prestige, and power are not distributed equally. Categories of people who share similar rewards are known as social class→ have similar life. Different social classes act differently toward health institution & have different morbidity & mortality rates.

20. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 20Social class What are the indicators used to classify people? Indices: occupation, income, education & place of residence. Why ? There are differences in:- Level of mortality- Level of morbidity- Use of health services In Britain: 5 Social classes ( according to occupation ) – The Black report (1980). In Iraq: because of transitional status of the community, it is difficult to classify people.

21. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 212- Social mobility : Social mobility restricted by personal & social characteristics such as age, sex, occupation, race & education. Religion limits the choice of activities & entry to desired social position. Social class & income restrict choices of neighborhood & neighbors. Open class societies foster variation in individuals behavior and achievement.

22. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 22Vertical mobility: from one class to another - Horizontal mobility: remain in the same social class but move from one social position to another, e.g. marriage and divorce From medical points of view :- Social mobility characterizes disease and methods of treatment. e.g.:

23. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 23Disease: showed social movement e.g. syphilis introduced to Africa from Europe.Treatment: tonsillectomy & circumcision moved from higher to lower social classes. Also Peptic Ulcer, CHD & Smoking followed a downward social courses. Infant feeding & contraception use.

24. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 24Social mobility of persons has clinical impacts as stress & strain. Social mobility enforces a series of transition into new social environment . - Status incongruity - Status inconsistencyIllness: Duodenal ulcer, schizophrenia , CHD, Hypertension & mental illnesses.

25. Status inconsistency It is a condition that occurs when individuals have some status characteristics that rank relatively high and some that rank relatively low. Status inconsistency can be quite pervasive, especially in societies in which ascribed statuses such as race and gender play an important role in stratification.Examples: In white-dominated societies, black professionals have high occupational status but low racial status that creates an inconsistency along with the potential for resentment and strain.Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 25

26. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 26Status inconsistency : Standing not only between the individual & those he relates with his new situation, but also among his" own status " & attributes i. e. between high ranking occupation & low income or between high social standing & low income status.

27. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 273- Urbanization : Expansion is not parallel to improvement of health: poor housing condition overcrowding, pollution, water supply, sewage disposal → level of stress. –Urbanization →poor health: ? T.B., unemployment, depression, delinquency & suicide →death.

28. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 28III: Demographic factors : Age: Different level of risk, Biological or behavioral. high death rate among infants and elderly people Sex: Women having higher level of morbidity but lower mortality, high life expectancy (biological factors) → high morbidity due to pregnancy & delivery. - Women are far more likely to visit the doctor than men. - Men generally underrepresented in health statistics - Women more likely to report both physical and psychological problems to their GP. - All behavioral factors in females are different from that among males. Marital Status: Married people have lower mortality than divorced or single → stable life .

29. 29Health and EthnicityMany studies in Western countries showed high morbidity and mortality among ethnic minorities in these countries. This difference may be explained by: 1- Poverty 2- Stress of migration and racism 3- Cultural deficit models. The deficit model asserts that racial/ethnic minority groups do not achieve as well as their White majority peers in school and life because their family culture is dysfunctional and lacking important characteristics compared to the White American culture.

30. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 30 IV- Psychosocial Factors : Type of personality: e.g. type –A Personality (active, compulsive, worrier, impatience, time urgency, struggle to achieve more & more in less time, emotion complex), competitive, ordered → prone to stress.

31. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 31The Study of Type A personalities showed an increased risk for developing cardiovascular diseases opened the door to health psychology.Studies have documented the link between psychosocial factors and health/disease.Unemployment and mortality, goal frustration and negative life events and gastrointestinal disorders, stress and CHD, etc.Socioeconomic status (SES) is consistently associated with health outcomes with people of higher SES having better health (in mortality rates and almost every disease) than people of lower SES.

32. Prof. Jasim N Al-Asadi Lectures in Medical Sociolgy Lecture 2 32Personality type : By Freud: Components of personality affect health & life of individuals. Id : the affective function . "cathexis " --- the emotional base of the personality. Ego : is the function of cognition → engage with the social system through interaction with others →what is actual? Superego : the function of evaluation of placing values on reality →tells what is ideal?

33. 33Health Caresystem 25%Biologicalendowment 15%Physicalenvironment 10%Socio-economicenvironment 50%Estimated Health Impact of Determinants of Health on Population health Status: (1997)25%15%10%SES 50%

34. 34Psychosocial Model of Cultural influencesLifestyle and BehaviorsDietExercise/Activity LevelsHealth related behaviors-smoking-tobacco use-alcohol useEmotion/stress/copingAttitudes and BeliefsDefinitions of healthConceptions of the bodyAttributions about disease causalityAttitudes about health and illnessLocus of ControlTreatment ComplianceHelp Seeking BehaviorsSocial Networks and SupportEnvironmentTemperatureClimateSanitationHealth Care SystemsQuality of CareSystems/OrganizationsInsuranceHealth/DiseaseCulture