20141217040052_08. mpu3313 mpu2313 topic 4

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INTRODUCTION

The twenty first century has been preceded by decades in which the advances ofscience and medical knowledge have resulted in an increase in lifespan as well asa reduction of global ill health. Many of the diseases and illness which claimedthe lives of people in the last century have been eradicated, while in manysocieties the number of children living healthy lives beyond childhood hasincreased immensely. There is a general optimism in relation to health in manycountries and particularly in Western countries, where ill health is deemed to bean incidental or occasional aspect of peoples lives rather than a determiningfactor. Health could be said to be booming relative to times past.

TTooppiicc

44 Factors

AffectingHealth andWellness

LEARNING OUTCOMES

By the end of this topic, you should be able to:

1. Explain the factors that affect the health and wellness of theindividual, family and community;

2. Describe the effects of culture on the health status and healthbehaviour of the individual, family and community;

3.

Identify the impact of poverty on the health status of theindividual, family and community; and

4. Discuss how education level affects the individual, family andcommunity health behaviour.

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TOPIC 4 FACTORS AFFECTING HEALTH AND WELLNESS42

Every year, the World Health Organisation (WHO) produces a report reflectingthe state of health across the world in relation to a specific aspect of health. Thereport includes a detailed expert assessment of global health in richer and poorer

nations, supported by the latest related statistical data. The report aims toprovide the countries themselves, associated agencies and internationalorganisations with the evidence they need to underpin health care policydecision making and service planning. It also aims to provide an indirect generaloverview of the impact of implemented strategies to improve health. The reportprovides a good basis for assessing the current health of populations on a globalscale.

The impact of any changes in the cultural, social or economic environment on lifeexpectancy is then calculated to illustrate how external factors (e.g., health and

employment policies) could have an effect on the life expectancy of theindividual. Studies have demonstrated that for a middle-aged, long-termunemployed man, the effect of returning to work under conditions of fullemployment would be to lower his risk of premature mortality (Mitchell et al.,2000). The studies indicate that changes in economic circumstances alone couldresult in the prevention of 37% of avoidable deaths in poorer areas.

The definition of health by the WHO has been determined by more than just thephysical condition of a human being. It is recognised that the cultural, social andenvironmental contexts have a major impact on health and life chances (Aspinall& Jacobson, 2004). These contextual factors which influence health are often

collectively known as the social determinants of health, which impact peopleshealth (directly or indirectly).

The social determinants of health care by nature are not completely divorcedfrom the individuals personal choices. As such, how or why they have an impacton health cannot simply be understood in isolation from the cultural, social andenvironmental contexts in which people live their lives and manage their health.

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TOPIC 4 FACTORS AFFECTING HEALTH AND WELLNESS 43

FACTORS AFFECTING HEALTH

Let us have a look at several factors that affect health. We will start looking into

the influence of culture on health.

4.1.1 Influence of Culture

Culture may be understood as a shared system of meanings, values and beliefslearned through socialisation (Haralambos & Holborn, 2008). In its simplestsense, culturemay be viewed as the rules of behaviour and the expectations ofus that we learn in particular social situations or at different stages of our lives.For example, as we grow from babies to adults in our families, we learn the rules

of behaviour and what is expected of us from our parents.

Culture may be seen as universal, in the sense that it is an aspect of life for all. Atthe same time, it varies between individuals and groups and may be modifiedover time through legislative, political or social action. For example, in the lastfive years smoking in public has become less socially acceptable in most culturesas a result of increased knowledge about the dangers of passive smoking and therisks to individual health, resulting in legislation to ban smoking in public places.Cultural beliefs and cultural learning occur on both an individual and grouplevel. Some values and beliefs that make up our culture may be personal to us asindividuals while others reflect the expectations of a social group (for example,families, communities and religious community).

Individual and group cultures are an essential part of a persons world view asthey may have an impact on how we live our lives and indeed how we makesense of the world and our place in it (Haralambos & Holborn, 2008). Our beliefsabout health, for example, about how we maintain or measure our health, areinformed by our culture and the influence of the groups we belong to. It is theclose relationship between culture, the individual and their community whichexplains why health is so frequently affected by it.

Culture has a significant contribution to make to health, not least because in allits forms it helps to provide the social fabric of communities, making themcommunities in the real sense and sustaining the individuals within them.

London Health Commission (2002)

4.1

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The interdependent nature of the relationship between cultural beliefs and healthmeans that the choices, opportunities and actions arising as a result are subject tovariability between individuals and groups as well as over time (Linsley, Kane &

Owen, 2011). Therefore, in practice, while health beliefs can be found to exist inall cultures, their meanings and importance to individuals and groups indiffering societies are not universal.

In addition, the increasing ethnic diversity and globalisation which exist in thetwenty first century mean that our health beliefs and behaviour are alsoinfluenced by exposure to cultures which differ from our own. Thus, health isexperienced and influenced within and between groups from the same anddiffering cultures in all societies, which in turn modify health outputs. Therefore,the variations in culture between and within social groups may have an effect on

the following:(a) Understandings of health how we understand health and ill health at

different stages in the lifespan, what our expectations are in relation to ourhealth;

(b) Health behaviour how we act to promote or maintain our health (diet andexercise) and that of others in our care (children, patients, dependants andpeers); and

(c) Illness behaviour and expression how we act at times of illness, whetherand when we seek support to manage illness and how we expect others to

behave when they are ill (seek medical help, practise self-care and take timeto recover).

The factors identified above indicate that culture may have an impact on thewillingness and ability of an individual or group to access health care servicesand to accept the care available. The key issues when considering the impact ofculture on health is to understand that complex and varied belief systems aroundspecific aspects of health exist in and between cultural groups. These beliefsystems may be evidenced in patient or client health behaviour such as:

(a)

Willingness to seek early advice or care for health concerns;

(b) Expressing or demonstrating doubts about the need for medicalintervention or procedures for specific health concerns; and

(c) Degree of compliance with medical advice or treatment.

It is important to appreciate the role of culture as a contextualising factor in apersons health and use this knowledge to inform assessment of their needs.

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4.1.2 Influence of Poverty, Education and SocialEnvironment on Health

The previous section identified the close association between culture andcommunities. Culture, however, is not the only factor which unites socialcommunities and impacts health. Poverty, educational attainment and socialenvironment are some of the key factors which have the greatest impact oncommunity health. Poverty, education and social environment are very closelyrelated and impact directly and indirectly the lives of the individuals who makeup a community.

There are many definitions of poverty and how we determine that someone isimpoverished. Townsend (1979) provides a useful definition of poverty whichtakes into account its impact on the daily lives of individuals and theircommunities.

Poverty is said to be a central concern in the health of the population. The effectsof poverty on the health of individuals, families and communities are welldocumented. Many studies have firmly established that families living on lowincomes have a lower health status than those with higher incomes (Hirsch &Spencer, 2008). This is a worldwide phenomenon. People living in poverty have areduced life expectancy and experience poorer health than the rest of thepopulation in all societies worldwide (Isaacs & Schroeder, 2004; Schulz & Houseet al., 2008).

Individual families and groups in the population can be said to be in povertywhen they lack the resources to obtain the types of diet, participate in theactivities and have the living conditions and amenities which are customary,or are at least widely encouraged and approved, in the societies in which they

belonged.

Townsend (1979)

ACTIVITY 4.1

1. Reflect on your own healthy behaviour and not-so-healthy

behaviour. List down these behaviours.

2. Identify strategies on how to overcome the not-so-healthybehaviour.

3. Discuss on the impact of culture on health.

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One of the major ways in which poverty affects health is that it increases theexposure to a living environment that increases the risk of ill health (such as poorhousing, inadequate sanitation or overcrowding) while at the same time creating

economic challenges which prevent people from maintaining their own health.For example, a limited budget may mean buying inexpensive foods, which aremore likely to be processed, fatty and lacking important nutrients. The situationis compounded by the fact that the poor are also more likely to live in poorenvironmental situations with limited local health care resources, thus incurringadditional costs in accessing health care.

Poverty has also been found to impact the mental and social aspects of health aswell as the physical. Educational attainment is directly linked to employmentprospects and the earning potential of an individual in any society. The majority

of well-paid jobs require more than a basic level of education and training. Thishas the obvious impact of reducing the chances of living in poverty andminimising exposure to some of the health risks mentioned earlier. Thissummation is reinforced by research, which has directly compared the healthoutcomes for individuals by educational attainment. Lower educationalattainment is related to reduced life expectancy, increased risk of prematuredeath and increased likelihood of living with poorer health, compared withindividuals who have higher levels of education. It has also been identified thatthere is a relationship between educational level and death from lung cancer,stroke and cardiovascular disease as well as increased risk of diabetes, asthma,dementia and depression. The link between poverty and low educationalattainment also has a negative impact on society as well as the individual. Theoverall effect is to reduce the pool of potential employees with the appropriateskills available to employers.

The social environment comprises the group and communities in which peoplelive. The social networks in a community exist at an individual and group leveland are important aspects of the ability to maintain health, along with familystructure, culture, access to facilities, economic status and the physicalneighbourhood. The consequences of living in poverty or relative wealth and loweducational achievement versus higher level qualifications, combined with other

aspects of an individuals life, underpin the social environment in which theylive. It is in this social context that health chances are determined, experiencedand managed by an individual through their lifespan. Consequently, it isimportant for us to remain aware that the effects of poverty, educationalachievement and the social environment act as modifying factors influencing thehealth of individuals, families and communities.

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4.1.3 Other Factors that Influence Health Status

There are many other factors that are said to affect or influence our health status.Some of these are internal factors and others are external. Let us have a look atsome of internal and external factors.

(a) Internal FactorsThe following are internal factors which influence health status:

(i) Genetic MakeupGenetic makeup influences biological characteristics, innatetemperament, activity level and intellectual potential. It has beenrelated to susceptibility to specific disease such as diabetes and breast

cancer. Moreover, genetic inheritance, or family history, has beenrelated to susceptibility to specific diseases, whereby family historyhas been demonstrated in the incidence of breast cancer and diabetes.People with blood group A have been shown to be more susceptibleto hypertension.

(ii) SexIt has been demonstrated that certain acquired and genetic diseasesare more common in one sex than in the other. The disorders that aremore common among females are osteoporosis, autoimmune diseases

such as rheumatoid arthritis, gall bladder disease and obesity. Thosemore common in males are stomach ulcers, abdominal hernias,respiratory diseases and many others. Males have been found to bemore aggressive than females, and this phenomenon is thought to beat least partially due to hormonal differences.

ACTIVITY 4.2

1. Identify the poverty rate in Malaysia.

2. What are the steps taken by the government to reduce poverty?

3. Discuss the link between poverty and level of education and thehealth status of the family.

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(b) External FactorsThe following are external factors which influence health status.

(i) RaceRace is also said to be associated with disease distribution. Forexample, diabetes is more prevalent among Indians than it is amongthe other races in Malaysia.

(ii) Age and Developmental LevelThe distribution of disease varies with age, where the capability forresponding to disease is less during the first few years of life andagain near the end of life. Infants seem to lack physiological andpsychological maturity. For example, infants or children at youngerage are more prone to diseases such as whooping cough and measles.Among the elderly, the declining physical and sensory-perceptualabilities will limit their ability to respond to environmental hazardsand stressors.

Age is also said to be related to distribution of disease. The greatestmortality risk factors are arteriosclerotic heart disease. For example,the average age of a Malaysian patient admitted with acute coronarysyndrome is 59 years old. Age has also been associated withdevelopmental needs or tasks that have major impact on potentialhealth behaviour. For example, during the stage of physical growth in

puberty, the needs of the adolescent to not only determine an identitybut also conform to peers have an impact on their lifestyle, risk-takingand the practice of unhealthy behaviours.

(iii) Mind body RelationshipThe mind-body relationship is explained as how the emotionalresponses to stress affect bodily functions and that emotionalreactions which occur in response to body conditions will alsoinfluence health. Emotional stress is said to increase susceptibility toorganic diseases or to precipitate them. Emotional distress may also

influence the immune system. Alterations in the immune system arerelated to the incidence of infections, cancer and autoimmunediseases.

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(iv) LifestyleAn individuals lifestyle, which includes patterns of eating, exercise,use of tobacco, drugs and alcohol and methods of coping with stress,

may also influence health. Overeating, getting insufficient exerciseand being overweight are closely related to the incidence of heartdisease, arteriosclerosis, diabetes and hypertension. Excessive sugarintake can increase the risk of dental caries.

(v) FamilyThe family passes on the patterns of daily living and lifestyle to theiroffspring, in addition to transmitting genetic predispositions. Bothphysical and emotional abuse may cause long-term health problems.A social environment which is free of excessive tension and a climate

of open communication, sharing and love fosters the fulfilment of thepersons optimum potential and will promote good emotional health.

Support system and social networks are important in shaping beliefs andbehaviour. Social networks become a referral system that people consult foradvice. Having a support network in ones family helps people avoid illness.

There are various factors that may affect the health of an individual, a familyand the community.

Poverty, education and social environment affect our health status and healthbehaviour.

Other factors that may affect our health status are genetic makeup, sex, race,age and developmental level, mind-body relationship, lifestyles and family.

ACTIVITY 4.1

1. What are the factors that affect health?

2. Can you think of more examples of internal and external factorsthat affect health? Discuss in a group.

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