Impact of Cultural and Social Factors on Health

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“Health is an essential requirement and a common objective for everyone. The advancement of society, irrespective of its economic standing, can be evaluated based on the health status of its population, equitable distribution of healthcare across various social groups, and extent of safeguarding against adverse health outcomes. It is imperative to prioritize equal accessibility to healthcare in order to uphold this principle.”

Promoting health equity globally and within countries requires addressing the deeper social structures and conditions that shape individuals’ lives, rather than just focusing on immediate disease factors. This encompasses considering the social hierarchy and the circumstances of people’s upbringing, living situations, work environments, and aging process. Taking action to improve health is not only economically beneficial but also a matter of fairness. Professor Sir Michael Marmot emphasizes the significance of ensuring good health for all.

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Despite the ideal scenario of universal good health or access to health-improving facilities worldwide, the growing global burden of diseases reveals the current state is far from perfect. South Asia, home to a quarter of the world’s population, serves as an example of this somber truth. According to the World Health Organization (WHO), health encompasses physical, mental, and emotional well-being.

Good health is more than just being disease-free and depends on a favorable environment and stable mental state. Medicine, as a social institution, has the responsibility of diagnosing, treating, and preventing illnesses. To fulfill this duty, Medicine incorporates various scientific fields such as life sciences, earth sciences, chemistry, physics, and engineering. Although science is commonly seen as the main factor in determining sickness, the sociological perspective emphasizes that social, cultural, and environmental factors also contribute to diseases. Sociology acknowledges that the well-being of its population and proper management of illness are crucial for any society.

Both communicable and non-communicable diseases are common in South Asian countries. Communicable diseases, such as respiratory infections (Tuberculosis), HIV/AIDS, infections at birth, diarrhoeal disease, malaria, and typhoid, are the leading causes of death among the population. Alongside these ongoing issues with communicable diseases, South Asians also face non-communicable diseases including heart attacks, strokes, and hypertensive heart diseases.

In terms of health conditions, urban regions have higher rates of overweight, central obesity, diabetes, high blood pressure, and other related conditions compared to rural areas. However, both urban and rural populations in South Asia show similar trends when it comes to these diseases. The occurrence of Communicable and Non-Communicable diseases in the region is influenced by social structures, cultural norms, and environmental conditions that are specific to each country. Poverty is one social factor that plays a role in the prevalence of these diseases.

Approximately half of the South Asian population resides in poverty, resulting in limited access to healthcare. This issue is particularly prevalent in rural regions, where individuals face higher susceptibility to diseases as a result of inadequate preventive and curative health facilities. Moreover, impoverished households encounter difficulties in relocating from unhealthy environments, securing adequate nourishment, and reaching accessible services. Furthermore, these marginalized communities often lack the necessary political power to advocate for improved services.

One of the main contributors to mortality in underdeveloped regions of South Asia is tuberculosis (TB), which is an infectious disease. Poverty and TB create a harmful cycle. Individuals from impoverished communities are twice as prone to contracting TB and are three times less likely to receive proper TB treatment or access care. Moreover, they are four times less likely to successfully complete TB treatment and face a five-fold increase in the likelihood of experiencing impoverishing expenses related to TB care. To cope with the disease, people may engage in actions such as reducing food consumption, selling assets, borrowing money, withdrawing their children from school, separating from their families, or delaying seeking medical attention.

The issue being discussed has multiple repercussions, including loss of income, social exclusion, and homelessness. Furthermore, there are several factors that significantly contribute to this problem such as inadequate housing conditions, overcrowding, lack of proper nutrition, and engaging in risky behaviors. Among women who can have children, tuberculosis is the leading cause of death. Particularly in South Asia, ‘food poverty’ is a major factor contributing to malnutrition and declining health. It is worth noting that China and India together have a population exceeding 350 million people who do not have access to essential nutritional needs. The World Health Organization (WHO) states that malnutrition greatly increases the likelihood of infection, infectious diseases, and child mortality.

Prostitution in South Asia takes various forms such as ‘red light areas’ and brothel-based prostitution. It is prevalent in big cities, medium-sized towns, transit business points along major commerce routes, close to major industrial centers, highways, and near military or paramilitary establishments at the borders. When examining HIV/AIDS, it is essential to take into account the social dimensions of health because this disease is firmly embedded within social structures and institutions.

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, Jessore, and Khulna3. Many women choose to enter this profession due to limited economic opportunities for them. It is often the highest-paying job available to women in Southeast Asia. However, the financial benefits of sex work are overshadowed by the health risks associated with it. Sex workers are at high risk of contracting HIV – the virus that leads to AIDS.

Over 50% of sex workers in Bombay are HIV-positive. The concept of designating specific areas for sex tourism in Asia has existed for a long time, including China’s pre-Communist era brothel trains called “comfort waggons.” This practice continues today, with certain countries such as Thailand legalizing prostitution for economic benefits. However, women engaged in prostitution in these South Asian countries face a high risk of contracting HIV, contributing to the increasing rates of HIV/AIDS. Migration is widespread in South Asia due to factors like rural-urban migration caused by poverty, natural disasters like those experienced in Bangladesh, Pakistan, and West Bengal, and conflicts such as Nepal’s Maoist Rebel issue.

The poor living conditions in slums and squatter colonies where migrants live increase their risk of contracting water-borne and air-borne illnesses such as typhoid and diarrhea. The group most impacted by Rural-Urban Migration in South Asia is street children, according to UNICEF. With a staggering 25 million street children in Asia, this issue is widespread throughout the region due to the influx of migrants from rural areas and neighboring countries into cities. In Bangladesh alone, there are over 600,000 street children, with 75% of them residing in Dhaka.

In addition, Pakistan has approximately 42,500 street children, Nepal has over 5,000 street children, and India has over 11 million street children. Kolkata alone accommodates at least 100,000 of these children. These children depart from their families in pursuit of job prospects to sustain themselves and ultimately find themselves on the streets or railway platforms. Unfortunately, they not only encounter mental health difficulties as a result of escaping domestic violence or familial issues but also suffer from deteriorating physical well-being while residing in urban locations.

The street children lack necessary resources and suffer from physical, emotional, and sexual abuse as well as exploitation. These acts are perpetrated by different individuals including police officers, hawkers, vendors, and other adults who exploit these vulnerable children for prostitution and trafficking. Many children in this circumstance engage in early and unsafe sexual activities, which heightens their susceptibility to HIV/AIDS and substance abuse. Furthermore, the rise of urbanization and income disparities in South Asia has resulted in the emergence of non-communicable diseases in this area.

Urbanization has a strong connection to negative health effects, which are primarily caused by increased work hours leading to high stress levels and easy access to abundant food contributing to issues like obesity. Additionally, urbanization also exacerbates the income gap, favoring the wealthy and worsening poverty for those who are less fortunate. These economic impacts raise concerns about the well-being of rural populations.

The lack of healthcare access for the impoverished, coupled with their declining social and economic conditions, increases their vulnerability to diseases. Additionally, gender discrimination greatly influences health outcomes by creating disparities in food and medical care accessibility, favoring boys over girls in terms of nurturing and care, impeding girls’ education, exposing women to workplace sexual abuse, and subjecting them to other forms of sexual harassment that negatively affect their health.

Gender discrimination is evident in the lower enrolment rates of girls in Primary schools, with only 83% of girls being enrolled compared to 90% of boys11 in South Asia. Although the gap decreases at secondary and tertiary levels, a significant number of girls still discontinue their education after primary school. This is concerning because a sound education is crucial for good health, and the insufficient enrolment and high dropout rates at the primary level result in an overall inadequate education for females.

This leads to a higher vulnerability to health hazards, especially for women in South Asia, particularly India and Bangladesh. In these regions, women face an increased risk of various forms of violence throughout their lives, such as domestic abuse, forced pregnancies, and sexual assault during times of conflict. These acts have a significant impact on the mental and physical well-being of women. Furthermore, societies tend to stigmatize and shame women more severely than men when they contract a disease, which discourages them from seeking necessary medical assistance.

Additionally, this trend is particularly noticeable in cases of tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS).

Rates of tuberculosis (TB) are generally elevated in South-East Asia, particularly among females who experience higher mortality rates compared to other regions. The stigma associated with TB, especially for women, creates barriers to successful treatment.

Education plays a pivotal role in shaping health outcomes for individuals and communities alike. It helps alleviate poverty by offering employment prospects and equipping individuals with skills for improved well-being. Additionally, education empowers women to make informed decisions regarding their health and nutrition practices, while also increasing the pool of healthcare providers and community educators.

The World Bank recommends the implementation of participatory health education for schoolchildren in impoverished communities as an effective strategy to promote healthier lifestyles and prevent noncommunicable diseases. The table below shows data on adult literacy rates and combined gross enrollment rates in various South Asian countries:


Country Adult Literacy Rate Combined Gross Enrollment Rate
India 61% 60%
Bangladesh 41% 53%
<t/><<d/Adult Literacy Rate: <e/t/><>Combined Gross Enrollment Rate: <e/t/>;

>>cd/>/Bhutan-> s/-<>s/ Adult Literacy R/s/-ate: <Myanmar9048 Sri Lanka9069 Source: Report of the WHO Regional Consultation on Social Determinants of Health New Delhi, India, 15-16

The data shows a clear link between adult literacy rates and CGERS in various countries. Countries with higher rates of adult literacy generally have higher levels of CGERS. This connection is important for health because education and literacy affect access to and understanding of health information. As a result, these factors impact attitudes and behaviors related to health, which ultimately affects overall health status.

When comparing Sri Lanka and Myanmar to Bangladesh and Nepal, it is evident that the latter two countries have a higher population of illiterate people. This makes them more susceptible to health issues. However, adult literacy rates in Sri Lanka and Myanmar are comparable to those found in developed nations. One factor that contributes to the prevalence of diseases throughout societies is the existence of cultural norms and practices that impede good health. A prime example of this is the prevalent use of untrained healthcare providers, which is particularly common in rural households.

The healthcare providers known as ‘quacks’ often lack the necessary knowledge and expertise for proper treatment of sick or diseased patients, potentially causing further deterioration. Cultural traditions in South Asia, such as Child Marriage, pose significant health risks. This practice is especially common in countries like India and Bangladesh. For example, in Bangladesh, 268% of births occur before the age of 15 through Child Marriage, while in India it is 142%, and Nepal has a rate of 90%.

Source: Demographic and Health Surveys, http:www. measuredhs. com, StatCompiler

The widespread practice of arranging marriages for girls at or before puberty is prevalent in many countries due to cultural reasons. These reasons include protecting family honor and the perceived rise in value of the girls. Parents may feel compelled to marry off their daughters at a young age out of concern for their safety and financial stability. Child marriage has a significant global impact on pregnancies occurring before the age of 15, placing immense pressure on these young married girls to conceive as soon as possible within their husbands’ households and communities.

This leads to severe health problems for young girls because of the following reasons:
•Their bodies (bone structure, pelvis, and reproductive organs) are not fully developed yet, making them at a high risk of complications during pregnancy and childbirth compared to older adolescents. 5
•Pregnant young adolescents often experience prolonged and obstructed labor, which can result in hemorrhage, severe infection, and even maternal death. 6
•Young girls who marry early are also more susceptible to sexually transmitted infections (STIs), including HIV/AIDS.

According to the text, it is common for young girls to be unable to negotiate sexual practices with their partners. The consumption of culturally specific products like ‘paan’ and ‘guthka’ in the Indian Subcontinent is a widespread practice. These products contain tobacco and betel nut, which have been found to act as a carcinogen when combined. The additives in these products, such as gold or silver flakes, can also cause acute toxicity. Manufacturers often claim misleading health benefits of these products, including improved digestion and memory. Some people believe that guthka users can even perform superhuman feats. Pollution is a significant environmental factor that contributes to various diseases. In South Asia, poorer individuals burn wood fuel in their homes, leading to indoor air pollution. This pollution is particularly prevalent in Nepal, rural India, and Pakistan and contributes to chronic obstructive airway disease. The increasing industrial activities in the developing South Asian region also lead to higher industrial pollution, which affects the health of the population by causing skin and respiratory diseases.

Environmental disruptions, such as floods, droughts, storms, fires, earthquakes, etc., have a significant impact on health. These natural disasters often result in disease outbreaks, making them particularly concerning for Bangladesh. The country experiences frequent floods and other calamities, leading to the spread of water-borne illnesses like typhoid, diarrhea, jaundice, dysentery, etc. Additionally, the health hazards are worsened by food shortages and unhygienic living conditions.

This was also exemplified during the Tsunami disaster in 2004. Groundwater, particularly shallow groundwater, in numerous South Asian locations, is contaminated with dangerously high levels of arsenic. Long-term ingestion of arsenic-laden drinking-water can result in the following health risks8: •Reduced child survival rates •cognitive impairment •cardiovascular diseases •Cancer. Aside from human waste and arsenic, drinking-water in South Asia can also be polluted with industrial pollutants. The economies of South Asian nations are progressing.

The workforce is increasingly focused on industrial production, leading to a decreased percentage of those involved in agriculture. However, industrial production often results in the creation of industrial waste containing harmful chemicals. The Indian Subcontinent lacks proper waste management techniques, especially when it comes to monitoring industrial waste. As a result, industrial waste has been found to contaminate ground and river water, as well as cause leaks in tailing pipes, further increasing the risks associated with these wastes.

In addition, natural phenomena such as rain, flooding, and wind have caused tailings to enter people’s homes. This issue is further exacerbated in India, where waste management includes dealing with radioactive waste. Even minimal exposure to low levels of radiation can result in health risks such as lung cancer. Ultimately, urgent intervention is needed to address this critical situation. To enhance health outcomes in the South Asian region, the following measures should be implemented: prioritizing and safeguarding human rights, as health and human rights are intricately connected.

Violation or neglect of the human rights of women, men, and children can lead to severe health consequences. These violations may include torture, violence, denial of essentials such as food and shelter, and more. The promotion and protection of human rights help decrease vulnerability to illness. It is important to recognize that access to healthcare facilities is a fundamental human right. Therefore, it is necessary to establish additional health centers in the economically disadvantaged regions of South Asia. Additionally, raising awareness through campaigns can help adjust societal and cultural norms in South Asia that contribute to significant health hazards.

This involves gender discrimination and child marriage, which should be urgently addressed by the government and other relevant parties in order to mitigate the associated health risks. It is crucial to launch extensive awareness campaigns and for the Ministry of Education in respective countries to undertake measures to ensure girls have equal opportunities for primary, secondary, and tertiary education. Furthermore, it is important to recognize that having laws against child marriage alone is insufficient in curbing this harmful tradition.

Stringent implementation should be enforced, as and when applicable. Empowering men and women in rural areas by providing more economic opportunities will have two advantages. First, it will decrease the rate of rural-urban migration and therefore reduce health issues related to such patterns of migration. Second, empowering women will decrease the health risks they face due to their vulnerable economic status. Steps should therefore be taken to provide them with economic opportunities, which will enable them to become self-dependent.

Implementing policies to protect the environment will not only decrease prostitution but also empower women to have control over their sexual activities with partners. It is essential for the government to establish strict guidelines for environmental protection to reduce the occurrence of diseases caused by environmental deterioration, especially air and water pollution. Waste management is a significant concern, and immediate action should be taken by the government and other relevant parties to halt the disposal of industrial waste in rivers.

Industrial effluent is polluting rivers across Bangladesh, leading to significant environmental issues. References: 1Commission of Social Determinants of Health. Geneva, World Health Organization. Available from: http://www. who. int/social_determinants/en/ 2,Social Determinants of Health, ‘The Solid Facts’, Second Edition, Edited by International Centre for Health and Society Richard Wilkinson and Michael Marmot 3Coalition Against Trafficking in Women, Factbook on Global Sexual Exploitation,Donna M. Hughes, Laura Joy Sporcic, Nadine Z.

Mendelsohn and Vanessa Chirgwin 4San Francisco Chronicle,The Role of Prostitution in South Asia’s Epidemic Push for safe sex in red-light districts, Sabin Russell, Chronicle Medical Writer,Monday, July 5, 2004 5,6,7 International Planned Parenthood Federation, United Nations Population Fund, and Global Coalition on Women and AIDS. 2005. Ending child marriage: a guide for global action. London: IPPF 8INTERNATIONAL CENTRE FOR DIARRHOEAL DISEASE RESEARCH, BANGLADESH J HEALTH POPUL NUTR 2008 Jun; 26(2):123-124 9OneWorld South Asia, Study flags radioactive waste management lapses, Madhusmita Hazarika, 08 December 2008 10MCMICHAEL A.

J. , CAMPBELL-LENDRUM D. H. , CORVALAN C. F. , EBI K. L. , GITHEKO A. , SCHERAGA J. D. , WOODWARD A., (WHO, 2003) indicated in their study on climate change and human health that there are risks and responses to this issue. According to the ‘Core indicators 2005: health situation in the South-East Asia and Western Pacific Regions’ report by WHO Regional Offices for South-East Asia and the Western Pacific (2005), there are also social determinants of health outlined in ‘The Solid Facts’ (Second Edition) edited by International Centre for Health and Society Richard Wilkinson and Michael Marmot (12,13).

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Impact of Cultural and Social Factors on Health. (2018, Jun 11). Retrieved from

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