The Social and Cultural Determinants Of Mental Health
11. October 2018 at 18:14
“Health is wealth”“If wealth is lost nothing is lost but if health is lost something is lost”.People of the present day confront many realities; pleasant ones such as the ever growing scientific progress on one hand and unpleasant ones such as the destructive elements of science on the other. Man stands perplexed between these.There have been drastic changes in the outlook of human beings that raise questions concerning tradition and its values. The absence of mutual care and respect could be considered the biggest crisis of this day. Mental health is in a way more important than physical health, as physical sickness, unless chronic can be cured relatively quicker. Mental sickness however, takes a longer time to heal.
Once there were two parrots at a man’s house. He wanted to go for a long journey, so he gave one parrot to a monk and one parrot to a butcher and started his journey. After months the owner of the parrots came back and took his parrots back home. Once when a guest came to see this man one parrot said please come in and sit down, can I give you some water to drink? This was the parrot at the monks place; the other parrot from the butcher placed asked what you want? Shall I chop it small etc. This is because of the atmosphere the parrots were. The one with the monk always heard kind words but the other parrot was always exposed to the butcher’s language so they responded in their respective ways of learning. Atmosphere plays a very important role in the growth.
World Health Organization defines health as “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” .
Good health enables people to participate fully in society and provides the “means by which people can pursue their goals in life”
What is mental health?
The World Health Organization describes mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community"
Traditional beliefs about mental Health
In the traditional belief system, mental illnesses are caused by a lack of harmony of emotions or, sometimes, by evil spirits. Mental wellness occurs when psychological and physiologic functions are integrated. Earlier thought patterns shared the Buddhist belief that problems in this life are most likely related to transgressions committed in a past life and that one’s previous life and future life are as much a part of the life cycle as one’s present life.
Factors that determine mental Health
Mental health differences occur with social or economic disadvantage. Health disparities negatively affect groups of people who have systematically experienced greater social or economic obstacles to health. These obstacles stem from characteristics historically linked to discrimination or exclusion such as race or ethnicity, religion, socioeconomic status, gender, mental health, sexual orientation, or geographic location. Other characteristics include cognitive, sensory, or physical disability .
As a result of the important work undertaken by the World Health Organization and its Commission on the Social, there is an increasing understanding of the ways in which social conditions — where we are “…born, grow, live, work and age…” — determine health outcomes. There is growing consensus that daily living conditions and the distribution of power, money and resources shape the incidence of physical health outcomes such as respiratory, cardiovascular and infectious diseases; cancers; obesity; and diabetes. By comparison, there is far less focus and collective agreement on the role of social conditions in shaping mental health outcomes. Mental health prevention and intervention efforts concentrate overwhelmingly on affecting individual, family and/or community change, while changing the broader social, political and economic conditions that impact mental health is often neglected.
Each stage of life also contributes to proper mental Health
Mental growth starts right from the time the baby is conceived by the mother. The mother has to be physical and mentally fit to deliver a healthy baby. She has to be given not only proper food to eat but also her emotions have to be taken care, as every change in the mother’s mental thoughts will have an ever lasting impact on the child.
Even thou children are born into a family the socio-cultural of the society at large effects the child’s growth from womb to tomb in different ways.
Erik Erikson, a German psychoanalyst heavily influenced by Sigmund Freud, explored many aspects of identity like ego, personal identity, socio-cultural identify. His theory of development considers the impact of external factors, parents and society on the development from childhood to adulthood. He explains them as follows
• Sense of trust (when baby is born):
The sense of trust may be strengthened or weakened by the positive and negative experiences. If the mother provides loving, warm, and consistent care, the infant develops trust in her .With the maternal-infant attachment, the infant develops trust and feels secure. A mother substitute also, should try to provide experiences that develop trust. The sense of trust is accomplished with experiences and events which infants are repeatedly receiving when they are hungry, uncomfortable, cold, and lonely. If infants get attention in time, they develop a trust as an integral part of their development. Each close contact with the infants is an opportunity for them to experience the pleasure of intimacy.
• Growth and development of a toddler (one to three years):
According to Erickson 1968 , when toddlers try to develop autonomy, during the process of autonomy, they overcome a sense of doubt. To hold on and let go technique is found during use of hands, eyes, mouth and sphincter. Toddlers can express emotion very strongly. They use “no” in their vocabulary. Swift change is seen in toddler’s mood. They may get angry if they are unable to manipulate an activity. A temper tantrum is common. Sudden changes in their behaviour are difficult for the parents to understand and manage with. Parents may give into toddler’s negativism, instead of handling it constructively. Toddlers like sameness, ritualism, which provides them with the sense of reliability and comfort. They prefer familial places, people, and routines.
• Pre-schooler (3 to 6 years):
The pre-schoolers are interested in the meaning of relations. They talk to imaginary friends; they project in imaginary play. They learn social norms. They like to take responsibility. Their aggression is turned toward their parents. By five years, they are cooperative, sympathetic, and usually generous with their toys. The pre-schoolers are interested in stories and they like outside world. Everyday experience and parental encouragement to practice skills, lead to coordinated use of their basic motor and perceptual abilities. Proficiency depends more on the practice than on the age. Normal pre-schoolers like constant activity.
• School age child (6 to 12 years):
The child may exhibit independence and still needs un-obstructive parental support. By the age of 7 years, school age children begin the stage of operational thinking. They learn to consider alternate solution to solve their problems. School going children develop a sense of industry versus sense of inferiority (Erickson 1968).A sense of industry is a sense of being able to make things perfectly. Those children who may fail to develop skills to make things may develop a sense of inferiority. School age children’s self-concept is influenced by interactions with their friends, family members, and other persons. They enjoy plays involving gross motor activities such as ball sports, biking. They enjoy playing with friends and exhibit cooperation and social skills.
• Adolescent (13 to 18 years):
According to Erickson, establishing a sense of identity is the developmental crisis of adolescence. Development of identity is the major need of the adolescent, before development of an intimate relationship. Adolescents perceive themselves as unique and distinct individuals. The adolescents experience unfamiliar feeling and seek peer approval because of the rapid physical growth and maturational changes. During this period, adolescents try to achieve autonomy from the family, hope to have a group identity and try to develop a sense of personal identity.
Adolescents are egocentric; therefore lack the ability to differentiate their own opinions from that of others. Because of their egocentrism, they lack understanding to assess the circumstances that require empathy and cooperation. During early adolescence, adolescents have concrete thinking. Gradually concrete functioning develops into abstract during middle adolescence. Adolescents experience different roles and are confused with role diffusion; Adolescents find it difficult to form satisfactory identity from the various aspirations, roles, and identifications.
• Early adulthood (20 to 39 years):
• Person has completed physical growth by the age of 20.
• Person is active.
• Severe illnesses are less common than in older age groups.
• Person tends to ignore physical symptoms and postpone seeking health care.
• Lifestyle habits such as smoking, stress, lack of exercise, poor hygiene, and family history of
• Disease increases the risk of future illness.
• Person has rational thinking habits
• Conceptual, problem solving and motor skills increase.
• Person identifies preferred occupational areas.
• Person separates from family and origin.
• Person gives much attention to occupational and social pursuits to improve socio economic status.
• Person makes decisions regarding career, marriage, and parenthood.
• Person needs to adapt to new situations.
• Person has the emotional maturity to develop mature sexual relationships.
• Person is at risk for sexually transmitted infections.
• Middle adulthood (40 to 59 years)
• Physical changes occur between 40 and 65 years of age.
• Individual becomes aware that changes in reproductive and physical abilities signify the beginning of another stage in life.
• Menopause occurs in women and climacteric occurs in men.
• Physiological changes often have an impact on self-concept and body image.
• Physiological concerns include stress, level of wellness, and the formation of positive health habits.
• Person may be interested in learning new skills.
• Person may become involved in educational or vocational programs for entering the job market or for changing careers.
• Changes may be including expected events, such as children moving away from home, or unexpected events, such as the death of a close friend.
• Time and financial demands decrease as children move away from home and couples face redefining their relationship.
• Adults may become grandparents.
• Many couples renew their relationships and find relationships and find increased marital and sexual satisfaction.
• The onset of menopause and climacteric may affect sexual health.
• Stress health, and medications can affect sexuality.
• Advanced adulthood (60+ years)
• Adjustment to deterioration in physical and mental health and well-being.
• Threat to independent functioning and fear of becoming a burden to beloved ones.
• Adjustment to retirement and loss of income.
• Loss of skills and competencies developed early in life.
• Coping with changes in role function and social life.
• Diminished quality and quantity of relationships and coping with loss.
• Dependence on governmental and social systems.
• Access to social support systems.
• Costs of health care and medications.
Mental health concerns:-
• Depression: The increased dependency that older adults may experience can lead to hopelessness, helplessness, lowered sense of self-control, and decreased self-esteem and self-worth; these changes can interfere with daily functioning and lead to depression.
• Grief: Client reacts to the perception of loss, including physical, psychological, social, and spiritual aspects.
• Isolation: Client is alone and desires contact with others but is unable to make that contact.
• Suicide: Depression can lead to thoughts of self-harm.
THE DIFFERENT TYPES OF MENTAL DISORDERS
• Adjustment Disorders
• Anxiety Disorders
• Childhood Disorders
• Eating Disorders
• Mood Disorders
• Neurocognitive Disorders
• Personality Disorders
• Psychotic Disorders
• Substance-Related Disorders
The Socio-Cultural Factors Which Determine Mental
Water takes the shape of the container it is in, same way mental health of each human being depends on certain factors which determine it they are.
Gender is not regarding sex. It is a social construct of the society. It decides the fate of many especially of the female sex. It’s very difficult to eliminate gender role. Education plays a very important role in this field. Education starts at home “A son who respects his wife proves that he has a good mother or sister”. So this education starts at home. Gender difference is mostly taught at home which affects the growth of children. For e.g. pink for girls, blue for boys; doll for girl, gun for boy is the trend of parents today. This creates a growth difference in the children as they grow. As what they learn in their childhood remains with them till their fire wood, so parents have to be careful in parenting. They should create a healthy atmosphere for children so that they grow up with freedom without being affected by the choice of the society and he/she grows up with freedom of thought and speech guided with right and wrong.
Status of women
Women suffer to this day even thou she has left her houses to offices, still there in no change in her services. The work she does is an addition to the already assigned work to her like cooking home keeping etc. Men are yet to change and bring equality in the work if both men and women are working the home chores should be shared between the husband and wife only then there is equality or she is ill-treated and it’s a pathetic condition. She will be no more soon because of the burden she has to carry.
This is also very important factor which contributes to mental health. Exclusion is the opposite of inclusion, exclusion can create insecurity as we are not aliens in this planet we need cooperation between human beings to live in this world not only human beings but also nature is needed as unless the equilibrium is maintained we can’t move further ahead.
Protection from Discrimination and Violence
This is the role of every government to protect its citizens from discrimination and violence, usually when government fails in their duty it leads to unrest which affects the mental health of the citizens.
Basic needs are food, clothing and shelter and if they provide it’s a booster to the mental health when a country fails to provide this that will lead to depression. There are certain factors related to this basic need like even though basic need is food, clothing and shelter the provider of these are education and income.
Mental illness is associated with large costs to individuals and society. Education improves various health outcomes but little work has been done on mental illness.
Income is the single most important determinant of mental health. There is a persistent correlation world-wide between low income and poor health. With few exceptions, the financially worst-off experience the highest rates of illness and death. Adequate income is a prerequisite for many other determinants of health, for example, adequate housing, a nutritious diet and educational opportunities.
The prevalence of depression has increased considerably in the last decades so much so that, the World Health Organization in1999 rated depression as one of the main three causes of disability and morbidity in the developed world. Antidepressant drugs have at the same time become household names as their prescription more than doubled in the last decade, and the stigma associated with mental health have dwindled.
The Commission on Social Determinants of Health (CSDH) was established by World Health Organization 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 Organization in July 2008 and it subsequently ended it’s functions.
Overarching recommendations of the Commission
1. Improve daily living conditions
2. Tackle the inequitable distribution of power, money, and resources
3. Measure and understand the problem and assess the impact of action
Inequities are killing people on a "grand scale" reports WHO's Commission. Not being able to fulfill our basic needs due to income inequality creates stress and impacts our mental health. It makes it hard to fully participate in our communities and do the things that interest us.
Mental Health of People Who Migrate
The social and mental health of people who migrate from place to place are very much affected and their acculturation to the new environment depends on the age and other factors that influence it. Cultural factors, such as language, age, gender, and others, can influence the mental health of, particularly immigrants. Culture influences the human health and belief system; these factors will have differing effects, depending on the individual's degree of acculturation and their socioeconomic Status.
Several key cultural factors that are relevant to this process are described below
• Language Knowledge of English is one of the most important factors influencing access to care.
• Level of acculturation
• Age In general, the younger people can easily adjust but it is not the same with the older generation
• Family structure and intergenerational issues
• Religious beliefs and spirituality
• Gender Historically, men have acculturated more rapidly than women. This standard may be changing, however, as women enter the work force.
Traditional Values vs. Modern Values
The war between traditional values and modern values between cultures also influence the mental status of human being as change is not inevitable by all. So the area which they live the governments of that place all can contribute to the mental health of a person, as some places do not have religious freedom, cultural pressure as ‘When you are in Rome be Romans’, peer pressure especially for the younger generation.
Traditional values Modern values
Male centric Independent decisions
Extended families Nuclear families
Ritualistic religion Not so traditional
Children dependent Children independent
Old age parents are looked after by children Parents look out for old age homes as they don’t want to be a burden for children
Marriage Live in relationships
Social hierarchy Freedom
Custom and tradition focused, reliance on the past Development focused, forward-looking
Traditional culture Multicultural
These include economic, social, cultural factors such as adequate housing, employment and education opportunities, access to good transport, and a political system that enhances health.
This plays a very import role in the life of people, as everywhere there is a government which can be
These governments will have a different impact on its people’s living under their control. They have a different world view so it is difficult to cope up at times as their worldviews differ according to their principles of ruling.
Western World View Middle-Eastern World View
Separation of religion and state Combination of religion and state, with religious authority
Freedom Social hierarchy
Capitalism Collectivism /Socialism
Liberalism Religious piety
Multicultural One culture, one ethnicity
Future innovation Past inspiration
Industrial / technological Agricultural
Development focused, forward looking Custom and tradition focused, reliance on the past
Compulsory Military Services
Certain countries when there is forced military services it can affect the mental status as it’s a forced service as there is completion from the side of the state. A person living in a war prone area is more affected so government should take adequate steps to prevent war. War is not a solution to any problem the after effects of war are too dangerous to the society and it can be also a budding stage to the next war because of human ego and self-esteem. Wars should be avoided; the money each country set apart to buy arms and ammunitions should be allocated for the betterment of each citizen. Army should be there for every country for its services to natural disasters and not for man making disasters.
Compulsory Religious Conversion
When the countries are not democratically governed and it is controlled by a theocratic or dictatorship leadership. The people who are living in that place are affected by the decision the heads take, as it would be based on their religion or the ideology. The decisions taken may not be acceptable by all but are forced to follow them. It leads to suffocation and retardation in growth as the mind is not free its suppressed and oppressed by the feeling of rejection.
Forced Heavy Taxation
When there is recession the government tries to put the burden on the people to improve its condition even thou the higher class of the society will not be affected the lower class will be affected as they will lose their basic need of life as they try day and night hard to make both ends meet and during hard times if they are burdened by more taxation to provide for war etc. it affects the people
Forced labour is any work or services which people are forced to do against their will under the threat of some form punishment. Almost all slavery practices, including trafficking in people and bonded labour, contain some element of forced labour. Forced labour affects millions of men, women and children around the world and is most frequently found in labour intensive and/or under-regulated industries, such as:
• Agriculture and fishing
• Domestic work
• Construction, mining, quarrying and brick kilns
• Manufacturing, processing and packaging
• Prostitution and sexual exploitation
• Market trading and illegal activities
This creates long standing mental health problems on human beings
An example from India will define what collective responsibility is.
Rural Unit for Health and Social Affairs (RUHSA)
It was started, responding to the felt need for providing health care services to a most backward rural development block in Vellore district. By Christian Medical College, Vellore (CMCH). The history dates back to the year 1944 when the “Rural Medical and Leprosy Unit” was proposed as a model training center for rural health care. The services provided by them are
• Outreach health services
• HIV Community based management program
• Diabetes management program
• Community Nutrition Program
• A model Cervical cancer “Screen, educate, Treat” program
• Referral Services
• Farmers club
• Micro finance
• Community college
• RUHSA has been actively involved in training rural youth in vocational training courses and paving the way for young people to find a better Future and thus contribute to rural development and better health.
• Elderly Recreation Center
• Mental Health Initiative
• Community volunteers for sustainable development
• The major aim of this service is to maximize the independence of mentally and physically challenged adult, children and elderly at home and with their working and social lives
• CBR for Physically Challenged
• Zero Waste Management Project
• Organic farming
• Water sanitation & Hygiene
• Regular course
• BSC. medical sociology
• PG diploma in health management (PGDHM)
• PG diploma in health administration (DHA)
• PH.D program in social science
Short Training Courses
• Capacity building training in primary health care for medical assistance
• Training on integrated health and development
• Field training for MSW students
• "Rural health care in India" elective posting for international students
A society can make a person or break a person. Even thou human beings grow physical it’s not a holistic growth. Physical growth and mental growth should go together hand in hand. Here we see all areas are taken care not only just health, as health will not be there if there are no supporting factors who keep up health.
A Tribute to the Father of Health Economics
Professor Gavin Mooney is known as an international founding father of health economics. He was born in Glasgow in 1943 and graduated from the University of Edinburgh before embarking on a career that saw him hold academic positions in the UK, Denmark and Australia. He moved to Australia permanently in 1993.
He was at the forefront of the development of techniques for applying economic theory and principles to the health sector, challenging the prevailing orthodoxy of prioritising efficiency over equity considerations in health care decision-making. Mooney is regarded as one of the leading health economics educators in the world and has taught on postgraduate programmes in nearly 30 countries. He received an Honorary Doctorate from UCT in June 2009.
His first job was as an actuary for a large insurance company. Personal experience along with the grim reality of the statistics that the poor and the wealthy die at different rates fuelled his passion for social justice. University postings around the world came next. While Mooney and many of his colleagues worked on the methods and theory of health economics, he felt pressed to put the ideas into service. In 1993 he moved to Australia. Having been influential in establishing the Centre for Health Economics Research and Evaluation in Sydney two years earlier, he joined the center and the University of Sydney as its first professor of health economics. He later established the Social and Public Health Economics Research Group to enable him to concentrate on his main intellectual passions: the economics of indigenous health, social justice and supporting the role of communities in decision-making about their health systems.
Described as 'one of the founding fathers of health economics', his research was driven by real world challenges and geared towards identifying practical solutions. If English is the universal language of flight controllers, then Mooney's Scottish accent is the universal voice of health economics. For this, he was widely loved and deeply admired. His passion for his field, and his dedication to serving others through it, had no bounds. It was infectious.
Gavin’s enduring commitment to improving Aboriginal health is what we will remember him for. He worked at both academic and community levels to assist in advancing Aboriginal community controlled health services.
He was a powerful voice on the social determinants of health, on Indigenous health and on the impact of doctor shortages in Australia and in developing countries.
At the news of the death of professor Gavin Mooney Australian health minister Tanya Plibersek said it is a 'tragic loss for the health community, both in Australia and internationally’. She further said: 'Professor Mooney was a fearless advocate for social justice, and in particular the role of citizen juries, leading debates on the importance of consumers in determining how their health resources are allocated.
The Need for Change in the Outlook for Better Tomorrows
Change is not welcomed by all, if accepted also it takes a long time and it does not happen overnight. Or it has to be that powerful that human hand can’t do anything, as its natural change of the nature. As human beings we often like to be safe in the cocoons and we believe that’s life, it’s difficult for us to digest the fact that there is a life outside it. The most beautiful life waits outside where we can fly to freedom also the colourful look of the wings is a delight to human eye.
In the ocean, waves are created by wind. It’s not just one wave it’s a continuous process only then the wave reaches shores and some become powerful some die down, same way we have to keep on drilling a new idea till it can change the situation.
I thought I can change the world and set out but I understood that it is not possible, so I decided to change my society I live in but that also was not possible. Then I decide to change my family but failed there also. Then I realized than changing the whole world it’s easy and better to change myself. When I change, my family changes, when my family changes in turn my society does, when society does the whole world does. This shows the change of one self if I am self-determined then there will be change.
“Little drops of water forms a mighty ocean”. A little leaven can change the whole batter, let us be a good leaven for change. So it’s a collective responsibility from an individual to a collective group to provide the needed care and support for the total growth of a human being. Developed countries have different polices for the keep up the citizens safe from all kind of suppression of others by passing rules and regulation to up keep them in good health.
As weather plays an important role in the growth of crops same way even society plays an important role in the development of a healthy society. Each human being needs love and care, if the fail to get it then they die. Mental health also comes under basic needs of life, if only food clothing and shelter is considered as need of life its wrong.
Action to reduce inequalities in health resulting from social, cultural and economic determinants requires a comprehensive approach involving strategies both within and outside the health sector. This is not an easy task. It requires broad acknowledgement of the important role of social, cultural and economic factors that determine mental health and of socioeconomic inequalities in health. It also requires a long term commitment to confirm that interventions are improving the health of low socioeconomic groups.
People with strong family, cultural and community ties have better health than people who are socially isolated. Single parent families, people with mental illness, people with disabilities, people living alone and older people are particularly vulnerable to social isolation.
Mental health is affected by social and cultural influences. Living and working conditions and broad socioeconomic, cultural and environmental conditions. A clean and safe environment, adequate income, meaningful roles in society, good housing, population-based services and utilities, affordable nutritious food, education and social support within communities all contribute towards good mental health. Failing in any of these factors can lead to retardation in growth, so governments should take necessary action for the up keeping of its citizens.