Impact of Cultural and Social Factors on Health

"Health is a universal human aspiration and a basic human need. The development of society, rich or poor, can be judged by the quality of its population's health, how fairly health is distributed across the social spectrum, and the degree of protection provided from disadvantage due to ill-health. Health equity is central to this premise. Strengthening health equity--globally and within countries--means going beyond contemporary concentration on the immediate causes of disease to the 'causes of the causes'--the fundamental structures of social hierarchy and the socially determined conditions these create in which people grow, live, work, and age. The time for action is now, not just because better health makes economic sense, but because it is right and just".

Professor Sir Michael Marmot,

Interim Statement of the Commission on Social Determinants of Health

As Professor Malcolm Marmot clearly states, good health is desired and required by all. Under ideal conditions, each and every member of society, around the globe, would either enjoy good health, or at least have access to facilities which would enable him to better his health condition. However, the rise in the global burden of diseases clearly indicates that the current situation is light years away from this ideal situation. South Asia, home to a quarter of the world's population, is a glaring example of the dismal current scenario.

Defining Health and Medicine

According to the World Health Organization (WHO), health is a state of complete well-being: physical, mental, and emotional. Therefore, good health encompasses more than being disease free, and depends upon a healthy environment and a stable mind.

Medicine is the social institution that diagnoses, treats, and prevents disease.1 To do so, Medicine depends upon most other sciences--including life and earth sciences, chemistry, physics, and engineering.

Popular belief dictates that science alone determines illness, but the sociological view points out that diseases and illnesses are also shaped by social, cultural and environmental factors. The study of sociology assumes that a well-functioning society depends upon healthy people and upon controlling illness.

Diseases predominant in South Asian Countries

Communicable Diseases

Inhabitants of South Asian Countries mainly suffer from communicable diseases, where the principal causes of death are respiratory infections (Tuberculosis), HIV/AIDS, infections at birth, diarrhoeal disease and tropical diseases such as malaria, typhoid, etc.

Non Communicable Diseases

Though communicable diseases still remain as the major concern, South Asians are now also suffering from non-communicable diseases such as heart attacks, strokes, hypertensive heart diseases, etc. The onset of these diseases, occurring primarily in the urban regions, are signified by high and rising rates of overweight, central obesity, diabetes, high blood pressure, etc. Such trends also exist in rural populations but are lower in magnitude.

Each of the Communicable and Non Communicable diseases which are predominant in South Asia has been shaped by the social structures of the individual countries, along with cultural norms and environmental conditions.

Social Factors behind Diseases

Poverty:

In South Asia, approximately half the population lives below the poverty line and has limited access to health care. Those living below the poverty line, or even in the rural areas, are usually more susceptible to diseases because they often cannot provide adequate preventive and curative health services. Adding to this problem is the fact that poor individuals and households cannot move from unhealthy surroundings, buy enough food or use the services that exist. Poor communities usually do not have the political power needed to get better services.

One of the leading causes of death in the least developed South Asian regions is the infectious disease tuberculosis (TB). Poverty and TB create a vicious cycle. Poorer populations are twice as likely to have TB, three times less likely to access care for TB, four times less likely to complete TB treatment and five times more likely to incur impoverishing payments for TB care2. In an effort to cope with the disease, people may decrease food intake, sell assets, borrow, withdraw children from school, leave their families or delay seeking care. There may be direct impact in the form of income loss, stigmatization and homelessness. Poor housing, overcrowding, malnutrition and risky behaviour also play important roles. Tuberculosis is the single leading cause of death among women of reproductive age.

One of the leading causes of malnutrition and ill health in South Asia is 'food poverty'. Over 350 million in China and India alone do not have access to basic nutrition requirements.13 Malnutrition increases the risk of infection and infectious diseases, and is one of the biggest contributors to child mortaility, according to WHO.

Prostitution and Sex Tourism:

HIV/AIDS is deeply rooted in social structures and institutions, making it a particularly important disease for studying the social aspects of health.

Across South Asia, prostitution exists in different forms, including 'red light areas' and brothel based prostitution. The region is home to a huge number of red light areas in big cities and medium towns, in transit business points on routes of business, as well as close to major industrial centres, and along highways and the borders, where there is military or paramilitary presence. Some of the largest red light areas in the region are Sonagachhi in Kolkata, GB Road in Delhi, Kamathipura in Mumbai, Budhwar Peth in Pune, Heera Mandi in Lahore, Patuakhali in Barisal, in Jessore and Khulna3.

Sex workers are forced to enter into this occupation due to limited economic opportunities for women, leaving prostitution as the highest paying job available to many of the women of Southeast Asia. The health costs, however, far outweigh the economic benefits. Sex workers are one of the major sections which become infected with HIV, the virus that causes AIDS. For instance, blood tests among commercial sex workers in Bombay have shown more than half of them are infected with HIV12.

The idea of creating designated areas for sex tourism in Asia dates back at least as far as pre-Communist China, where brothel trains, given the euphemism of 'comfort waggons' were a long accepted part