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University of Toronto Scarborough
Health Studies
Rhan- Ju Song

HLTC05 –Social Determinants of Health Lecture 3: Social Origins of Illness and Disease Tuesday, September 25, 2012 Context  Social  Cultural  Economic  Physical Human Variables in Disease Incidence  Demography: age, sex, ethnicity, SES status  Biology: genes, degree of immunity, nutritional status, susceptibility  Behaviour: nature of risk behaviours, cultural traditions influencing disease transmission and persistence, and psychological factors influencing manifestation of disease o Plays a role in diseases Economic situation  Influences all the factors below: o Family structure o Gender roles o Marriage patterns o Sexual behaviour o Contraceptive patterns o Population policy o Pregnancy & childbirth practices o Child-rearing practices o Body-image alterations o **Diet / Nutrition (food prep, taboos) will be mentioned throughout the lecture Different Cultures/Ethnicities:  Know these variables and how they affect health  Like how taboo affects health or how religion affects health o Dress o Personal hygiene o Housing arrangements o Sanitation o Occupations o Religion o Funerary customs o Culturogenic stress o Migrant status o Seasonal travel o Use of ”chemical comforters” o Leisure pursuits o Domestic/household animals o Self-treatment and lay strategies Case Studies (Helman, 2007)  know each one in detail from the article; understand the significance  Cervical cancer in Latin America:  Hepatitis B and cultural practices:  Coronary heart disease among Japanese:  AIDS and sexual practices in Brazil: Variations in Medical Treatment and Diagnosis  Variations in surgical rates between US, Canada, England, Wales  Notable differences in caesareans, hysterectomy o Based on the country and their variation of health and society’s perspective on health care  Factors: cultural values of surgeon, patient and society (value systems, priority to health care, technology changes) where they live play a part in determining frequency with which surgery used as treatment for conditions  Not just looking at behaviour, issue of how the practice of biomedicine, can also differentiate health status  Biomedicine is an objective science: o Treats based on diagnoses from doctors o Follow a certain protocol Individual Behaviour Risk and “Healthism”  Increasingly today: origin of health problems in the individual o Health in our own hands o notion of risk  A consumerist movement as well....lifestyles and material goods: health food, equipment, pills, vitamins, etc. o Economically  health food, amount of equipment, buying pills, vitamins  “Healthism” as a new religion o Play into a perspective of health due to the biomedicine  But often ignores large social causes of ill health, o i.e., poverty, inequality, overcrowding, pollution, etc.  Reinforced by medical perspective of “individual risk factors”, common in epidemiological reports o Stats say that over time, the term ‘risk’ has increased  Personal risk management Cultural Perception of Disease  Lay definitions of abnormality or disease  What is/isn’t presented at doctors’ offices depending on someone’s beliefs, e.g., menstrual pain/lack of, hip dislocation, backache and SES  “Disease” vs. “Illness” o Disease  Doctors deal with disease that can be defined by certain symptoms  Disease is objective term  Difference between science (western) and non-science o Illness  “Cultural epidemiology”, investigating local concepts of illness and social context; interested in patterns of stress in a community, perceptions of causes, the meanings they give to it, and their help-seeking behaviour o Lay person’s perception of illness o In their culture, it’s considered a way to describe their illness Differing Perspectives on Disease  Biomedicine: disease is an objectively defined and discrete biological entity that exists separately from social groups and social contexts; “disease as a category in nature, a finite and objective reality discoverable through scientific endeavour” (Singer 2004: 9) o Objective fact  Medical Anthropology: disease is culturally defined; there are “social origins of both the biomedical conception of disease and the expression of the sicknesses labelled diseases by doctors” (Singer 2004: 9) o Disease as a social construct Medical Technological Advances  Complex way of looking at disease  Played a role in changing definition of ‘disease’  Significant factor in disease construction  With technological development: must consider who controls the funding and implementation of new technologies, who operates and deter
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