South African population features: • Population and demography (definitions): fertility, mortality, migration, birthrate, death rate, immigration rate, infant mortality rate, life expectancy –pg 31-32 in Pretoruis. • 2 main factors that shape death rates and life expectancy. Race & Ethnicity: • Definitions • Prejudice and discrimination- pg 50 in Pretoruis. • Strategies for working with diverse clients- pg 52-53 in Pretoruis. Age: • Ageism- pg 58 in Pretoruis. • Problems in inter-age interaction and how these manifest in health care- 58 in Pretoruis. • Adhering to principles- pg 59 in Pretoruis Disability: • Medical model- pg 61 in Pretoruis • Social model- pg 63 in Pretoruis • Definitions of disability and stigma- pg 64 in Pretoruis. • Strategies detrimental to patients who are disabled- pg 66 in Pretoruis + students to read through ‘preferred terminology’- pg 67 in Pretoruis Gender: • Gender socialization- pg 69 in Pretoruis • Defining ‘gender’- pg 70 in Pretoruis • The gender experience of health, illness and health care: Gender differences in respect of understanding and experiencing sickness and disease- pg 71 in Pretoruis, Gender differences in respect of morbidity and mortality- pg 71 in Pretoruis • Maternal health and reproductive health (MDG’s) + causes- pg 73 in Pretoruis

1. Sociocultural
context of health
and health care
delivery By C Settley

2. South African population
features- pg 31-32 in Pretoruis
• Population
– A group of people who live in a specific
geographical area.
– All the inhabitants of a particular place.
• 54.96 million (2015) SA
• 321.4 million (2015) USA

3. South African population
features:
• Demography
– the study of statistics such as births, deaths,
income, or the incidence of disease, which
illustrate the changing structure of human
populations.
– Composition
– Distribution
– Growth/decline
– Characteristics
– Trends

4. South African population
features:
• Population size is determined based on
the values of:
– Fertility (births)
– Mortality (deaths)
– Migration (movement of individuals from one
geographical area to another)

5. South African population
features:
• Natural increase:
– Is the most important component of overall
population change over time.
– Is calculated by the relationship between the
birth rate (the number of live births for every
1000 members of a population in a given
year) and the death rate (the number of
deaths in a year for every 1000 members of a
population).

6. South African population
features:
• Natural increase:
– Developing societies usually have a high rate
of natural increase (>2), while rate is much
lower for developed countries.
– The formula for the rate of natural increase is:
• For example, Madagascar's crude birth rate (37.89) minus the crude death
rate (7.97) is 29.92; divide that by 10 and the result is 2.992%,
Madagascar's rate of natural increase.
• The average global birth rate is 18.5 births per 1,000 total population in
2016.

7. South African population
features:
• Apart from natural increase, population size and
change are determined by how many people enter the
country and how many leave the country.
• Immigrant: a person who comes to live permanently
in a foreign country.
• Emigrant: a person who leaves their own country in
order to settle permanently in another.
• Immigrant rate: The number of emigrants departing
an area of origin per 1,000 population in that area of
origin in a given year.

8. South African population
features:
• Population change:
Population change= (births-deaths)+(immigrants-emigrants)
Calculate the population change for 2011 & 2012.

9. South African population
features:
2011
• Population change= (births-
deaths)+(immigrants-emigrants)
• (14.0-12.0)+(8.0-7.0)
• 2+1
• = 3
2012
• Population change= (births-
deaths)+(immigrants-emigrants)
• (12.0-10.0)+(15.0-9.0)
• 2+ 6
• = 8

10. Concepts
• Infant mortality rate:
– The infant mortality rate (IMR) is the number of deaths of infants under one year old
per 1,000 live births. This rate is often used as an indicator of the level of health in a
country.
– Visit https://www.brandsouthafrica.com/south-africa-fast-facts/health-facts/decrease-
in-infant-mortality-in-south-africa
– The under-five mortality rate had declined from 77.2 deaths per 1 000 live births in
2002 to 45.1 deaths per 1 000 live births deaths in 2015.
– Why?
– The Millennium Development Goals (MDGs) are the world's time-bound and quantified
targets for addressing extreme poverty in its many dimensions-income poverty,
hunger, disease, lack of adequate shelter, and exclusion-while promoting gender
equality, education, and environmental sustainability.

11. Millennium Development Goals
(MDGs)
• MDG 1: eradicate extreme poverty and hunger
• MDG 3: promote gender equality and empower
women
• MDG 4: reduce child mortality
• MDG 5: improve maternal health
• MDG 6: combat HIV/AIDS, malaria and other
diseases
• MDG 7: ensure environmental sustainability
• MDG 8: develop a global partnership for
development

12. Concepts
• Life expectancy:
– the average period that a person may expect to live.

13. Factors that shape death rates
and life expectancy
• Health care practice
• Socioeconomic positions
• when infant mortality rates are high and
life expectancy is low…
– It points to poor living conditions
– Poor healthcare
– In other words….

14. Factors that shape death rates
and life expectancy
• Improved healthcare like immunisation of
children, reduces the number of deaths
from infectious diseases and improved
living conditions like proper sanitation and
nutrition contribute to a lower infant
mortality rate.
• Read SA’s demographic profile- pg 32-35
in Pretoruis.

15. Race & Ethnicity- pg 49 in Pretoruis
• Race:
– the term race refers to groups of people who
have differences and similarities in biological
traits deemed by society to be socially
significant, meaning that people treat other
people differently because of them. Racism,
then, is prejudice based on socially significant
physical features.

16. Race & Ethnicity
• Ethnicity:
– refers to shared cultural practices,
perspectives, and distinctions that set apart
one group of people from another. That is,
ethnicity is a shared cultural heritage. The
most common characteristics distinguishing
various ethnic groups are ancestry, a sense of
history, language, religion, and forms of
dress.

17. Race & Ethnicity
• Prejudice:
– a negative outlook toward a person or group,
based on the perceived status or
characteristics of that person or group;
prejudices are often held independently of
facts about the person or group.

18. Race & Ethnicity
• Discrimination:
– the unjust or prejudicial treatment of different
categories of people, especially on the
grounds of race, age, or sex.

19. Racism of nurses towards
patients
Continuum of nurses 'commitment to caring
• Resistant care
– Resents the fact of having to help patients from a different race
– Feels that it is additional work
• Generalist care
– Aware of the patient’s cultural or racial diversity, but regarded it
as a non issue
– Feels that basic human respect would cover all patients
– Passive care
• Impassioned care
– Regards caring for patient’s with different cultures as a positive
challenge
– Desire is to learn from patients
– Eager to know how to accommodate them

20. Strategies for working with
diverse clients
• On an individual level
– Connect with clients
– Deal with the family
– Accommodate cultural practices
– Balance your own expectations
• External ways of dealing with diverse clients
– The healthcare setting
– Role of colleagues
– Commitment of the institution
– Education

21. Racism between colleagues
• What to do:
– 1. Remain Calm
– 2. State the Obvious
– 3. Bring in Management
– Follow hospital/institution protocol

22. Patients acting in a racist
manner towards nurses
• Seek help, advise & support
• Set limits with patients
• Obtain back up
• Deal with the issue at the institutional level

23. Age- the social significance
• Biological trait
• Defines what is appropriate
• Society decides what is old and also what
is appropriate for which age group

25. Ageism
• prejudice or discrimination on the grounds
of a person's age.

26. Age manifests in the following
ways:
• Marginalisation
• The use of dismissive and demeaning
language
• Humour and mockery
• Physical, sexual, financial and emotional
abuse. Neglect, medical abuse.
• Economic disadvantage
• Restricted opportunities or life chances

27. How to combat ageism
• Nurses are encouraged to adhere to the
following principles:
– Personhood… ascribe value to people of
all ages.
– Citizenship… acknowledge the
relationship between an individual and the
society. Emphasise the rights and
responsibilities and their values.
– Celebration … age is to be celebrated as
an achievement.

28. Disability
• a physical or mental condition that limits a
person's movements, senses, or activities.
• a disadvantage or handicap, especially
one imposed or recognized by the law.

29. Approaches to disability
• Medical model of disability
– The medical model of disability views disability as a ‘problem’
that belongs to the disabled individual. It is not seen as an issue
to concern anyone other than the individual affected.
– For example, if a wheelchair using student is unable to get into a
building because of some steps, the medical model would
suggest that this is because of the wheelchair, rather than the
steps.

30. Approaches to disability
• Social model of disability
– The social model of disability says that disability is caused by the
way society is organised, rather than by a person's impairment
or difference.
– It looks at ways of removing barriers that restrict life choices for
disabled people.
– The social model of disability, in contrast, would see the steps as
the disabling barrier.
– This model draws on the idea that it is society that disables
people, through designing everything to meet the needs of the
majority of people who are not disabled.
– There is a recognition within the social model that there is a
great deal that society can do to reduce, and ultimately remove,
some of these disabling barriers, and that this task is the
responsibility of society, rather than the disabled person.

31. • a course leader who refuses to produce a hand-out in a larger font
for a visually impaired student. The student cannot therefore
participate in the class discussion;
– Medical approach
• a member of staff who refuses to make available a copy of a
PowerPoint presentation before a lecture. This creates a barrier to
learning for the dyslexic students in the group who are likely to have
a slower processing and writing speed and who will struggle to
understand and record the key points;
– Medical approach
• a Students’ Union society that consults with disabled members
before organising an event in order to make sure that the venue is
accessible.
– Social approach

32. • a course leader who meets with a visually impaired member of the
group before the beginning of a course to find out how hand-outs
can be adapted so that the student can read them;
– Social approach
• a member of staff who makes PowerPoint presentations available
on Blackboard to all members of the group before a lecture. This
allows dyslexic students to look up unfamiliar terminology before the
lecture, and gives them an idea of the structure that will be followed.
This ‘framing’ helps students to understand and retain the
information;
– Social approach
• a Students’ Union society that organises an event that is not
accessible to disabled members
– Medical approach

33. Approaches to disability
• Many people are willing to adopt the social model
and to make adjustments for students who have a
visible disability. However, they are not as
accommodating with students who have a hidden
disability, or a disability that is not clearly
understood. An important principle of the social
model is that the individual is the expert on their
requirements in a particular situation, and that this
should be respected, regardless of whether the
disability is obvious or not.

34. Disability and stigma
• How the stigmatised handle situations:
– They avoid contact
– They attempt to correct the failing
– They try to appear to be in control
– They may use it for secondary gain
– They view discrimination as a blessing
– They view ‘normal’ negatively

35. • Read the preferred terminology- pg in
Pretoruis

36. Gender
• Gender socialisation
– the process by which males and females are
informed about the norms and behaviors
associated with their sex.
– process by which individuals are taught how
to socially behave in accordance with their
assigned gender, which is assigned at birth
based on their biological sex.

37. Gender
• Gender socialisation
– Today it is largely believed that most gender differences are
attributed to differences in socialization, rather than genetic and
biological factors.
– Gender stereotypes can be a result of gender socialization: girls
and boys are expected to act in certain ways that are socialized
from birth. Children and adults who do not conform to gender
stereotypes are often ostracized by peers for being different.

38. Terms
• Gender: The socio-cultural phenomenon of the division of people
into various categories such as male and female, with each having
associated roles, expectations, stereotypes, etc.
• Sex: Either of two main divisions (female or male) into which many
organisms can be placed, according to reproductive function or
organs.

39. Gender differences in respect of understanding
and experiencing sickness and disease
• Women:
– 15-44 years of age, women are hospitalized
at a higher rate than men.
– Not due to ill health but rather because this is
their period of reproduction.
– Apart from that, they visit health care facilities
more often for antenatal care and family
planning.

40. Gender differences in respect of understanding
and experiencing sickness and disease
• Women:
– Responsibility of caring for the ill (traditional
expectation).
– Caring of children and elders.
– This brings them into contact with the
healthcare system more often.
– Poverty.
– Social roles.
– Commitments.

41. Gender differences in respect of understanding
and experiencing sickness and disease
• Men:
– Seeking healthcare is determined by gender.
– Studies have shown that men do not discuss
their symptoms.
– Individualistic view of their symptoms.
– Prefer not to join support groups.
– Delay seeking health regardless of symptoms
that are evident.

42. Gender differences in respect of understanding
and experiencing sickness and disease
• Men:
– ‘bad’ patient stigma.
– Do not adhere.
– Do not come for check- ups.
– Due to gender role.
– Requirement (or perception?) that men should
stay in control, be strong, not cry… ‘be a man’
(expectations).
– Negative consequence: high death rate due to
occupations, lifestyle.

43. Gender differences in respect of
morbidity and mortality
• Morbidity: Condition of being ‘diseased’.
• Women live longer than men according to research.
• Globally.
• Women appear to be biologically stronger.
• Stillbirths, premature deaths, sudden infant deaths are
more common to occur in males.
• Female hormones.
• Later in life, women more prone to being diagnosed
with heart disease as oestrogen levels drop.
• Socio economic conditions.

44. Maternal health and
reproductive health
• Maternal mortality is a huge problem
• MDG’s by the UN.
• See box 2.4 – page 74
• Causes of maternal deaths:
– Direct obstetric causes
– Indirect causes
– HIV infection
– Incidental causes unrelated to pregnancy

46. References
• http://ljhsdcurtis.pbworks.com/w/page/314
94243/Life%20Expectancy%20of%20%20
South%20Africa%20compared%20to%20
United%20States
• https://www.boundless.com/sociology/text
books/boundless-sociology-
textbook/gender-stratification-and-
inequality-11/gender-and-socialization-
86/gender-socialization-495-3393/