- Discuss the influence of bio-cultural factors on diseases and nutritional status
- Differentiate between disease and illness ?
1 Diseases
Disease is a pathological state of the organism, without regard to cultural or psychological acceptance. Disease was considered as western concept whereas illness is culturally defined and diagnosed using traditional knowledge. Culture not only help to understand the health condition but also assist with available resources to cope, protect and prevent by adjusting physical and social environments.
Investigation of people of different culture may inform native system of disease identification, nomenclature and other related issues. It was observed that there are universal perceptions and society specific perceptions with reference to health and disease. At each step of suffering of causation, experience and expression of suffering, the contribution of culture is recognized.
Though the concept of health and illness are biological but they are also related with socio-cultural contexts. As a result, in health studies, beliefs and pattern of disease connected with health and disease should be included. Certain symptoms were found to be unique to specific cultural groups known as culture bound syndromes. Examples of the syndromes are 1. Koro, a condition in which people believe that sexual organs are shrinking which is observed among people of Southern China and South-East Asia; 2. Latah syndrome, initially begins as an exaggerated amazing response to a surprising event and later result into a lifelong condition. This syndrome is noticed among the people of Malaysia and Indonesia 3. Bebinan, this syndrome was found among the people of Bali. Sufferers of this syndrome suddenly start crying, run away, collapse after exhaustion and later forget all the happenings and 4. Tabacazo syndrome was reported among the people of Chile. The cardinal symptoms of this syndrome are loss of consciousness with aggression, agitation and despair.
Comparative studies on mental health inform different view points on mental disorders in different cultures. For example, in case of suicide, culture act as either facilitator or protective factor against suicides. Goldstan et al (2008) reported that among adolescent immigrants or adolescents belonging to immigrants to United States, pressures and stresses to assimilate the adapted country culture while retaining their cultural identity act as facilitator of suicides whereas access to community and extended family support, traditional activities and spirituality serve as a protection against suicides among adolescent African/Indian Americans. Some genetic or acquired diseases are found in all cultures (Hassan, 2012) and some disease like non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes and chronic respiratory disease are caused by exposure to risk factors like tobacco and alcohol consumption, physical inactivity, overweight, high blood pressure and high blood cholesterol which are socially patterned. High burden of these risk factors was shown to be shifting from high to lower income countries due to higher consumption of tobacco, alcohol, less healthy diet such as less fish, vegetables, fibres and more meat in low income people and physical inactivity in higher income folk (Stringhini and, Bovet, 2017). To better understand the role of bio-cultural factors in diseases, the following examples using Kuru, Sickle cell anaemia, Lactate intolerance and Pibloktoq diseases, are described.
- Kuru: Kuru, a prion disease (accumulation of ‘prion’ proteins in the brain).This disease was reported in Fore tribe belonging to Papua New Guinea. It caused 1000 deaths during the period of 1957-61. The disease transmission from one person to other was reported due to the practice of endocannibalism, a ritual of eating the dead bodies of relatives contracted to Kuru disease. After doing away the ritual of endocannibalism, the decline in the occurrence of Kuru was reported (Alpers, 2008).
- Sickle Cell Trait: The name of this disease is derived due to sickle shape of haemoglobin(HGB), the carrier protein of oxygen to the cells of body tissues in the body. This is due to mutation in the gene for beta globin of HBG as a result of which amino acid ‘Valine’ is replaced with ‘glutamic acid’ in sixth position of Beta globin gene. Carriers of sickle trait (SCT) inherit the abnormal sickle cell gene from one of the parents and normal beta globin gene from another parent. Normally red blood cells (RBC) are discoid in shape and move easily in the blood vessel. When they assume sickle shape, they block the blood vessel and increase the risk of stroke, infections, episodes of pain (pain crises) and eye abnormalities. The symptoms of carriers of SCT are yellow skin, swelling of limbs and whites of eyes. Frequency of SCT is higher in Western Africa. It was noted that frequency of SCT was lower in hunter and gathering people than those dependent on agriculture. When forests were cleared for the development of agriculture which provided breeding ground for the transmission of Plasmodium falciparum, a protozoan parasite responsible for the malaria. People with SCT are heterozygotes for Sickle Cell gene and are resistance to the infection of malaria than normal people or homozygotes for the sickle cell disease (Khongsdier, 2007).
- Lactase Intolerance :In population in which dairy products are major dietary components continue to synthesize the enzyme lactase-phlorizin hydrolase beyond childhood. This enzyme is responsible for the digestion of lactose (carbohydrate) present in the milk. This phenomenon is called lactase persistence and inherited as autosomal dominant trait. Approximately 35% of people was shown to possess lactose persistence haplotype across the world with the highest frequency in Americans of European origin and European residents and lowest frequency among South-East Asians and Sub-Saharan Africans (Hassan et al. 2016). Those who fail to produce adequate levels of the enzyme lactase phlorizin suffer from abdominal pain, diarrhoea, flatus, borborygmi and distension. This is known as lactase intolerance. The frequency of lactase intolerance was reported to be approximately 65% in World populations being most common among African Americans, Asians and Hispanics/Latinos and the lowest frequency has been noted among people of European origin (Malik and Panuganti, 2020).
- Pibloktoqor Arctic Hysteria:This aberrant behaviour is noticed among Eskimos. This condition is characterized by four phases. First phase or prodrome lasts hours to days containing irritation and social withdrawal; second phase stay 30 minutes and involves symptoms like sudden onset of extreme and wild excitement, running in the streets, shouting, tearing off clothes and throwing available objects; third phase may stay for 12 hours and consists of fits, stupor, calmness or comma; and final phase is characterized by complete amnesia (Fulk, 2012). This condition is caused by hypervitaminosis A due to higher consumption of liver and fats of arctic and marine animals, which are rich sources of Vitamin A in traditional diet of Eskimo and storage of Vitamin A in poisonous quantities. This is a good example of interaction of biology and cultural factors (Khongsdier, 2007; Landy, 1985).
2 Nutrition
Food consumption ensures availability of essential nutrients to the body and its expenditure provides energy to perform physical, mental and reproductive roles and maintenance of health. Malnutrition may cause ill health and diseases. Culture facilitates the availability and consumption of food.
Nutritional anthropology explores the role of biological and social forces in the usage of food and also investigate the nutritional status of populations. Jerome et al. (1980) explained ecological model for food and nutrition and opined that environmental (climate, soil properties, fauna and flora and water resources) and social sectors/factors (social organizations, technology (tools and techniques), culture (religious beliefs on food, ideas on food and health, food preferences/ restrictions and, use of food in social interactions) influence the nutrition of people. Environment sector/factor provide conditions for production and procurement of food while the social sectors facilitate the production and distribution in social groups (Pelto et al.2000).
The bio-cultural approach emphasizes the investigation of interaction of both sectors/factors. Interaction of biology and culture takes place through genetic, physiological and socio-cultural adaptations. Genetic adaptations are passing of genes from one generation to other through hereditary that improve the survival of organisms with advantageous genes. This phenomenon is explained by the studies of differences in the ability of older children and adult populations in digesting milk without gastric disturbances. During the time of chronic caloric deficits, one form of physiological adaptation is reducing the basal metabolic rate. Growth stunting observed in early childhood is a physiological adaptation to inadequate food. Socio-cultural adaptations consist of behavioural and technological innovations. Development of manioc processing to better utilize bitter manioc and maize processing techniques helpful in preventing pellagra can improve the ability of people to utilize food resources are the examples of cultural adaptations (Pelto et al.2000)
Agriculture though improves the yields of energy but this innovation involves other costs also. Investigation of food patterns of long time periods suggested hat they were positive cultural adaptations which maximized nutritional prosperity. The negative aspects of biological and cultural adaptations came to the notice were denial of food to certain sections of society such as women and children; maintenance of discriminatory food patterns by enforcing of non-verbal and informal customs by the followers of certain practices; and imposing of food prohibitions through traditional beliefs and food restrictions. Practice of food prohibitions was reported as a cause of vitamin A deficiency/xerophthalmia in the children of Malaysia (McKay,1971; Pelto et al.2000). The role of bio-cultural factors in nutrition are explained by nutritional Rickets, low prevalence of ulcer among Garo and malnutrition.
Nutritional Rickets : This occurs due to softening and weakening of bone in children and caused by low vitamin D/sun exposure/calcium intake (WHO, 2019). Nutritional Rickets was recognized as a significant problem among Asian immigrants in United Kingdom (Black, 1989; Hassan, 2012). Factors like less exposure to sunlight due to less coverage of limbs, vegetarian diet, poor intake of vitamin D, maternal vitamin D deficiency and feeding of infants with vitamin D poor Cow’s milk were found to be responsible for Rickets among them (Black, 1989). This is good example of interplay of cultural factors and physical disease.
Low Prevalence of Ulcer Among Garo of North-East India: Garo tribal people consume rice with curries of vegetables, pulses, meat and egg. They boil most of their food item and rarely consume fired or spicy food. They drink alkali water extracted from plant ash which neutralize the acid production in the stomach. The low prevalence of ulcers among Garo was considered to be due to their dietary habits and type of cooking which is a good example of culture acting as protective factor against ulcer disease (Hassan, 2008).
Malnutrition: This condition is due to deficiencies, excesses or imbalances in a person’s intake of energy or nutrients (WHO, 2016). It causes decreased working capacity leading to poor productivity, increase poverty, low standards of living and illness and disease. Malnutrition is caused by increased energy expenditure, reduced dietary intake, reduced absorption of macro and micronutrients and increased losses or changed requirements (Saunders and Smith, 2010) which affects their body fitness and results in maladaptation to the working demands in less mechanized and labour intensive tasks which influences other components of wellbeing (Khongsdier, 2007).