sociocultural dimensions

2. 1. Identify social determinants of health
2. Define culture
3. List elements of culture
4. Determine the impact of culture on health
5. Distinguish between collectivistic and individualistic cultures
6. Discuss components of cross-cultural health care
communication
7. Outline skills of culturally competent public health practitioner
8. Provide examples of body language across different cultures

3.  Health is a fundamental concept and is a
significant part of our living.
 There are different interpretations of
health by different groups and societies.
 According to the World Health
Organization (WHO), “Health is a state of
complete physical, mental and social well-
being and not merely absence of disease.”

4.  There are many factors (e.g genetic, behavioral, environmental) that influence
health. These are called determinants of health.
 Social and cultural environments have a big impact on our health. These are
called socio-cultural determinants of health.
Conditions such as
 Poverty
 Poor education
 Food insecurity
 Bad housing conditions
Major determining social factors of inequality both among and within countries in
terms of health, disease occurrence and premature deaths.
 Improper sanitation
 Unemployment
 Unsecure and hazardous working
places
 Lack of access to health care

5. • Culture comprises of different beliefs, perceptions, behaviors which are shared
among the members of society, it gives direction to a person whether something
is right or wrong.
• Culture influences the decisions taken by an individual in various ways and
therefore it is necessary to understand the person’s cultural background to
communicate effectively with him
Examples of how culture affects the health behavior of an individual. Studies in
different cultures found that:
1. 45% of adults believed that illness was caused due to the ‘will of god’
2. 26% believed that past evils were the reason for causing T.B
3. 48% believed that ghost intrusion leads to epilepsy
4. 36% believed that ‘fate’ is the reason for causing a disease.

6.  Social determinants of health are the conditions in which people
are born, grow, live, work and age. They include factors like
socioeconomic status, education, neighborhood and physical
environment, employment, and social support networks, as well as
culture and access to health care
 A study found that medical care itself only accounted for 10–20% of
the contributors to people’s health outcomes. By contrast, the
many social determinants of health play a much bigger role in
influencing a person’s health, making up 80–90% of the contributing
factors.

8. This group encompasses a person’s access to healthcare and
its quality.
Factors include:
Access to primary healthcare
Health insurance coverage
Health literacy
Income to purchase medications and lab tests

9. This refers to the link between a person’s finances and
their health.
Examples of factors are:
Poverty
Employment
Food security
Housing stability
How can economic stability achieved by employment?

10. This category focuses on the connection between a person’s
access to education and its quality, and their health.
Examples include:
Secondary education
Higher education
Language and literacy
Childhood development

11. This group revolves around the ways a person lives, works,
plays, and learns and how these relate to the person’s
health.
Factors include:
Civic participation
Discrimination
Detention
Conditions within a workplace

12. This group considers a person’s housing and environment
and the role they play in the person’s health.
Factors include:
Quality of housing
Transportation
Access to healthy foods
Water quality
Crime and violence

13. Culture is the patterns of ideas, customs and behaviors shared by a particular
people or society. These patterns identify members as part of a group and
distinguish members from other groups.
What are the elements of culture?
 Values, Beliefs, attitudes and lifestyle behaviors
 Customs: Holidays, clothing, greetings, typical rituals and activities.
 Marriage and Family: Type of marriage (i.e. arranged, free, same sex, etc.)
 Geographic origin
 Food
 Economy and Trade
 Art/drama/music
 Language.
 Faith/Religion.

14. Culture has been described as an iceberg, with its most
powerful features hidden under the ocean surface.
Explicit cultural elements are often obvious but possibly
less influential than the unrecognized elements
providing ballast below.
The cultural continuum
Culture is commonly divided into two
broad categories at opposite ends of a
continuum: collectivistic or individualistic.
Most cultures fall somewhere between the
two poles, with characteristics of both.
Also, within any given culture, individual
variations range across the spectrum.

15. Characteristics of collectivistic and individualistic cultures
Collectivistic Individualistic
Focus on the group “we” Focus on the individual “I”
Responsibility for the family and extended
family
Value autonomy, responsibility for themselves
and immediate family
Goals of the group take the precedence over
the goals of the individual
Goals of the individual take the precedence
over the goals of the group
Work and private lives intermixed Private and work lives separate
Pleasure from group achievement Pleasure from individual achievement
Communication is indirect (speak in circles),
focuses on the relationship between the
communicating individuals
Communication is more direct, very precise
and to the point, focuses on the purpose of
communication, hence, it is more open and

16. • Being familiar with characteristics of
collectivistic and individualistic cultures is
useful because it helps practitioners to
‘locate’ where a family falls within their
cultural continuum and to personalize
patient care.
• Collectivistic and individualistic cultures can
give rise to different views on human
health, as well as on treatment, diagnoses
and causes of illness.
• Depending on where a patient ‘fits’ along
their cultural continuum,
including extended family in discussions
about disease origin, diagnosis and
treatment may be helpful.
• Consent for certain diagnostic and
therapeutic interventions may be needed
from extended family members.

17. • A physician might expect a 26-year-old mother to make a
decision regarding her child’s treatment alone. Having just
completed an evaluation of her 6-year-old, the physician
presents two options for investigation.
• The mother shies away from making a firm decision and
answers you in vague terms. She seems to speak in circles,
almost dancing around the choice, even after hearing all the
information needed to decide which care path to follow.
• You know that she has finished high school, and note
impatiently that you have already spent an hour with her.
• The following week, she returns. You worry about the length
of the visit and falling behind with other patients.
• To your surprise, she is decisive. She discussed investigation
options with her husband and mother-in-law, and together
they have arrived at the best solution. She can now
confidently pursue the investigation of her child’s condition.

18. 1. What are the health care provider’s and mother’s cultures?
The health care provider’s culture is individualistic, while the mother’s is more
collectivistic.
2. What is the problem with mother’s culture type?
The mother needed to consult before she could provide an answer.
3. Explain the differences in the communication style?
Communication styles differ. The mother feared embarrassing the provider by
doubting advice, but also didn’t feel comfortable stating that she would have to
bring the choice home to decide.
4. Is woman’s behavior changed by her educational level?
Education level is not an issue: it’s a red herring.

19. 1. How patients and health care providers view health and illness. What patients and health
care providers believe about the causes of diseases? For example, some patients are
unaware of germ theory (a growing living organism causes the disease) and may instead
believe in fatalism, a djinn ‫الجن‬ (in rural Afghanistan, an evil spirit that seizes infants and is
responsible for tetanus-like illness), the 'evil eye', or a demon. They may not accept a
diagnosis and may even believe they cannot change the course of events. Instead, they can
only accept circumstances as they unfold.

20. 2. Which diseases or conditions are stigmatized and why? In
many cultures, depression is a common stigma and seeing a
psychiatrist means a person is “crazy”.
3. What types of health promotion activities are practiced, or
recommended? In some cultures, being “strong” (would
consider “overweight”) means having a store of energy
against famine, and “strong” women are desirable and
healthy.
4. How illness and pain are experienced and expressed. In
some cultures, impassiveness is the norm, even in the face of
severe pain. In other cultures, people openly express
moderately painful feelings. The degree to which pain should
be investigated or treated may differ.

22. 5. Where patients seek help, how they ask for help and, perhaps, when
they make their first approach. Some cultures tend to consult allied
health care providers first, saving a visit to the doctor for when a
problem becomes severe.
6. Patient interaction with health care providers. For example, not
making direct eye contact is a sign of respect in many cultures, but a
care provider may wonder if the same behavior means her patient is
depressed.
7. The degree of understanding and compliance with treatment options
recommended by health care providers who do not share their cultural
beliefs. Some patients believe that a physician who doesn’t give an
injection may not be taking their symptoms seriously.

23. Health care professionals belong to professional cultures with their own language such as
epidemiological and medical terms. These terms are not familiar to the public and hinder
the public’s understanding of written and spoken health messages. Understanding can be
further hindered when other cultural differences exist.
What health professionals can do?
Being aware of and navigate across culture difference is a competency known as ‘cultural
competence’.
Demonstrating awareness of a patient’s culture can:
 Promote trust
 Better health care
 Lead to higher rates of acceptance of diagnoses
 Improve treatment adherence

24. • Cross-cultural communication in
healthcare has 3 vital
components: language fluency,
culture, and health literacy.
• The culturally competent provider
can assess a patient’s level in each
of the 3 areas and adjust
communication accordingly, to
increase the chance of successful
healthcare delivery and outcomes.

25. • Health literacy is how well one
understands basic health
information and services needed
to make appropriate health
decisions.
• Examples include:
• Providers can help develop
patients’ health literacy by
communicating in plain, simple
language, avoiding technical
language and jargon, and
checking comprehension.

26. • Both the patient and provider bring
cultural filters to the healthcare
setting. The filter includes beliefs,
norms, and practices surrounding
wellness, illness and healthcare
delivery.
• When possible, providers should
incorporate patients’ customs and
beliefs to increase the likelihood of
successful outcomes.

27. • Patients speaking non-native language may
not fully understand information and
instructions, and may lack the skills to ask for
clarification.
• They also face the additional challenge of
health-specific vocabulary and terminology,
some of which may not exist in their native
language.
• The culturally competent provider is able to
quickly assess the language fluency level
(low, intermediate, high) of patients and
apply communication strategies that ensure
patient understanding.

29. • Body language is a non-verbal, sub-
consciously interpreted and generated set
of body movements, postures, gestures,
etc.
• Because body language is not as clearly
defined as spoken language, it can be
understood and interpreted in many
different ways.
• In today’s world, where globalization is an
unstoppable phenomenon, knowing and
understanding body language, its
interpretation around the world, and its
cultural significance is very important in
building and maintaining good relationships.

30. • These differences may arise due to many reasons:
• Time
• Economic status
• Social status
• Gender
• Cultural differences
• In this modern world, where the horizons are always
expanding, and the lines between cultures are becoming
thinner, it is very important to have an idea of how
body language varies across cultures around the
world.

31. Greetings: How people of different
cultures greet each other
Gestures: Different gestures mean
different things in different
cultures. Knowing these
differences is important.
Postures: Interpretations of
postures vary across cultures

32.  The way two people greet each
other varies widely and depends on
the following factors apart from the
culture those factors belong to.
Level of acquaintance ‫الصلة‬
Location
Gender
Age
 It is very important to know and
understand the greetings of a place
when you are guest there.

33. • The hug This is a very common form of
greeting in the US, where the French
consider it as a very intimate gesture.
• The kiss-on-two-cheeks This is very common
way of greeting the France. But people in
the US might not be comfortable with it.
• Peck on the cheek Common in Britain
between two females or a male and a
female.

34. • Rubbing noses In New Zealand,
among Maori people, this is
called ‘Hongi’ meaning ‘sharing
breath’.
• Bowing In Japan this can range
from a slight nod in the head to a
full 90 degree bend.
• A hand shake A common way of
greeting in the US and Mexico,
especially among men or

35. Activity (1): ON greetings
•Expected mimics and behaviors in greetings situations
•(Text: US, French and Japanese students in an
academic environment)
•Role play in a group of 3

36. •In the US, a thumbs up
means “OK” or “good”.
•However, it is considered an
abuse in Australia, Brazil,
South Italy, Germany,
Greece, and some Islamic
nations.

37. • Slurping your soup is considered good
manners in Japan and implies that you
actually like the food, but in most other
cultures it is bad manners.
• In some societies like Germany punctuality
(respect time) is given utmost importance.
Being 10 minutes late even to an informal
gathering is considered very rude.
• Pointing your feet towards a Buddha statue
is a serious offence in Buddhist countries.
• Pointing your finger in a direction might
mean showing that direction in many
cultures, but in Middle East and Russia, is a
no-no.
It is preferable to show a direction with an open
palm.

38. • The victory sign may seem harmless; but in
Britain, if you show it with the palm facing you, it
is a very offensive gesture.
• Having your fingers crossed is generally a sign of
good luck in many places, but not in Paraguay. It
is considered offensive there.
• Snapping your fingers to get someone’s attention
sends a vulgar message in France and Belgium.
• Hands in pockets might be common in some
places, but is considered impolite in many
regions around the world.
• Hook ‘em Horns are supposed to be a cheering
symbol in Texas, wishing good luck in Brazil and a
curse in Africa.

39. •The “OK sign” is one such sign which
has many multiple meanings.
• In America, it may mean approval.
• In Brazil, Italy, Germany, and Greece, it is a
very offensive insult.
• In southern France, it might also mean ‘zero’
or ‘worthless’ depending on the facial
expression.

40. • Shaking head sideways
• In the US, it means ‘no’.
• In Bulgaria, it means ‘yes’.
• Nodding the head up and
down
• In the US, it means ‘yes’.
• In Bulgaria, it means ‘no’.

41. Postures are a very
important form of body
language, and are
generally involuntary
unlike gestures.
Like gestures, even
postures carry various
meanings across cultures.

42. • Be aware of your posture when you attend
meetings or are dining.
• Sitting cross-legged is seen as disrespectful in
Japan, especially in the presence of someone
older or more respected than you.
• Showing the soles of your shoes or feet can
offend people in parts of the Middle East.
• American men cross their legs in an ankle-on-
knee fashion
• The European men and women cross their legs
in knee-on-knee fashion.