1. Socio- Cultural Factors in Health and Disease

2. Stress: Definition: “The generalized response of the organism to environmental demands". Stress can come from any situation or thought that makes you feel frustrated, angry, or anxious. What is stressful to one person is not necessarily stressful to another. Stressor: The actual environmental influence – whether physical, psychological, social, or cultural- that produces stress.

3. The Reason behind the Stress: WHO definition, "stress (and disease that result from it) represents an unsuccessful attempt on the part of the body to deal with adverse factors in the environment". There are many reasons for this failure of adaptation including physical, psychological, socio-cultural, moral and religious characteristics.

4. Stress is a normal part of life
Stress is a normal part of life. In small quantities, stress is good -- it can motivate you and help you be more productive, also called Eustress. However, too much stress, or a strong response to stress, is harmful, also called Dystress. It can set you up for general poor health as well as specific physical or psychological illnesses like infection, heart disease, or depression. Persistent and unrelenting stress often leads to anxiety and unhealthy behaviors like overeating and abuse of alcohol or drugs.

5. Types of Stressors: 1. Negative experiences: They include such events as severe illness or trauma, natural disasters, divorce, bereavement, marital conflicts, unemployment, wartime retirement, inter-personal tension at work, migration, and excessive exposure to heat, cold, damp or noise etc. 2. Positive experiences: Such as promotion, engagement, the birth of a child, winning a great deal of money or getting a new best job. Most of stressors involve major changes in the role of an individual or changes in the life styles.

6. Pathological Effects of the Stress: The relatively new field of psych-neuro-immunology (PNI), declared the relationship between psychological state, the endocrine system and the body's defense or immune system. Although still characterized by non-specificity, there is evidence that stress may adversely affect the immune system and thus increase susceptibility to infections and other illnesses.

7. Factors influencing the stress response: Stress represents a pathological and physical response to environmental events and is mediated by a number of factors, including: 1. The individual characteristics. 2. The physical environment. 3. The social factors. 4. The economic status. 5. The cultural background. 6. The religion and the adopted philosophy of life.

8. The stress of the culture: 1. Socio-cultural death. 2
The stress of the culture: 1. Socio-cultural death. 2. False positive diagnostic tests and diagnostic labels. 3. The effects of modern medicine (White coat hypertension and hyperglycemia). 4. Coronary heart disease (CHD), TABP or personality type A and its relationship with IHD.

9. Social factors in health and Disease: 1
Social factors in health and Disease: 1. Stage of infectious diseases (controlled). 2. Stage of degenerative, neoplastic and social diseases: - These have multiple etiology. - Main causes occur due the way we live in.

10. Scientific social etiology in health and diseases I – Personal characteristics: A- Social identity: Not modifiable these are biological factors as age, sex, race and heredity Modifiable as marital status, occupation etc.

11. Scientific social etiology in health and diseases I – Personal characteristics: B- Personal habits: - Smoking → lung cancer - Early promiscuity → cervical cancer - Unhealthy dietary behavior → Hypertension, IHD, obesity and DM. - Sedentary life style → Obesity, hypertension and IHD. - Alcoholics → Obesity, IHD and liver cirrhosis and cancer.

12. Scientific social etiology in health and diseases I – Personal characteristics: C- Psychological make-up: Personality type A → IHD. Psychological tensions and stress → Asthma and peptic ulceration.

13. Scientific social etiology in health and diseases II – Life Events: A- Stress: Perforation of peptic ulcer diseases during stress events as in post operative patients, while stress is found to do little (if nothing) as a risk factor in coronary heart diseases (it is just initiating).

14. Scientific social etiology in health and diseases II – Life Events: B- Social Discontinuities: Irrespective whether the events being pleasant or unpleasant such as bereavement or have anew child, loss of job, divorce and others. These Social Discontinuities require readjustment These life events have been scored on a social readjustment rating scale according to the amount of expected adjustment.

15. Social Readjustment Rating Scale
Life events
100
Death of spouse 73
Divorce 50
Marriage 45
Retirement 20
Change of residence

16. Scientific social etiology in health and diseases II – Life Events: C- Geographical mobility (migration; internal or external, optional or forced): - Moves lead to state of incongruity and inconsistency (psychological upset). - Social and cultural deprivation and its consequences. - Increase in morbidity (both infectious and CNCDs) and in mortality.

17. Scientific social etiology in health and diseases III – Social Context: A- Economic factors (Sudden or chronic “loss” or “gain” of huge deal of money): - Unemployment: lead to increase in morbidity, mortality, hospital admissions and suicide attempts. - Very high employment: lead to increase mortality due to stress, smoking and alcohol.

18. Scientific social etiology in health and diseases III – Social Context: B- Social disintegration (equal to stress of living alone in Western societies): Social unrest weather in or outside home. C- Urbanization (Especially 1st 10 years): The overcrowding and high rise flats, all lead to serious mental illnesses known as “new town blues”. D- Social class: Different social classes associated with different morbidity and mortality.

19. Cultural factors: All people, whether rural or urban, have their own beliefs and practices concerning health and disease. These customs and beliefs (cultural background) of the human are of three types: 1. Positive values. 2. Useless. 3. Negative values. Some of these cultural factors, hallowed by centuries of practice, have stood in the way of implementing health programs.

20. Cultural (Lay) theories of illness causation: I- The individual: 1- On the Patient's Responsibility: A- Unhealthy life styles (especially in Western societies). B- Breach of taboo (STDs). C- Past sins (leprosy and even tuberculosis).

21. Cultural (Lay) theories of illness causation: I- The individual: 2
Cultural (Lay) theories of illness causation: I- The individual: 2. Outside the Patient's Responsibility (invasion) Beliefs about the Blood (dirty blood). 4. Yin Yang theory.

22. Cultural (Lay) theories of illness causation: II- THE NATURAL WORLD: 1
Cultural (Lay) theories of illness causation: II- THE NATURAL WORLD: 1. Climatic Conditions (cold and heat) The Effects of Sky (sun and moon) Living Organisms (germs) Environmental Irritants (dirty air).

23. Cultural (Lay) theories of illness causation: III- The social world: 1
Cultural (Lay) theories of illness causation: III- The social world: 1. Blaming Other People Physical Affection The Social Context. 4- Envy eyes and witches.    

24. Cultural (Lay) theories of illness causation: IV- THE SUPERNATURAL WORLD: Wrath of gods and goddesses (small pox).