The document provides an overview of social and cultural factors that influence health. It discusses how social determinants of health are shaped by various social, economic and political forces. Key factors discussed include income, education, employment, social support systems, culture, and the built environment. The document also examines how these social determinants impact health equity and disease patterns in populations. Major international initiatives that aim to promote health equity by addressing social determinants of health are also summarized.

1. SOCIAL AND CULTURAL
FACTORS IN HEALTH
Dr.SUMAN LOHANI
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2. Table of contents:
Introduction
Historical background
Importance of SDH
Health equity
 Social patterning of the disease
Various social and cultural factors
SDH in SDG
Conclusion
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3. OBJECTIVES
- To provide an overview of social variables that have been researched
as inputs of health
- To know about social and cultural factors that influences health at
multiple levels throughout life course
- To know about different activities around the globe related to social
determinants of health in promoting health
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6. Health
“Health is a state of complete physical, mental,
and social well-being and not merely the absence
of disease or infirmity to lead a socially and
economically productive life”
-WHO(1948)
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10. SOCIAL DETERMINANTS OF HEALTH
 Conditions(social, economic, and physical) in the environment-
environments (e.g., school, church, workplace, and neighborhood) in which
people live, learn, work, play, worship, age and system put in place to
deal with the illness.
 Impacts a wide range of health, functioning, and quality-of-life outcomes
and risks.
These circumstances are in turn shaped by the wider set of forces; social,
political and economic.
 The patterns of social engagement and sense of security and well-being
are also affected by where people live.
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11. Historical Events in Social
Determinants Of Health
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12.  The Commission on Social Determinants
of Health (CSDH) was established by WHO
in March 2005 to support countries and
global health partners in addressing the
social factors leading to ill health and
health inequities.
 The Commission aimed to draw the
attention of governments and society to
the social determinants of health and in
creating better social conditions for health,
particularly among the most vulnerable
people
 The commission delivered it's report to the
World Health Organisation in July 2008
and it subsquently ended it's functions.
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13. Three Principles of Action:
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17. AIM:
“To engage high level political support to make progress on national
policies to address social determinants of health to reduce health
inequalities.”
Five Thematic Areas:
1. Adopt better governance
2. Promote participation
3. Reorient health sector
4. Strengthen global cooperation
5. Monitor progress and address accountability
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- HiAP is a policy strategy,
which targets the key social
determinants of health
through integrated policy
response across relevant
policy areas with the
ultimate goal of supporting
health equity.
- HiAP is thus closely
related to concepts such as
‘intersectoral action for
health’, ‘healthy public
policy’ and ‘whole-of-
government approach’.

19. Healthy People 2020
Goal:
Create social and physical environments that
promote good health for all.
Healthy People 2020 Approach to Social
Determinants of Health
A “place-based” organizing framework,
reflecting five (5) key areas of social
determinants of health (SDOH), was
developed by Healthy People 2020.
These five key areas (determinants) include:
 Economic Stability
 Education
 Social and Community Context
 Health and Health Care
 Neighborhood and Built Environment
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23. Ottawa charter on health promotion
WHO (1986)
Identifies 8 key determinants of health:
peace, shelter, education, food ,Income, a stable eco-system, sustainable
resources, social justice, and equity.
Improvement in health requires a secure foundation in these basic
prerequisites.
Advocate
• Good health is a major resource for social, economic and personal
development and an important dimension of quality of life.
• Political, economic, social, cultural, environmental, behavioral and
biological factors can all favor health or be harmful to it.
• Health promotion action aims at making these conditions favorable
through advocacy for health.
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24. IMPORTANCE OF SOCIAL AND CULTURAL
FACTORS IN HEALTH
In order to become a effective health professional, one must
understand;
The ways people think about health and illness
Individual behavior and habits that influences health
How you and your actions are perceived by the community where
you work
How culture interacts with environment, economy and politics to
affect health
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25. SOCIAL CULTURAL CONDITIONS
• Lifestyle which denotes the way people live ,reflects whole range of
social values, attitudes and activities.
• It is composed of cultural and behavioral patterns and lifelong
personal habits(smoking, alcoholism) that has developed through
socialization.
• Association between health and lifestyle of individual
• Achievement of optimum health demands adoption of healthy
lifestyles.
• Health is both consequences of an individual lifestyle and a factor
determining it.
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26. SOCIAL AND ECONOMIC INDICATORS
REALTED TO HEALTH
Rate of population increase
Income distribution
Work conditions
Adult literacy rate
Housing
Food availability
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27. Health equity
” The absence of unfair and avoidable or remediable differences in
health among population groups defined socially, economically,
demographically or geographically”
-WHO(2004), Department of Equity ,Poverty and Social Determinants of Health
-Health inequalities are socially produced, systematic in their
distribution across the population and unfair
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28. • Epidemiological research has clarified the nature and scope of health
inequalities through investigations revealing the existence of
persistent social gradients in health for a wide variety of health
indicators.
• Whitehall study (Marmot et all,1978) was pioneer in this regard.
• Whitehall Studies investigated social determinants of health,
specifically the cardiovascular disease prevalence and mortality rates
among British civil servants.
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29. • This study went beyond confirming the longstanding perception that
the rich lives longer, healthier lives than the very deprived.
• It showed that even among relatively well-off members of the society,
a social gradient in health exists, with the most privileged category
showing better outcomes than the group immediately below, which
in turn enjoys better health than the category just beneath it, and so
forth.
• This gradient is observed for practically all diseases and health status
measures and across all segment of the socioeconomic spectrum
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30. • During the late 1990s and 2000s,evidence accumulated that existing
global and national health policies had failed to reduce inequalities
and indeed substantial progress in average health indicators had
been accompanied by widening health gaps between privileged and
disadvantaged groups.
• In recent years, public health’s responsibility to confront health
inequalities at global, national and local level has been increasingly
recognized.
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31. Theories on social patterning of disease
1. Psychosocial approaches
2. Approaches that emphasizes the social production of the disease
(political economy of health)
• also described as materialistic or nonmaterialistic position
• Do not deny negative psychosocial consequences of income
inequality .
• argues that the interpretation of links between income inequality
and health must begin with structural causes of inequalities and
emphasize inequality’s material aspects, instead of focusing primarily
on perception of inequality.
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32. • The effect of income inequality on health reflects both lack of
resources held by the individual and systematic under investments
across a wide range of community infrastructure.
• Economic processes and political decisions condition the private
resources available to individual and shape the nature of public
infrastructure-education, health services, transportation,
environmental controls, availability of foods ,quality of housing,
occupational health regulations that forms “ neomatrial” matrix of
contemporary life.
• Thus income per se is but one manifestation of a cluster of material
conditions that affects population health.
-(Davey Smith 2003)
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37. • Richard Wilkinson have sought to link altered neuroendocrine
patterns and compromised health capability to peoples perception
and experience of their place in social hierarchy.
• Living in settings of inequality constantly forces people to compare
their status, possession, life circumstances with those of others,,
endangering shame and anger in disadvantaged, chronic stress that
undermines health
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40. CULTURE
• Culture is an umbrella term which encompasses the social
behavior and norms found in human societies, as well as the
knowledge, beliefs, arts, laws, customs, capabilities and
habits of the individuals in these groups.
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41. CULTURE
-“Culture acts as a template for the organization of social and
psychological processes, much as a genetic system provides such a
template for the organization of organic processes.”
- Geertz, 1973. The interpretation of cultures.
 Culture is often described with an iceberg model, where there are
certain elements of the system, that are visible to us. However, the
majority of factors that shape our behavior lie well below the surface
of awareness.
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42. A system of thoughts & behaviors shared by a group of people
 Cultural backgrounds have tremendous impact on our lives
 contributes to the richness of human experience
 an integrated pattern of beliefs and behavior
 Varies from local group to group
Coexists with members’ individual distinctness
 Is valued for itself
 Endures and evolves
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43. CULTURAL PRACTICES
 Supernatural causes:
o Wrath of god
o past sin (tuberculosis,leprosy)
o Ghost spirit(various mental illness)
o Walking barefoot(hookworm and
other parasitic infestation)
o Seeking of traditional healers for disease and illness
o Holy dip(transmission of communicable disease.e.g.typhoid,cholera,diarrhea,etc)
o s
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44. Food habits
o Food taboos :beef ,pork, alcohol
o Vegetarian(vitB12 deficiency)
o Non-vegetarian(chronic liver disease,cardiovascular disease,diabetes,GI Cancer)
o Fasting (Hindus/Muslim)
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46. Maternal and child health
oMale child preferences(increased abortion-ill effect on maternal health)
oAvoidance of food during pregnancy and postpartum period(green
vegetables,meat-leads to anemia)
oDelivery by untrained dais at home(5% acc to NDHS SURVEY,2016)
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47. oPrelacteal feed ( prevalence of 29% ,acc to NDHS survey 2016))
oDiscarding of colostrum
oChhaupadi pratha
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50. Oral hygiene:
Twigs of neem, charcoal, tooth powder, with finger:
bacterial plaques on teeth surface
Pan chewing smeared with lime
Deposition of tartar gingivitis pyorrhea,
dental abscess and stomatitis
 Personal hygiene
Use od same soaps, common cloth to wipe body
cross-infection
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51. Addiction
Smoking hubble bubble: spread of tuberculosis
Reverse smoking: oral cancer(Andhra Pradesh)
Smoking: chronic bronchitis, emphysema, CAD, oral cancer, GI cancer,
ca urinary bladder, Pulmonary tuberculosis, IUGR
tobacoo chewing
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52. Alcoholism: broken family, gastritis, loss of appetite, malnutrition
,alcoholic cirrhosis, chronic lung disease
Second hand smoke risk
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54.  Purdah/veil/burkha
• VitD deficiency
• Rickets
• Obesity
• Rashes
• Respiratory diseses(common cold,bronchial asthma)
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55. • Circumcision :Muslim, Jews
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56. Good cultural practices:
Physical activities
Bathing during mensuration
Ritual bathing during religious ceremony
Sleeping habits
-adults(min 6hrs)
-newborn(12-18hrs)
-infants and children(8-12hrs)
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58. SUSTAINABLE DEVELOPMENT GOALS
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• The Sustainable Development Goals are the blueprint to achieve a
better and more sustainable future for all.
• They address the global challenges we face, including those related to
poverty, inequality, climate change, environmental degradation,
peace and justice.
• The SDGs encompass 17 integrated goals, including 169 associated
targets.
• The 17 Goals are all interconnected, and in order to leave no one
behind, it is important that we achieve them all by 2030.

59. oThe focus of these SDGs are on poverty, food, education, equity, and
empowerment of women, water and sanitation, energy, employment,
equity, finance, socially healthy working, and living environment.
o The Sustainable Development Goals set out an ambitious and
transformational vision for a world free of poverty, hunger (two main social
determinates of disease), and disease.
oThe SDGs position health as a key feature of human development
emphasizing the fact that social, economic, and environmental dimensions
of development influence health and health inequalities and in turn benefit
from a healthy population
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60. Conclusion
There is strong evidence indicating the factors outside the health
care system significantly affecting health,known as social
determinants of health.
 Social determinants of health have direct impact on health
The current challenge today is just not improving average health
indicators but also reducing unfair distribution in health that exist
among social groups, between and within countries.
Public health should be concerned with strengthening health equity
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62. REFERENCES
• Park’s Textbook of Preventive and Social Medicine, 25th edition
• McGinnis, J.M., Williams-Russo, P. and Knickman, J.R. (2002) The case for more
active policy attention to health promotion. Health Affairs 21 (2) pp.78-93.
• Canadian Institute of Advanced Research, Health Canada, Population and Public
Health Branch. AB/NWT 2002, quoted in Kuznetsova, D. (2012) Healthy places:
Councils leading on public health. London: New Local Government Network.
Available from New Local Government Network website
• Bunker, J.P., Frazier, H.S. and Mosteller, F. (1995) The role of medical care in
determining health: Creating an inventory of benefits. In, Society and Health ed
Amick III et al. New York: Oxford University Press. Pp 305-341.
• www.who.int/social_determinants/strategic-meeting/en/
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63. • www.bing.com/images/search?q=ottawa+ charter+of+health+promotion
• www.who.int/healthpromotion/conferences/previous/ottawa/en/index1
• www.who.int/sdhconference/en
• http://www.euro.who.int/en/health-topics/health-determinants/millenium-development-
goals/millennium-development-goals
• wp.com/equityforchildren.org/wp-content/uploads/2013/05/millenium-development-
goals.png
• www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.ht
mh
• www.rwjf.org/en/library/research/2011/05/education-matters-for-health
• www.healthypeople.gov/2010/hp2020/advisory/SocietalDeterminantsHealth
• ourworldindata.org/lifeMy Writings on Burqas, Niqabs, Jilbabs, Chadors, Hijabs, and other
Islamic Coverings
• The Middle East Explodes with Obesity
• Niqabs and Burqas as Security Threats
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64. Thank you!
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