Understanding The Social, Economic And Cultural Determinants Of Health And Their Role In Epidemiological Transition

The Epidemiological Transition from Infectious Diseases to Chronic Diseases due to Socio-Economic and Cultural Determinants

Dsicuss about the Family History on the Incidence of Diabete.

The understanding the social, economic and cultural determinants of health helps in understanding the transition from infectious diseases to chronic diseases. Because the choices that people make for nutrition, exercise and lifestyle depend on their socio-economic status. The ability or inability to spend on inputs required for health promoting action decides the course of the health of an individual or a family. Better education, an assured source of income, ability to spend on medication and adhere to it are factors that ensure a person’s ability to lead a healthy life. People from low socio-economic strata have in the past suffered from infectious diseases and have now transitioned to chronic disease. The improved delivery of public health programs, such as, immunisation programs, fortified nutrition and treatment with antibiotics has reduced morbidity and mortality due to infectious diseases but more people now suffer from chronic disease. Health determinants shape the accessibility to preventive measures that can be adopted to prevent chronic diseases like diabetes, hypertension, cardiovascular diseases obesity and cancer. Cultural factors, such as, belonging to a certain race, ethnicity, being an immigrant or practice of religion also impact whether a person will suffer from chronic disease.

The theory of epidemiological transition was first proposed by Omran in 1971, when it became clear that the leading cause of mortality had shifted from infectious disease to chronic diseases (Santosa, Wall, Fottrell, Högberg, & Byass, 2014). This change in the pattern of mortality has been observed after increase in life expectancy, lower rate of fertility due to an ageing population and reduced infant mortality. Social determinants of health that underlie the reduction in mortality from infectious diseases include better sanitation, immunisation programs, antibiotic therapy and better public health policy implementation (Gazzinelli, Correa-Oliveira, Yang, & Kloos, 2012). Populations that suffer from poverty and are discriminated against on the basis of race and ethnicity and are socially marginalised still suffer from greater morbidity and mortality due to infectious diseases and chronic disease (Quinn & Kumar, 2014).

The quality of the physical environment has improved for the middle and affluent but the poor of the world continue to live in environments where they remain vulnerable to infectious disease. The epidemiological transition to chronic disease is also affected by social determinants of health since where a person is born, where one grows and lives. Conditions in which a person works and ages also has a bearing on the health. The role of social factors is significant and health inequalities in countries and the world are determined to a large degree by the social determinants. Lack of education, segregation on the basis of race, low degree of social support results in higher mortality when death occurs due to chronic, non-communicable diseases, such as, myocardial infarction, cancer and cerebrovascular disease (Braveman & Gottlieb, 2014). According to a study that studied the impact of socio-economic levels on mortality due to chronic disease found that people from low socio-economic levels are 1.6 times more likely to die due diseases associated with risky health behaviours that include alcohol consumption, poor dietary choices and low physical activity (Stringhini, et al., 2010). Hypertension, diabetes, cancer and cardiovascular diseases are the leading causes of morbidity and mortality. Earlier believed to be diseases of the affluent these non-communicable diseases are known to afflict people from lower socio-economic populations in developed countries and in countries that are low on the development index. In a study on the health behaviours of type-2 diabetes patients with 818 participants, it was found that social inequity accounts for higher risk in terms of modifiable risk factors of health behaviour and obesity for participants who are from lower socio-economic levels (Stringhini, et al., 2010).

Role of Public Health Programs, Immunization and Antibiotic Therapy in Transition

The cultural and economic ramifications of type 2 diabetes, a chronic disease preventable through lifestyle modifications was studied in Algeria. The study participants were divided into 6 groups based on their income from level 1 with less than $125 incometo level 6 whose earnings were more than $ 622. The impact of their ability to make healthier choicesand stick to dietary recommendations in food and prescribed exercise was studied. Education was found to have an impact on their ability to buy and consume low fat and low carbohydrate diets. The affluent played sport and had better access to physical exercise. Risk of complications was lower among the affluent rather than people from lower socio-economic strata (Ferdi, Abla, & Chenchouni, 2016).

In a Canadian study, it was that people from low socio-economic backgrounds were not only more likely to suffer from diabetes but were also more likely to die from the ensuing complications due to poor management of the disease. The study concluded that women who are part of families with low levels of education, had lower food security and lived areas where material deprivation was likely were at a higher risk of suffering from diabetes. Men were affected only by low levels of education with respect to the incidence of this chronic disease. A situation where family income is precarious the family is stressed economically and less likely to spend on nutritious meals. Low income usually translates into lower availability of resources and the consequence is poor nutritional choices. Areas where ethnic groups live in higher concentrations have benefits for the health of the women. Social cohesiveness, better self-evaluation and mitigation of racism are factors that provide protective benefits to the women (Rivera, Lebenbaum, & Rosella, 2015).

Another study has found that lower socio-economic status is associated with obesity, diabetes, hypertension, dyslipidemia and coronary artery disease. Low perception of the self is often independent of the actual income, level of education and occupation and increases risk of chronic disease (Tang, Rashid, Godley, & Ghali, 2016). A similar impact of low socio-economic levels on the health of young adults was observed in Japan, where economic recession led to temporary work and low incomes. Risks were greater due to increase in obesity, low physical activity and smoking. Increased risk of type 2 diabetes associated with retinopathy and proteinuria was observed in many patients (Funakoshi, et al., 2017).

Poor living environment, such as, poor sanitation increased chances of morbidity and mortality due to infectious disease, due to infection from contaminated drinking water, better breeding grounds for disease vectors owing to residential environment with poor sanitation caused more disease. Poverty and poor implementation of immunisation schedules made the children more vulnerable to disease and mortality. Similarly, chronic disease are more likely to affect the socio-economically deprived because they cannot afford to make better lifestyle choices or may be poorly informed or motivated to take better nutrition and get more physical exercise. The transition from the epidemiology of infectious disease to chronic disease has meant more morbidity and mortality for the socio-economically deprived strata of societies in developed nations and the developing nations. So, the focus of public health initiatives should continue to target the deprived and educate them about the importance of nutritious diets and remaining physically active.

Impact of Socio-Economic Levels on Mortality and Risk of Chronic Diseases

Cultural factors shape the way people make lifestyle choices. Immigrants who have moved to developed countries may start making unhealthy food choices and start consuming junk food that can increase the risk of chronic disease. They may indulge in smoking more than before. An increase socio-economic levels may be registered as a positive outcome of immigration but it may not translate into benefits for health. Adoption of customs, value and behaviour from a new culture may not always translate into better health. People who practice religion may derive benefits in terms of better coping mechanisms, reduced stress due to the spiritual practices. Adherence to healthy behaviours and self-management of chronic disease is better in well adjusted individuals (Gary-Webb, Suglia, & Tehranifar, 2013).

In conclusion, it is evident that although the epidemiological transition has occurred from infectious diseases to chronic diseases, the socio-economically impoverished sections of the society have been affected by infectious diseases earlier and chronic diseases in present times. The lack of means to stay safe from infections and the inability to make better lifestyle choices has kept the poor vulnerable to morbidity and mortality. Public health priority now is to inform people on making better nutritional choices and prevent the occurrence of disease. People with lower incomes have fewer choices in terms of buying and consuming healthy food, they may be less motivated to adhere to medication and exercise due to higher levels of stress. If they are immigrants or have an insecure employment and lower levels of education, their chances of suffering from cardiovascular disease, diabetes, cancer, obesity and hypertension are higher. They cannot afford to spend time and money on physical activity. Cultural values and religious beliefs also offer protective benefits to people and ensure better coping mechanisms when present.

References

Braveman, P., & Gottlieb, L. (2014). The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. . Public Health Reports, 129(Suppl 2):19–31.

Ferdi, N. E., Abla, K., & Chenchouni, H. (2016). Effect of Socioeconomic Factors and Family History on the Incidence of Diabetes in an Adult Diabetic Population from Algeria. Iranian Journal of Public Health, , 45(12), 1636–1644.

Funakoshi, M., Azami, Y., Matsumoto, H., Ikota, A., Ito, K., Okimoto, H., & Miura, J. (2017). Socioeconomic status and type 2 diabetes complications among young adult patients in Japan. . PLoS ONE, 12(4), e0176087.

Gary-Webb, T. L., Suglia, S. F., & Tehranifar, P. (2013). Social Epidemiology of Diabetes and Associated Conditions. Current Diabetes Reports,, 13(6), 850–859.

Gazzinelli, A., Correa-Oliveira, R., Yang, G.-J. B., & Kloos, H. (2012). A Research Agenda for Helminth Diseases of Humans: Social Ecology, Environmental Determinants, and Health Systems. PLoS Neglected Tropical Diseases , 6(4): e1603. .

Quinn, S. C., & Kumar, S. (2014). Health Inequalities and Infectious Disease Epidemics: A Challenge for Global Health Security. Biosecurity and Bioterrorism?: Biodefense Strategy, . Practice, and Science, 12(5): 263–273.

Rivera, L. A., Lebenbaum, M., & Rosella, L. C. (2015). The influence of socioeconomic status on future risk for developing Type 2 diabetes in the Canadian population between 2011 and 2022: differential associations by sex. International Journal for Equity, 14: 101.

Santosa, A., Wall, S., Fottrell, E., Högberg, U., & Byass, P. (2014). The development and experience of epidemiological transition theory over four decades: a systematic review. Global Health Action, 7(10).

Stringhini, S., Sabia, S., Shipley, M., Brunner, E., Nabi, H., Kivimaki, M., & Singh-Manoux, A. (2010). Association of socioeconomic position with health behaviors and mortality. JAMA, 303(12):1159-66.

Tang, K., Rashid, R., Godley, J., & Ghali, W. (2016). Association between subjective social status and cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis. BMJ Open, 6(3):e010137.