Post RN BScN 2nd Semester
UNIT I: HEALTH AND ILLNESS
A SOCIO-CULTURAL PERSPECTIVE
Saima Victor
Post RN BScN

Objectives
At the end of the unit learners will be able to:
 Explain the concept of culture
 Discuss the importance of socio cultural anthropology and its
relation to health
 Explain the concept of society at micro and macro levels
 Describe the concepts of health, illness and disease, society,
community, culture,
 Discuss health and disease as a product of social behaviour

Culture
 Culture refers to the cumulative deposit of knowledge,
experience, beliefs, values, attitudes, meanings,
hierarchies, religion, notions of time, roles, spatial
relations, concepts of the universe, and material objects
and possessions acquired by a group of people in the
course of generations through individual and groups.
 Culture is the systems of knowledge shared by a relatively
large group of people.
 Culture is the sum of total of the learned behavior of a
group of people that are generally considered to be the
tradition of that people and are transmitted from
generation to generation.

 The position that the ideas, meanings, beliefs and values
people learn as members of society determines human
nature. People are what they learn. Optimistic version of
cultural determinism place no limits on the abilities of
human beings to do or to be whatever they want. Some
anthropologists suggest that there is no universal "right
way" of being human. "Right way" is almost always "our
way"; that "our way" in one society almost never
corresponds to "our way" in any other society.
CULTURAL DETERMINISM

 Ethnocentrism is the belief that one's own culture is
superior to that of other cultures. It is a form of
reductionism that reduces the "other way" of life to a
distorted version of one's own. This is particularly
important in case of global dealings when a company or
an individual is imbued with the idea that methods,
materials, or ideas that worked in the home country will
also work abroad.
CULTURAL ETHNOCENTRISM

 Different cultural groups think, feel, and act differently. There is
no scientific standards for considering one group as intrinsically
superior or inferior to another. Studying differences in culture
among groups and societies presupposes a position of cultural
relativism. It does not imply normalcy for oneself, nor for one's
society. It, however, calls for judgment when dealing with groups
or societies different from one's own. Information about the
nature of cultural differences between societies, their roots, and
their consequences should precede judgment and action.
Negotiation is more likely to succeed when the parties concerned
understand the reasons for the differences in viewpoints.
CULTURAL RELATIVISM

 1- Symbols are words, gestures, pictures, or objects that
carry a particular meaning which is only recognized by
those who share a particular culture. New symbols easily
develop, old ones disappear. Symbols from one particular
group are regularly copied by others. This is why symbols
represent the outermost layer of a culture.
 2- Heroes are persons, past or present, real or fictitious,
who possess characteristics that are highly prized in a
culture. They also serve as models for behavior.
MANIFESTATIONS OF CULTURE

Cont..
 3- Rituals are collective activities, sometimes superfluous
in reaching desired objectives, but are considered as
socially essential. They are therefore carried out most of
the times for their own sake (ways of greetings, paying
respect to others, religious and social ceremonies, etc.).
 4-The core of a culture is formed by values. They are
broad tendencies for preferences of certain state of
affairs to others (good-evil, right-wrong, natural-
unnatural).
 Symbols, heroes, and rituals are the tangible or visual
aspects of the practices of a culture. The true cultural
meaning of the practices is intangible; this is revealed
only when the practices are interpreted by the insiders.

 People even within the same culture carry several layers of
mental programming within themselves. Different layers of
culture exist at the following levels:
 The national level: Associated with the nation as a whole.
 The regional level: Associated with ethnic, linguistic, or
religious differences that exist within a nation.
 The gender level: Associated with gender differences (female
vs. male)
 The generation level: Associated with the differences between
grandparents and parents, parents and children.
LAYERS OF CULTURE

 The social class level: Associated with educational
opportunities and differences in occupation.
 The corporate level: Associated with the particular
culture of an organization. Applicable to those who are
employed.

Cultural differences
 Cultural differences are the various beliefs, behaviors,
languages, practices and expressions considered unique to
members of a specific ethnicity, race or national origin.
... While these various differences can create a more
vibrant office, they can also lead to more than a few
problems resulting from culture clash.
 Cultural diversity is the quality of diverse or different
cultures, as opposed to monoculture, the global
monoculture, or a homogenization of cultures, akin to
cultural evolution. The phrase cultural diversity can also
refer to having different cultures respect each other's
differences

Culture shock
 Culture shock is a sense of anxiety, depression, or
confusion that results from being cut off from your
familiar culture, environment, and norms when living in a
foreign country or society. Those experiencing culture
shock go through distinct phases of euphoria, discomfort,
adjustment, and acceptance.

community
 A community is a social unit with commonality such as
norms, religion, values, customs, or identity. Communities
may share a sense of place situated in a given geographical
area or in virtual space through communication platforms.
 The two main types of communities are
 1-Major which are self-sustaining and self-regulating (such as
a forest or a lake)
 2-Minor communities which rely on other communities (like
fungi decomposing a log) and are the building blocks of
major communities.

Community identity
 Community identity is based on birth and belonging
rather than on some forms of acquired qualifications or
accomplishments. These kinds of identities are called
ascriptive i.e. they are determined by birth and
individual's choice is not involved.
 A good community is a cohesive, safe, confident,
prosperous and happy place. It is free of poverty and
crime, providing a high quality of life for everyone that
lives there. It values and promotes open, participative
development processes underpinned by a continuous
culture of trans-generational learning.

Community development and functions
 Community development is a holistic approach grounded
in principles of empowerment, human rights, inclusion,
social justice, self-determination and collective action
(Kenny, 2007).
 The community has five functions:
1-production-distribution-consumption: The community
provides its members with the means to make a living. This
may be agriculture, industry, or services.

2- socialization
The community has means by which it instills its norms and values in its
members. This may be tradition, modeling, and/or formal education.
3-social control
The community has the means to enforce adherence to community
values. This may be group pressure to conform and/or formal laws.
4- social participation
The community fulfills the need for companionship. This may occur in
a neighborhood, church, business, or other group.
5- mutual support
The community enables its members to cooperate to accomplish tasks
too large or too urgent to be handled by a single person. Supporting a
community hospital with tax dollars and donations is an example of
people cooperating to accomplish the task of health care.

Anthropology
 The study of human societies and cultures and their
development.
 The study of human biological and physiological
characteristics and their evolution.
 The Four Subfields
 Archaeology. Archaeologists study human culture by
analyzing the objects people have made. ...
 Biological Anthropology. ...
 Cultural Anthropology. ...
 Linguistic Anthropology.

Cultural Anthropology
 the branch of anthropology concerned with the study of
human societies and cultures and their development.
 Sociocultural anthropology is the study of human
similarities and differences and their impact on a wide
range of social phenomena. ... Through a range of
research methods anthropologists analyze what unites
diverse peoples as well as what distinguishes them from
one another.
 Sociocultural anthropologists focus on the study of
society and culture, while often interested in cultural
diversity and universalism. Additionally, sociocultural
anthropology is often split into social anthropology and
cultural anthropology. ... Linguistic Anthropology.

Medical Anthropology
 Medical Anthropology is a subfield of anthropology that
draws upon social, cultural, biological, and
linguistic anthropology to better understand those factors
which influence health and well being (broadly defined),
the experience and distribution of illness, the prevention
and treatment of sickness, healing processes ..

Role of Anthropology in understanding
health and disease
 Medical Anthropology is a subfield of anthropology that
draws upon social, cultural, biological, and
linguistic anthropology to better understand those
factors which influence health and well being (broadly
defined), the experience and distribution of illness, the
prevention and treatment of sickness, healing processes
... The sociology of health and illness
covers sociological pathology (causes of disease and
illness), reasons for seeking particular types of medical
aid, and patient compliance or noncompliance with
medical regimes. Health, or lack of health, was once
merely attributed to biological or natural conditions.

Society
 A society is a group of individuals involved in persistent social
interaction, or a large social group sharing the same spatial
or social territory, typically subject to the same political
authority and dominant cultural expectations.
 Two primary components of a society are its culture and its
social structure. Society is one of the basic sociological
terms. In simple sense, society is a large grouping that shares
the same geographical territory, shares a common culture and
social structure, and expected to abide by the some law
 Macro-level sociology looks at large-scale social processes,
such as social stability and change. Micro-level sociology
looks at small-scale interactions between individuals, such as
conversation or group dynamics.

Health
 Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity. The enjoyment of the highest attainable standard
of health is one of the fundamental rights of every human
being without distinction of race, religion, political belief,
economic or social condition.
 There are five main aspects of personal health: physical,
emotional, social, spiritual, and intellectual.

Illness
1: an unhealthy condition of the body or mind Germs can
cause illness.
2 : a specific sickness or disease Colds are a
common illness. illness.
 Examples of chronic illnesses are:
Alzheimer disease and dementia.
Arthritis.
Asthma.
Cancer.
COPD.
Crohn disease.
Cystic fibrosis.
Diabetes.

Disease
 Disease, any harmful deviation from the normal structural
or functional state of an organism, generally associated
with certain signs and symptoms and differing in nature
from physical injury. A diseased organism commonly
exhibits signs or symptoms indicative of its abnormal
state.

Bio behavioral Factors in Health and
Disease
 Relationships between behavior and health has been aided by
technology and by conceptual advances in the behavioral,
biological, and medical sciences. Our understanding of the
interactions between brain function and behavior has been
enriched by advances in behavioral neurobiology,
neuroscience, and neuroendocrinology from molecular
mechanisms to psychological systems.

STRESS, HEALTH, AND DISEASE
 The Stress Response
 the study of stress has provided a major link in explaining
the behavioral variables and the biological factors that
influence physical health. Stress both causes and modulates
a diversity of physiological effects that can enhance
resistance to disease or cause damage and thereby promote
disease. For example, stress-related hormones, such as
cortisol and epinephrine, have protective and adaptive
functions as well as damaging effects.
 https://www.ncbi.nlm.nih.gov/books/NBK43737/

Homeostasis
 Individual behavior is important because it increases or
decreases the pathophysiological cost of stress through
diet, exercise, and other activities.
 The stress response is an important component of the
body's regulatory systems. The maintenance of constant
and appropriate internal conditions and functioning in the
face of changing environmental demands is
called homeostasis, an idea first developed by Walter
Cannon (1936). The stress response, however, primarily
involves reaction in an emergency.

Allostasis and Allostatic Load
 An important new attempt to understand the relationships
between environmental and behavioral challenges and
stressors, the physiological responses to these events, and
disease uses the terms allostasis and allostatic
load. Allostasis is the maintenance of overall stability
(homeostasis) through the constant adjustment and
balancing of various components in the process of
adapting to challenge. Sterling and Eyer (1988)
 Allostatic load is the wear and tear the body experiences
as a result of repeated allostatic response (McEwen,
1998; McEwen and Stellar, 1993).

Protective and Damaging Effects of Stress
Mediators
 A behavioral response to challenge or stress can be
protective or damaging. The risk of harm or disease can
be increased by such patterns of behavior as hostility or
aggression, and it can be reduced by cooperation and
conciliation. Cigarette-smoking, excessive alcohol
consumption, high fat consumption, and exposure to
physical hazards increase the risk, as does insufficient
physical activity. The link of allostasis and allostatic load
can be applied to various behavioral responses (Perseghin
et al.,1996)

 The mediators of protective and damaging effects of
allostatic responses are mainly adrenal steroids and
catecholamines. Other hormones—such as
dehydroepiandrosterone, prolactin, growth hormones,
and the cytokines—also mediate adaptive or maladaptive
effects, but their consequences are often specific to an
organ or a system. Once the mediators are released, they
produce their effects by acting on cellular receptors. The
effects can be classified as primary effects; secondary
outcomes, which are risk factors for disease; and tertiary
outcomes, which are diseases themselves (McEwen and
Seeman, 1999

Neurotransmitters, Experience, and
Behavior
 Changes in balance among neurotransmitters in the brain can
influence behavioral responses to potentially stressful situations,
can alter the interpretation of stimuli, and might be associated
with anxiety and depression.
 Serotonin is a neurotransmitter with widespread influences
throughout the brain. The serotonin system exerts widespread
influence over mood and mood disorders, such emotional
responses as hostility and aggression, arousal, sensory perception,
and higher cognitive functions. For example, low concentrations
of brain serotonin are associated with increased incidence of
suicide (Brown et al., 1982; Mann, 1998), impulsive aggression
(Brown et al., 1982; Higley et al., 1996a, 1996b), and the abuse
of alcohol and other substances (Higley et al., 1991).

Neural and Endocrine Effects on the
Immune System
 Many chemical messengers of the nervous and endocrine
systems are immunomodulatory, and these substances are
important in regulating inflammatory and immune
responses (Felten et al., 1987).

Stress and Immune System Function
 The recognition of the importance of bidirectional
communication between neural, endocrine, and immune
systems through shared ligands and receptors led to a major
research emphasis on immunoregulation by hormones, peptide
neuromodulators, and neurotransmitters.
 The primary function of the immune system is to protect the
host from infectious and malignant challenges. Acute stress
enhances immune function, and it does so in part by
promoting immune cell translocation to sites of immune
challenge (Dhabhar et al., 1995, 1996), whereas chronic stress
has the opposite effect: it impairs immune function (Dhabhar
and McEwen, 1999; Hermann et al., 1995).

Cont….
 Various aspects of immune function in states of stress-
induced neuroendocrine activation, with a primary
emphasis on negative, immunosuppressive outcomes, have
been reported (Dobbs et al., 1993; Kiecolt-Glaser et al.,
1996).

Behavioral and Psychosocial Factors
 Psychosocial factors can influence the course of chronic
human disease along several pathways. Behavior that has
perceived short-term benefits, such as mood-enhancement
induced by cigarette-smoking or excessive alcohol
consumption, but that causes long-term injury constitutes
one.
 Another involves the influence of social and environmental
factors, such as socioeconomic status or stress on disease
processes.
 A third consists of individual psychological factors, such as
hostility and depression, that interact with the other two
pathways to increase susceptibility to illness.

Anger
 Anger is a psychological state thought to be related to
hostility. Expression of anger has been shown to trigger
myocardial infarction. In a study of patients undergoing
coronary angiography, recall of anger was a potent stimulus
that induced vasoconstriction in diseased coronary arteries,
but not in healthy arteries (Boltwood et al., 1993). The
recall of anger can also produce an acute impairment in
ventricular function in patients with CHD (Ironson et al.,
1992.

Hostility
 Hostility is the psychosocial variable most often
associated with the incidence of CHD (Booth-Kewley and
Friedman, 1987). In the context of physical health,
hostility is defined usually as a stable attribute
characterized by mistrusting cynicism that leads to
antagonistic or aggressive behavior and feelings of anger
(Miller et al., 1996)

Depression
 Depression affects about half of patients who experience
myocardial infarction. Depression predicts significantly
poorer outcome with heart disease (Denollet et al.,
1996; Denollet and Brutsaert, 1998; King, 1997) and roughly
doubles the risk of recurrent cardiovascular events (Barefoot
et al., 1996; Barefoot and Schroll, 1996.

Summary
 Depression often gets worse if it isn't treated, resulting in
emotional, behavioral and health problems that affect every area
of your life. Examples of complications associated
with depression include: Excess weight or obesity, which can lead
to heart disease and diabetes. Pain or physical illness.
 Some examples of chronic illnesses that may cause depression are
diabetes, heart disease, arthritis, kidney disease, HIV and AIDS,
lupus, and multiple sclerosis (MS). Hypothyroidism may also lead
to depressed feelings.
 Epidemiological data indicate that depression is a significant risk
factor for the development of symptomatic IHD in otherwise healthy
people, exerting an effect independent of previously established
cardiovascular risk factors including sex, weight, activity, blood
pressure, and smoking.