Topic X Factors

Affecting
Health and
Wellness

LEARNING OUTCOMES
By the end of this topic, you should be able to:
1.

Explain the factors that affect the health and wellness of the
individual, family and community;

2.

Describe the effects of culture on the health status and health

behaviour of the individual, family and community;

3.

Identify the impact of poverty on the health status of the

individual, family and community; and

4.

Discuss how education level affects the individual, family and

community health behaviour.

X INTRODUCTION
The twenty first century has been preceded by decades in which the advances of
science and medical knowledge have resulted in an increase in lifespan as well as
a reduction of global ill health. Many of the diseases and illness which claimed
the lives of people in the last century have been eradicated, while in many
societies the number of children living healthy lives beyond childhood has
increased immensely. There is a general optimism in relation to health in many
countries and particularly in Western countries, where ill health is deemed to be
an incidental or occasional aspect of peoples lives rather than a determining
factor. Health could be said to be booming relative to times past.

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FACTORS AFFECTING HEALTH AND WELLNESS

Every year, the World Health Organisation (WHO) produces a report reflecting
the state of health across the world in relation to a specific aspect of health. The
report includes a detailed expert assessment of global health in richer and poorer
nations, supported by the latest related statistical data. The report aims to
provide the countries themselves, associated agencies and international
organisations with the evidence they need to underpin health care policy
decision making and service planning. It also aims to provide an indirect general
overview of the impact of implemented strategies to improve health. The report
provides a good basis for assessing the current health of populations on a global
scale.
The impact of any changes in the cultural, social or economic environment on life
expectancy is then calculated to illustrate how external factors (e.g., health and
employment policies) could have an effect on the life expectancy of the
individual. Studies have demonstrated that for a middle-aged, long-term
unemployed man, the effect of returning to work under conditions of full
employment would be to lower his risk of premature mortality (Mitchell et al.,
2000). The studies indicate that changes in economic circumstances alone could
result in the prevention of 37% of avoidable deaths in poorer areas.
The definition of health by the WHO has been determined by more than just the
physical condition of a human being. It is recognised that the cultural, social and
environmental contexts have a major impact on health and life chances (Aspinall
& Jacobson, 2004). These contextual factors which influence health are often
collectively known as the social determinants of health, which impact peoples
health (directly or indirectly).
The social determinants of health care by nature are not completely divorced
from the individuals personal choices. As such, how or why they have an impact
on health cannot simply be understood in isolation from the cultural, social and
environmental contexts in which people live their lives and manage their health.

TOPIC 4

4.1

FACTORS AFFECTING HEALTH AND WELLNESS

43

FACTORS AFFECTING HEALTH

Let us have a look at several factors that affect health. We will start looking into
the influence of culture on health.

4.1.1

Influence of Culture

Culture may be understood as a shared system of meanings, values and beliefs

learned through socialisation (Haralambos & Holborn, 2008). In its simplest
sense, culture may be viewed as the rules of behaviour and the expectations of
us that we learn in particular social situations or at different stages of our lives.
For example, as we grow from babies to adults in our families, we learn the rules
of behaviour and what is expected of us from our parents.
Culture may be seen as universal, in the sense that it is an aspect of life for all. At
the same time, it varies between individuals and groups and may be modified
over time through legislative, political or social action. For example, in the last
five years smoking in public has become less socially acceptable in most cultures
as a result of increased knowledge about the dangers of passive smoking and the
risks to individual health, resulting in legislation to ban smoking in public places.
Cultural beliefs and cultural learning occur on both an individual and group
level. Some values and beliefs that make up our culture may be personal to us as
individuals while others reflect the expectations of a social group (for example,
families, communities and religious community).
Individual and group cultures are an essential part of a persons world view as
they may have an impact on how we live our lives and indeed how we make
sense of the world and our place in it (Haralambos & Holborn, 2008). Our beliefs
about health, for example, about how we maintain or measure our health, are
informed by our culture and the influence of the groups we belong to. It is the
close relationship between culture, the individual and their community which
explains why health is so frequently affected by it.
Culture has a significant contribution to make to health, not least because in all
its forms it helps to provide the social fabric of communities, making them
communities in the real sense and sustaining the individuals within them.
London Health Commission (2002)

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The interdependent nature of the relationship between cultural beliefs and health
means that the choices, opportunities and actions arising as a result are subject to
variability between individuals and groups as well as over time (Linsley, Kane &
Owen, 2011). Therefore, in practice, while health beliefs can be found to exist in
all cultures, their meanings and importance to individuals and groups in
differing societies are not universal.
In addition, the increasing ethnic diversity and globalisation which exist in the
twenty first century mean that our health beliefs and behaviour are also
influenced by exposure to cultures which differ from our own. Thus, health is
experienced and influenced within and between groups from the same and
differing cultures in all societies, which in turn modify health outputs. Therefore,
the variations in culture between and within social groups may have an effect on
the following:
(a)

Understandings of health  how we understand health and ill health at

different stages in the lifespan, what our expectations are in relation to our
health;

(b)

Health behaviour  how we act to promote or maintain our health (diet and
exercise) and that of others in our care (children, patients, dependants and
peers); and

(c)

Illness behaviour and expression  how we act at times of illness, whether

and when we seek support to manage illness and how we expect others to
behave when they are ill (seek medical help, practise self-care and take time
to recover).

The factors identified above indicate that culture may have an impact on the
willingness and ability of an individual or group to access health care services
and to accept the care available. The key issues when considering the impact of
culture on health is to understand that complex and varied belief systems around
specific aspects of health exist in and between cultural groups. These belief
systems may be evidenced in patient or client health behaviour such as:
(a)

Willingness to seek early advice or care for health concerns;

(b)

Expressing or demonstrating doubts about the need for medical

intervention or procedures for specific health concerns; and

(c)

Degree of compliance with medical advice or treatment.

It is important to appreciate the role of culture as a contextualising factor in a

persons health and use this knowledge to inform assessment of their needs.

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FACTORS AFFECTING HEALTH AND WELLNESS

45

ACTIVITY 4.1
1.

Reflect on your own healthy behaviour and not-so-healthy

behaviour. List down these behaviours.

2.

Identify strategies on how to overcome the not-so-healthy

behaviour.

3.

Discuss on the impact of culture on health.

4.1.2

Influence of Poverty, Education and Social

Environment on Health

The previous section identified the close association between culture and
communities. Culture, however, is not the only factor which unites social
communities and impacts health. Poverty, educational attainment and social
environment are some of the key factors which have the greatest impact on
community health. Poverty, education and social environment are very closely
related and impact directly and indirectly the lives of the individuals who make
up a community.
There are many definitions of poverty and how we determine that someone is
impoverished. Townsend (1979) provides a useful definition of poverty which
takes into account its impact on the daily lives of individuals and their
communities.
Individual families and groups in the population can be said to be in poverty
when they lack the resources to obtain the types of diet, participate in the
activities and have the living conditions and amenities which are customary,
or are at least widely encouraged and approved, in the societies in which they
belonged.
Townsend (1979)
Poverty is said to be a central concern in the health of the population. The effects
of poverty on the health of individuals, families and communities are well
documented. Many studies have firmly established that families living on low
incomes have a lower health status than those with higher incomes (Hirsch &
Spencer, 2008). This is a worldwide phenomenon. People living in poverty have a
reduced life expectancy and experience poorer health than the rest of the
population in all societies worldwide (Isaacs & Schroeder, 2004; Schulz & House
et al., 2008).

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One of the major ways in which poverty affects health is that it increases the
exposure to a living environment that increases the risk of ill health (such as poor
housing, inadequate sanitation or overcrowding) while at the same time creating
economic challenges which prevent people from maintaining their own health.
For example, a limited budget may mean buying inexpensive foods, which are
more likely to be processed, fatty and lacking important nutrients. The situation
is compounded by the fact that the poor are also more likely to live in poor
environmental situations with limited local health care resources, thus incurring
additional costs in accessing health care.
Poverty has also been found to impact the mental and social aspects of health as
well as the physical. Educational attainment is directly linked to employment
prospects and the earning potential of an individual in any society. The majority
of well-paid jobs require more than a basic level of education and training. This
has the obvious impact of reducing the chances of living in poverty and
minimising exposure to some of the health risks mentioned earlier. This
summation is reinforced by research, which has directly compared the health
outcomes for individuals by educational attainment. Lower educational
attainment is related to reduced life expectancy, increased risk of premature
death and increased likelihood of living with poorer health, compared with
individuals who have higher levels of education. It has also been identified that
there is a relationship between educational level and death from lung cancer,
stroke and cardiovascular disease as well as increased risk of diabetes, asthma,
dementia and depression. The link between poverty and low educational
attainment also has a negative impact on society as well as the individual. The
overall effect is to reduce the pool of potential employees with the appropriate
skills available to employers.
The social environment comprises the group and communities in which people
live. The social networks in a community exist at an individual and group level
and are important aspects of the ability to maintain health, along with family
structure, culture, access to facilities, economic status and the physical
neighbourhood. The consequences of living in poverty or relative wealth and low
educational achievement versus higher level qualifications, combined with other
aspects of an individuals life, underpin the social environment in which they
live. It is in this social context that health chances are determined, experienced
and managed by an individual through their lifespan. Consequently, it is
important for us to remain aware that the effects of poverty, educational
achievement and the social environment act as modifying factors influencing the
health of individuals, families and communities.

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FACTORS AFFECTING HEALTH AND WELLNESS

47

ACTIVITY 4.2
1.

Identify the poverty rate in Malaysia.

2.

What are the steps taken by the government to reduce poverty?

3.

Discuss the link between poverty and level of education and the
health status of the family.

4.1.3

Other Factors that Influence Health Status

There are many other factors that are said to affect or influence our health status.
Some of these are internal factors and others are external. Let us have a look at
some of internal and external factors.
(a)

Internal Factors
The following are internal factors which influence health status:
(i)

Genetic Makeup
Genetic makeup influences biological characteristics, innate
temperament, activity level and intellectual potential. It has been
related to susceptibility to specific disease such as diabetes and breast
cancer. Moreover, genetic inheritance, or family history, has been
related to susceptibility to specific diseases, whereby family history
has been demonstrated in the incidence of breast cancer and diabetes.
People with blood group A have been shown to be more susceptible
to hypertension.

(ii)

Sex
It has been demonstrated that certain acquired and genetic diseases
are more common in one sex than in the other. The disorders that are
more common among females are osteoporosis, autoimmune diseases
such as rheumatoid arthritis, gall bladder disease and obesity. Those
more common in males are stomach ulcers, abdominal hernias,
respiratory diseases and many others. Males have been found to be
more aggressive than females, and this phenomenon is thought to be
at least partially due to hormonal differences.

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(b)

External Factors
The following are external factors which influence health status.
(i)

Race
Race is also said to be associated with disease distribution. For
example, diabetes is more prevalent among Indians than it is among
the other races in Malaysia.

(ii)

Age and Developmental Level

The distribution of disease varies with age, where the capability for
responding to disease is less during the first few years of life and
again near the end of life. Infants seem to lack physiological and
psychological maturity. For example, infants or children at younger
age are more prone to diseases such as whooping cough and measles.
Among the elderly, the declining physical and sensory-perceptual
abilities will limit their ability to respond to environmental hazards
and stressors.
Age is also said to be related to distribution of disease. The greatest
mortality risk factors are arteriosclerotic heart disease. For example,
the average age of a Malaysian patient admitted with acute coronary
syndrome is 59 years old. Age has also been associated with
developmental needs or tasks that have major impact on potential
health behaviour. For example, during the stage of physical growth in
puberty, the needs of the adolescent to not only determine an identity
but also conform to peers have an impact on their lifestyle, risk-taking
and the practice of unhealthy behaviours.

(iii) Mind-body Relationship

The mind-body relationship is explained as how the emotional
responses to stress affect bodily functions and that emotional
reactions which occur in response to body conditions will also
influence health. Emotional stress is said to increase susceptibility to
organic diseases or to precipitate them. Emotional distress may also
influence the immune system. Alterations in the immune system are
related to the incidence of infections, cancer and autoimmune
diseases.

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FACTORS AFFECTING HEALTH AND WELLNESS

49

(iv) Lifestyle
An individuals lifestyle, which includes patterns of eating, exercise,
use of tobacco, drugs and alcohol and methods of coping with stress,
may also influence health. Overeating, getting insufficient exercise
and being overweight are closely related to the incidence of heart
disease, arteriosclerosis, diabetes and hypertension. Excessive sugar
intake can increase the risk of dental caries.
(v)

Family
The family passes on the patterns of daily living and lifestyle to their
offspring, in addition to transmitting genetic predispositions. Both
physical and emotional abuse may cause long-term health problems.
A social environment which is free of excessive tension and a climate
of open communication, sharing and love fosters the fulfilment of the
persons optimum potential and will promote good emotional health.

Support system and social networks are important in shaping beliefs and
behaviour. Social networks become a referral system that people consult for
advice. Having a support network in ones family helps people avoid illness.

ACTIVITY 4.1
1.

What are the factors that affect health?

2.

Can you think of more examples of internal and external factors

that affect health? Discuss in a group.

There are various factors that may affect the health of an individual, a family
and the community.

Poverty, education and social environment affect our health status and health
behaviour.

Other factors that may affect our health status are genetic makeup, sex, race,
age and developmental level, mind-body relationship, lifestyles and family.

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RS AFFECTING HEALTH AND WELLNESS
W

E
Educational
a
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Poverty

H
Health
behav
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nvironment
Social en

H
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