INTRODUCTION TO HEALTH ANTHROPOLOGY.pptx

The study of man in relation to health I.e how man perceive their health

1. PUBLIC HEALTH ANTHROPOLOGY

2. COURSE DESCRIPTION: This course examines the relationships between ill-health states and culture. The course also examines customs, and beliefs in relationship to life styles, social interactions and developmental processes within groups, sub-groups and lineages. The course further provides the student with a better understanding of the dynamics of ill-health states from the cultural perspectives. Lastly the course reviews and explains relevant and appropriate behavioral models to clarify public health anthropological issues and situations.

3. COURSE OBJECTIVES: At the end of the course, the students will: 1. Define culture, health and disease 2. Identify the link between culture, illness definition and health practices. 3. Identify Nigerian socio- cultural groups and their unique beliefs. 4. Evaluate the relationship between customs, beliefs and lifestyles 5. Become acquainted with the dynamics of ill-health states from cultural perspective. 6. Explains relevant and appropriate behavioral models to clarify anthropological issues and situations. 7. Describe globalization and health anthropology

4. Texts Robert Pool & Wenzel Geissler . Medical Anthropology: Understanding Public Health. Open University Press. Magraw – Hill Education Anthropological Approaches: Uncovering Unexpected Insights About the Implementation and Outcomes of Patient-Centered Medical Home Models. Agency for Healthcare Research and Quality Other related materials

5. Introduction: Public Health Anthropology Anthropology The term anthropology is derived from Greek words: Anthropos and logos . Anthropos means mankind or human being logos means study or science .

6. Anthropology is a broad scientific discipline dedicated to the comparative study of humans as a group, from its first appearance on earth to its present stage of development. It is a science that investigates the strategies for living that are learned and shared by people as members of human social groups; It examines the characteristics that human beings share and diverse ways that people live in different environments; It also analyzes the products of social groups: material objects (tools, cloths, houses, etc ) and nonmaterial creations (beliefs, values, practices, institutions, etc ). ( World Book Encyclopedia .Vol.1 PP. 545-548)

7. Anthropology seeks to explain how and why people are both similar and different by examining human biological and cultural past; and comparing contemporary human societies (Howard and Dunaif-Hattis , 1992:3).

8. Four misconceptions about anthropology Anthropology is limited to the study of " primitive " societies. 2. Anthropologists only study the rural people and rural areas . 3. Anthropologists are only interested in the study of far away, remote unusual communities living isolated from the influences of modernization. 4. Anthropology wants to keep and preserve primitive , defunct cultural practices in museums and anthropologists are advocates of defunct, obsolete culture.

9. Historical Overview of Anthropology Father of Anthropology: Franz Boas born in Germany 1858 - 1942 Over the centuries (ancient to medieval times), curious-minded people have been fascinate by DIVERSE and similar nature of humans. The present academic anthropology has its roots in the works and ideas of the great ancient and Medieval Greek, Roman, and Hebrew philosophers and social thinkers. People who were interested in the nature, origin and destiny of man, and the morality and ethics of human relationships

10. During the 19th century, anthropology as an academic discipline was born out of the intellectual atmosphere called the Enlightenment, ( The New Encyclopedia Britannica ( Macropedia ).Vol. 27 PP.326-331). A movement built on an 18th century social philosophy of Darwinian Theory of Evolution that emphasized human progress and the question of purpose (Scupin and DeCorse , 1995).

11. A major impetus for the growth of anthropology as a profession in late 1870s was the expansion of western colonial powers and their consequent desire to better understand the people living under colonial domination (Howard and Dunaif-Hattis,1992). For example, In the United States, the government sought information on Native American people who were being subdued and placed on reservations. Anthropology at the time was a profession primarily for the museums. The major desire was to record local customs before they disappeared and were forgotten.

12. In the early 1900s, anthropologists emphasized the study and documentations of social and cultural differences or features among human groups. This approach is called ethnography.

13. By the mid-1900, however, anthropologists attempted to discover universal human patterns and the common biopsychological traits that bind all human beings. It aims at the comparative understanding and analysis of different ethnic groups across time and space ( Kottak , 2002; Scupin and DeCorse , 1995). This approach is called ethnology.

14. Distinguishing Features and Scope of Anthropology Its Broad Scope: Anthropology is very vast; it covers all aspects of human ways of life and culture in a social group relationship. Anthropologists are interested in all human beings, whether living or dead, ''primitive'' or ''civilized'' and that they are interested in many different aspects of humans, including their skin color, family lives, marriages, political systems, tools, personality types, and languages. ( Kottak , 1994, 2002; Howard and Dunaif-Hattis , 1992)

15. Anthropologists are, for example, interested to: know and explain why certain cultures practice widowhood forcing the widow to drink water used in washing her husband’s corpse. Why some Nigerian ethnic group use objects such as palm oil, salt honey, etc during naming ceremonies. Why female circumcision in African culture, etc in Gumuz goes to a bush to give birth during labor, how the South-western Nigeria practice birth control methods and why Fulani practice sharo festival , or why the South-Eastern Nigerian woman rides bikes more than other women

16. 2. Its Unique Approaches Anthropologists investigate the distinctive features of different cultures; and what factors account for the similarities in certain beliefs, practices and institutions that are found across cultures ( Scupin and De Corse, 1995). . Holistic : Studying one aspect of the ways of life of a group of people by relating it to other complex related aspects of life. Relativistic : To study and explain a certain belief, practice or institution of a group of people in its own context. It does not make value judgment, i.e., declaring that ‘this belief or practice is good’ or ‘that is bad.’ Comparative : Comparison of certain aspects of the culture of a group of people by comparing it across societies and different times; i.e., the present with the past, the modern with the traditional, etc.

17. 3. Emphasis Insiders' View: Focus on how the people themselves perceive and understand their world, how a particular group of people explains the world, etc. This is what is called emic perspective. 4. The Micro-focus: Focus on small-scale society or community in their social organization, economic and political structure, and tend to be homogenous in their overall character.

18. 5. Its Method of Research : The hallmarks of anthropology are qualitative research methods such as extended fieldwork, focus- group discussion, participant observation, in-depth and key informant interviews.

19. Major branches and specializations in anthropology Specializations in physical/biological anthropology : primatology, paleoanthropology, anthropometry, population genetics, forensic anthropology Specializations in sociocultural anthropology : medical anthropology, urban anthropology, anthropology of religion, ecological anthropology, demographic anthropology, development anthropology, economic anthropology, etc Specializations in archeological anthropology : historical archeology, prehistoric archeology, Ethnoarcheology , classic archeology, underwater archeology, biblical archeology, cultural resource management, etc Specializations in linguistic anthropology : sociolinguistics, historical linguistics, structural linguistics, etc Applied Anthropology : policy analysis and implementations

20. Contributions of Anthropology 1. Gives us an insight into different ways and modes of life of a given society, to understand the logic behind and justification for human activities and behavior. 2 It helps us understand our own ways of lives. Many aspects of our lives seem to us normal, so we don't know the logic behind our behavior. Example: Eating amala , is assumed to be normal to those whose staple (main) food item is amala . As we study anthropology, we encounter different ways of lives from ourselves, hence we get opportunity to appreciate and understand ourselves through the others' ways of lives.

21. 3 Helps us fight against prejudices and discriminations. Ethnocentrism – the attitude that one's own culture and one's own way of life is the center of the world and the best of all. This arises from ignorance about other ethnic groups and their ways of lives. 4. Used as a tool for development. The application of anthropological knowledge and research results in the solution of some social problems or the implementation of project plans.

22. 5. Anthropologists bring a holistic approach to national and international development agencies. 6. Anthropologists use their expertise in particular subjects to formulate practical ways of coping with immediate social problems. Public Health/Medical anthropologists, for example, investigate the interrelationship between human health, nutrition, and cultural beliefs and practices.

23. Theories in Sociocultural Anthropology “A theory is a statement or statements of how and why specific facts are related” ( Macionis , 1997: 15) “A theory is a set of interconnected hypotheses that offer general explanations for natural or social phenomena”, Scupin and DeCorse (1995).

24. Theories Evolutionism: The history of humanity and its sociocultural systems have developed following unilineal path marked by persistent progression from technological and societal simplicity to complexity (Hammond, 1971: 394). Societies that were able to develop new social and cultural forms that facilitate a more efficient adaptation to changing environmental circumstances had a better chance of competing for survival. Those that did not risked extinction” (ibid. p 392). The theory was criticized as an ethnocentric one that paved the way for the colonization processes and racist ideologies

25. Diffusionism Diffusionism developed in early part of 20th century; maintained that societal change occurs when societies borrow cultural traits from one another. Cultural knowledge regarding technology, economy, religious views, etc , diffuses or spreads from one society to another. This may explain the similarities and differences in cultural features between societies. The weakness of this theory, like evolutionism, was that it was ethnocentric in its assumptions. The diffusionists believed that nonwestern societies are inherently inferior and not innovative in creating civilizations.

26. Historical Particularism This theory developed in early 20th century by an American anthropologist, Franz Boas mainly in reaction to unilineal evolution, provided an alternative to the question of why societal differences and similarities exist. Historical Particularism thus emphasizes that each society has its own particular historical development. This view led to the development of the idea of cultural relativism

27. Functionalism The theory sees culture as a complex (integrated) system whose parts work together to promote solidarity and stability. it states that our social lives are guided by social structure , which are relatively stable patterns of social behavior ( Macionis , 1997, Howard and Dunaif-Hattis , 1992). Relationships among the parts of society create functional (beneficial consequences to the individual and the society) and dysfunctional (negative consequences).

28. Culture and Personality theory This perspective, also called psychological anthropology maintained that the various patterned aspects of culture shape the personality of individuals within a given society, and also personality once developed could in turn affect the further development of culture (Hammond,1971). The theory was influenced by neo-Freudian psychology , which emphasized the primacy of infantile and early childhood experience in shaping the personality. Early anthropologists such as Bronslaw Malinwoksi and Margaret Mead attempted to show that psychological traits vary widely across cultures. Societies instill different values by training children differently. Adult personalities reflect a culture’s child-rearing practices ( Kottak , 1994).

29. Marxist Anthropological Theory Marxist theory derived from Karl Marx’s writing stated that societies pass through different stages of development. This theory assumes that the systems of producing material goods influences and shapes society. Unlike functionalists who stressed order, stability and equilibrium in society, Marxist anthropology argued that society is in constant struggle of social class conflicts among the dominant and minority groups in society.

30. Cultural Ecology The main idea of this view is that each culture is seen as a specific instance of patterned adaptation to a specific environment; the dynamic interaction between man and his environment is such that culture modifies the environment and the latter also puts its limits to human culture. The cultural ecology perspective emphasizes how human use of nature influences and is influenced by social organization and cultural values ( Kottak , 2002).

31. Cultural Materialism The theory advanced by Anthropologist Marvin Harris states that the key factors and determinants of socio-cultural evolution are the infrastructures that include technology, environment and material conditions. As the infrastructure of a society changes, the other aspects of society also change accordingly.

32. Anthropological Structuralism Theory Gives attention to the cognitive or underlying mental structures that provide order to culture. It states that “the origin of universal principles that order the ways in which we behave and think about the world is to be found in the structure of human thought. Luke 6:45 “ The good person out of the good treasury of his heart produces good, and the evil person out of his evil treasury produces evil, for his mouth (actions) speaks from what fills his heart”.

33. Ethno science Sometimes referred to as cognitive anthropology mainly focus on understanding and describing how a specific people view their world. A specific people perceive and structure their environment through language; and the nature of the rules and principles that guide their decision making

34. Symbolic Anthropology This theory is the study of culture through the interpretation of the meaning of symbols, values and beliefs in society. Cultural traditions like texts are to be interpreted and described.

35. Public Health Implication of Anthropological Studies Health, disease and illness are as much sociocultural in their nature as they are physical. 2. Despite certain steps being taken, the dominant trend in the medical/ health sciences training is highly focused on the biomedical and ecological dimensions of health and disease. Given the bio-psycho-social nature of human being and health, this is very incomplete. Such highly narrow focus in the training of heath professionals and design of health policies and strategies is not appropriate. it does not provide the whole picture about the issue.

36. 3. Human health and wellbeing are deeply linked to sociocultural factors such as the entrenched poverty, high level of illiteracy, poor implementation of policies, religious views, traditional values and institutional shaping of people’s worldviews about health and disease.

37. Cultural contextualization in social institution

38. Concept of culture Culture : The system of shared beliefs, values, customs, behaviours , and artifacts that the members of society use to cope with their world and with one another, and that are transmitted from generation to generation through learning. It refers to all the features of a society's ways of life: e.g. production, modes of dress, routine living habits, food preferences, the architecture of private and public building, the layout of fields and farms, systems of education, government, law, religion, moral precepts and other capabilities and skills.

39. Features & Characteristics of Culture Culture is learned – it is not inherited biologically, it is acquired from associating with others, e.g. language, eating and drinking, dressing, walking, behaving, reading, etc. Culture is social – No man can acquire it without the association of others. Culture is shared – customs, traditions, values, beliefs are all shared by man in a social situation. Culture is transmitted – Parents pass cultural traits to their children from one generation to the next. It is not transmitted through genes but through language.

40. Culture is continuous Culture varies from society to society Cultural process undergoes changes. Culture is integrated. Value system is interlinked with morality, customs, beliefs and religion. Culture is responsive to the changing conditions of a physical world. Culture is gratifying: It is the process through which human beings satisfy their needs. Food, shelter, clothing and desires for status, fame, money, sex, etc. are all fulfilled according to the cultural ways.

41. Elements of Culture Values: Standard for discerning what is good and just in society. Values often suggest how people should behave, but they do not accurately reflect how people do behave. Example: Marital monogamy is valued, but many spouses engage in infidelity. Beliefs : The tenets, views or convictions that people hold to be true. Norms : Describe how to behave in accordance with what a society has defined as good, right, and important, and most members of the society adhere to them. Formal and informal norms (Rules or laws)

42. Symbols – gestures, signs, objects, signals, and words that help or provide clues to understanding the peoples’ world and experiences. Symbols convey strong messages. Language – Symbolic system through which people communicate and through which culture is transmitted.

43. Social Institutions Institutions are the established social organizations which come into being through social interaction and subsequently regulate the behavioral pattern of the members of the society. Institution has a member of folkways, mores and laws which all members of society are expected to follow to make their life in society easier. If there were no organized ways of obtaining a livelihood, competition and conflicts would be so fierce that many people would not survive. Folkways, mores and laws, vary from society to society because institutional forms themselves are different.

44. Basic Social Institutions The Basic institutions are those which are regarded as being necessary for the maintenance of social order in a given society

45. Families and Households : A fundamental social group consisting of a man and a women and their offspring. Family is the unity of two or more people through blood relation, marriage or adoption. Family in a society works as a social support for an individual. Three main functions of a family - 1. To give an identity. 2. To rear future generation. 3. To promote a culture.

46. Governments and Legal Institutions: The office, function, authority, or organization that sets forth and administer public policy and the affairs. A government consists of a legislative branch which writes law and policy, executive branch which executes law and policy, and judicial branch which enforces law and policy. This includes local, state, and national, all branches of the armed forces and non political organizations dedicated to influencing the processes of government/policies

47. Economic/market Institutions : Social organizations dedicated to barter and trade. This includes all corporations and businesses. Religious Organizations : Groups of people who share a common, codified belief in and reverence for a supernatural power accepted as the creator and governor of the universe. Educational Institutions: Social organizations dedicated to teaching skills and knowledge to individuals.

48. Functions of Institutions: Simplify Action for the Individual: An institution organizes many aspects of behaviour into a unified pattern making a participant in an institution to pass from one complicated set of behaviour traits to another towards a recognized goal. Provide Role and Status for Individuals: The institutions provide for individual the opportunity for the development of peculiar characteristics and determine his role and status. Some people serve in groups devoted to public welfare. Others find a place in business, professions, public service or in the home. Some shine in sports, others in literature or art.

49. Provide Order to the Society: Institutions provide unity to the society otherwise law of the jungle would prevail if there were no institutions that maintained order. Provide a Means of Social Control: All major institutions, the family, the school, the religious, the State inculcate basic values that control the basic concerns of life.

50. Characteristics of Community or a whole society

51. Community Community : A group of people residing in the same locality and under the same government or a group or class having common interests. Man cannot live in isolation. People living in a particular locality for a longer period of time develop a sort of likeness or similarity, common ideas, common customs, common feelings, common traditions among themselves. Examples of community include a village, a tribe, a city or town.

52. Community characteristics affect its cohesion and the kinds of interests different groups may wish to protect Communities Are People Sharing Locality An interdependent social group Interpersonal relationships through social networks A culture that includes values, norms, attachments to the community as a whole

53. Communities operate on Social System – Basic units and roles Associations Institutions Family structure, etc Communities Are Built on Social Capital (connections among individuals)

54. Communities are structured through Political System Power relations Leadership structure Subgroups Disenfranchised groups Formal and informal leadership

55. Cultural System – Basic beliefs and ways of life including technologies Economic base – Resource base, ways of earning a living and distribution of resources Historical factors - population and settlement history; and - conflict history.

56. Social factors ethnicity and language family structure caste and other social divisions gender relations.

57. Distinction between Community and Society Society: Society is an organized, encompassing group of people who live together, connected with one another and share mutual beliefs, values and way of living. It consists of a government, health care, education system and several occupations of people.

58. 1. Society is a web of social relationships. But community consists of a group of individuals. It is a specific group.  2. Society is abstract. Community is concrete.  3. A community is bound by territorial units but society has no definite geographical area.  4. There can be more than one community varying in size, physical appearance, organization and specialized functions. But there cannot be more than one society in a community.

59. 5. Community: Known with a particular name, common Life, common interest 6. Community Sentiment: feeling of belonging together, speak the same language 7. Permanence: natural growth

60. Tradition and culture: Tradition: The body of practices (behaviors) based on beliefs that are passed from generation to another (family, community, national). Culture is what a group of people have cultivated over a period of their history. Culture gives a glimpse of the peoples past and understanding of their behavior. Ethnic Group : A social organization consisting of many extended family groups related by a distant, common language, food, and other traits through a common ancestry. Ethnicity: The distinctiveness by which different societies preserve their original culture. Cultural universals: patterns or traits that are globally common to all societies

61. Assignment for the class Topic: Nigerian People and Culture Cultural heritages of your ethnic group: language, marriage rites, burial rites, birth rites, dressing, greeting, music, folklore, religion, rituals, food, architecture, economy, politics, healthcare, and other tangible cultural monuments, natural sites and cultural landscapes. Discuss how it relates to peoples beliefs

62. Nigerian people and culture Nigeria is a society with ample cultural heritage that are scattered within the diverse ethnic nationalities. Cultural heritages : language, marriage rites, burial rites, birth rites, dressing, greeting, music, folklore, religion, and other tangible cultural monuments, natural sites and cultural landscapes. Some of these cultures have died due to western cultural influence. There are more than 250 ethnic tribes that call present-day Nigeria home. Three largest and most dominant ethnic groups: Hausa, Yoruba, and Igbo. Smaller groups: Fulani, Ijaw, Kanuri, Ibibio, Tiv , and Edo. Prior to their conquest by Europeans, these ethnic groups had separate and independent histories.

63. These various ethnic groups never considered themselves part of the same culture. This lack of Nigerian nationalism coupled with an ever-changing and often ethnically biased national leadership led to severe internal ethnic conflicts and even a civil war. Bloody confrontations between or among members of different ethnic groups still continue today. Main environmental regions: savanna, tropical forests, and coastal wetlands. These environmental regions greatly affect the cultures of the people who live there. The dry, open grasslands of the savanna make cereal farming and herding a way of life for the Hausa and the Fulani. The wet tropical forests to the south are good for farming for the Yoruba, Igbo, and others in this area. Small ethnic groups living along the coast, such as the Ijaw and the Kalabari , are forced to keep their villages small due to lack of dry land. Living among creeks, lagoons, and salt marshes makes fishing and the salt trade part of everyday life in the area.

64. Language Affiliations English is the official language of Nigeria, used in all government interactions and in state-run schools. In northern Nigeria many people who are not ethnic Hausas speak both Hausa and their own tribal language. The dominant indigenous languages of the southwest is Yoruba and Southeast Igbo. Pidgin is often used in ethnically mixed urban areas as a common form of communication among people who have not had formal education in English.

65. Symbolism For the fact that there is little feeling of national unity among Nigerian people, there is little in terms of national symbolism. What exists is the government’s representation of the nation. The main national symbol is the country's flag. Other national symbols include the national coat of arms, the national anthem, the National Pledge, and national motto: Peace and Unity, Strength and Progress.

66. Cultural/Ethnic Transformations Nigeria’s ethnic groups have been influenced significantly Northern societies: Contact with the Islamic world through Trans-Sahara trade with North Africans and Arabs led to the conversion of the Kanem-Borno Empire to Islam in the eleventh century. This conversions throughout the north brought with it changes in law, education, politics, wealth and class structure. Strict Islamists, Fulani, in the bid to suppress increasing corruption, excessive taxation, and unfair treatment of the poor in 1804 launched a jihad against the Hausa states in an attempt to cleanse them of these non-Muslim behaviors and to reintroduce proper Islamic ways.

67. Southern Societies: Outsiders heavily influenced the societies of southern Nigeria. Soon after the arrival of Portuguese in 1486 followed by British, French, and Dutch, the trade in slaves replaced the original trade in goods. Many of the coastal communities sold their neighbors, whom they had captured in wars and raids, to the Europeans in exchange for things such as guns, metal, jewelry, and liquor. The slave trade had major social consequences. Violence and intertribal warfare increased as the search for slaves intensified. The increased wealth accompanying the slave trade changed social structures in the southern area to the extent that Leadership, which had been based on tradition and ritual, soon was based on wealth and economic power.

68. After the British decided that slave trade was immoral and ordered it stopped in 1807, they began to force their newfound morality on the Nigerian people. A new economy based on raw materials, agricultural products, and locally manufactured goods saw the growth of a new class of Nigerian merchants. These merchants influenced by Western ways became involved in politics and often criticized traditional rulers for keeping to their traditional ways. Because being successful was based on wealth and politics, production and merit not on traditional community standing, a new divide within the local communities developed. It was not unusual to find a former slave transformed into the richest, most powerful man in the area.

69. Christian missionaries brought Western-style education to Nigeria as Christianity quickly spread throughout the south. The mission schools created an educated Nigerians who also sought increased contact with Europe and a Westernization of Nigeria. The growth of increasing and fearful loss of traditional culture thus began. Today nationalistic movement of the elite is struggling to promote Nigerian foods, names, dress, languages, and religions.

70. Architecture: Nigerian architecture is as diverse as its people. The traditional architecture has greatly been eroded in modern Nigeria. With the influx of oil revenue and foreigners, Nigerian cities have grown to resemble many Western urban centers. Lagos, for example, is a massive, overcrowded city filled with traffic jams, movie theaters, department stores, restaurants, and supermarkets. Very little urban planning, streets are laid out in a confusing and often incomprehensible fashion, adding to pedestrian and traffic chaos. The influx of people has put a strain on many services.

71. In rural areas, houses often are designed to accommodate the environment in which the people live. The Ijaw live in the Niger Delta region, where dry land is very scarce. To compensate for this, many Ijaw homes are built on stilts over creeks and swamps, with travel between them done by boat. The houses are made of wood and bamboo and topped with a roof made of fronds from raffia palms. The houses are very airy, to allow heat and the smoke from cooking fires to escape easily. Igbo houses tend to be made of a bamboo frame held together with vines and mud and covered with raffia palms or banana leaves. They often blend into the surrounding forest and can be easily missed if you don't know where to look. Men and women traditionally live in separate houses.

72. Architecture in the north is heavily influenced by Muslim culture. Homes are typically geometric, mud-walled structures, often with Muslim markings and decorations. The Hausa build large, walled compounds housing several smaller huts.

73. Food Western influences, especially in urban centers, have transformed Nigerian eating habits in many ways. City dwellers are at home with canned, frozen, and prepackaged foods. Rural Nigerians tend to stick more with traditional foods and preparation techniques. (1 page paper “Traditional food of your tribe, what is its significance to the server and served). Food in Nigeria is traditionally eaten by hand. In the south, crops such as corn, yams, and sweet potatoes form the base of the diet. This is often served with a palm oil based stew made with chicken, beef, goat, tomatoes, okra, onions, bitter leaves, or whatever meats and vegetables might be on hand. Fruits such as papaya, pineapples, coconuts, oranges, mangoes, and bananas also are very common in the tropical south.

74. In the north, grains such as millet, sorghum, and corn are boiled into a porridge-like dish. This is served with an oil based soup usually flavored with onions, okra, and tomatoes. Sometimes meat is included, fresh milk and yogurt are common. Alcohol is very popular in the south but less so in the north, where there is a heavy Islamic influence. The most popular form of alcohol is palm wine which can further be distilled into gin like liquor. Special ceremonies would not be complete without participants sharing in a meal.

75. Economy More than 50 percent of Nigeria's population works in the agriculture sector. Most farmers engage in subsistence farming, producing only what they eat themselves or sell locally.

76. Politics Indigenous cultural systems were very useful in galvanizing growth and development in the early times of Nigerian history. For instance, the Igbo political culture was patterned along gerontocracy (ruled by the elders) and decentralization arrangements. Decisions were taken in a village square setting in manners that accommodated all. Decisions were taken democratically and immediate and distant environments were exploited for the common good. For the Yorubas , the political system was monarchical and structured with consultative mechanisms in-built. The decisions for the communities were taken after due consultation with the Oye Mesis (Oba-in-Council). Decisions are never taken unilaterally. The Hausas of the Northern part practiced Emirate system that was very and sharply hierarchical. Power and authority flowed from the top (from the Emir) and followers were expected to follow.

77. Infant Care Newborns in Nigerian societies are regarded with pride. They represent a community's and a family's future and often are the main reason for many marriages. Throughout Nigeria, the bond between mother and child is very strong. During the first few years of a child's life, the mother is never far away. Nigerian women place great importance on breast-feeding and the bond that it creates between mother and child. Children are often not weaned off their mother's milk until they are toddlers.

78. Religion It is estimated that 50 percent of Nigerians are Muslim, 40 percent are Christian, and that the remaining 10 percent practice various indigenous religions. Muslims can be found in all parts of Nigeria, their strongest footholds are among the Hausa and the Yoruba. Christianity is most prevalent in the south of Nigeria. The vast majority of Igbo are Christians, as are many Yorubas .

79. While Islam and Christianity are the dominant religions in Nigeria, neither is completely free of influence from indigenous religions. Most people who consider themselves good Muslims or good Christians often also follow local religious practices. Most indigenous religions are based on a form of ancestor worship in which family members who have passed into the spirit world can influence things in the world of the living. Followers of the traditional Yoruba religion believe that hundreds of spirits or minor gods have taken the place of the supreme god in influencing the daily lives of individuals.

80. Rituals For most indigenous religions, priests and priestesses are common. Traditional priests and priestesses get their power and influence from their ability to be possessed by their god or by their ability to tell the future or to heal. Because many of the indigenous religions are based on various spirits or minor gods, each with influence over a specific area of nature, many of the traditional rituals are based on paying homage to these gods and spirits. For example, The Kalabari , Okrika , and Ikwerre tribes of the Niger Delta region all have water spirits sacred to their peoples. The Yoruba hold sacred Shango their god of thunder. Many Igbos revered the Igbo earth goddess Ani.

81. Medicine and Health Care Traditional medicine, known as juju, is common at the rural level. Practitioners of juju use a variety of plants and herbs in their cures. Most families also have their own secret remedies for minor health problems. Many rural people do not trust Western-style medicine, preferring instead to use traditional ways.

82. Epidemics and Culture

83. Epidemic: Definition Epidemic (Greek epi "upon or above" and demos "people") is a sudden severe outbreak or spread of a disease (communicable and non communicable) to a large number of people in a given population within a short period of time, usually two weeks or less.

84. Communicable disease outbreaks cause millions of deaths each year. The most commonly reported epidemic outbreaks in Nigeria: Cholera, Typhoid fever, Hepatitis A and B, Dysentery, Malaria, Measles, Cerebrospinal Meningitis, HIV/AIDS, Avian Influenza, Human monkey pox and hemorrhagic fevers (e.g. Ebola, Lassa fever, and Yellow fever).

85. Cultural Factors that influence Epidemics Although generally communities pride themselves on strong cultural values and practices, most of the cultural practices heighten the risks and spread of diseases within a community.

86. Family ties: With several households connected by family ties or other relationships, the limits of individual households are not always clearly defined. Intra- and extra- community relations: Individual household cares for its immediate family, kingship networks (Extended) Traditional solidarity of standing by the sick, culture of touch, hold, hug and kiss the sick

87. Funeral and Burial Practices Washing and cleaning of the dead body, getting into contact with the deceased's body Civil unrests/mass refugee movements and resettlement camps Travel pattern influences disease outbreaks: Severe Acute Respiratory Syndrome (SARS) Religion: In most Nigerian culture, diseases and death are generally perceived as a culmination of natural and metaphysical causes such as witchcraft and punishment from gods or ancestral spirits for breaking taboos and various forms of transgressions.

88. Water supply: River/Stream/Pond Cultural practice of pure water Excreta disposal: Defecating in bushes or open spaces that are close to water sources, around people’s homes allowing flies, mosquitoes, domestic animal, fishes feasting on them. Poor hygiene

89. Waste Disposals

90. Poor living conditions: Overcrowding in small room

91. Food: Supply, Handling hygiene, Preservation and transportation methods, eating practices, etc.

92. Bush-meat hunting, preparation, and consumption

93. Poor use of public health infrastructures Traditional and faith healers Marriage and sex: polygamy, pre and extra-marital affair. It is culturally acceptable irrespective of religion for a married man to have concubines outside their matrimonial homes but it is the ladies that the culture frowns at.

94. Religious rejection of immunization (population control) Denial of reality Use of cow dung on the umbilical cord, this results in tetanus

95. Beliefs that children are usually not given foods like egg, meat etc. for fear that they will become thieves, witches/wizards, this leads to a condition of kwashiorkor which is as a result of lack of protein in the system. Female Genital Mutilation

96. Incisions/Tattoos

97. Culture and Its Importance to Healthcare

98. Culture Culture: Total person's learned beliefs, thoughts, and behaviors, values, customs, and traditions, communication style, views on relationships, and the different ways of interacting with others. Culture is shaped by many things, including race, ethnicity, nationality, heritage, socioeconomic status, education, etc.

99. Health Health is “a complete state of physical, social, mental well -being and not necessarily the absence of infirmity or disease” Disease on the other hand is defined as a form of deviation from normal functioning which has undesirable consequences because it produces personal discomfort or adversely affects the future health status of individuals

100. Illness Illness is the feeling of being unwell or sick. An illness has its own risk; since it’s a general feeling and something more personal, a person may feel well even if the disease is still present. The feeling of wellness even with the presence of disease can lead to drug resistance in the future.

101. An illness can be caused by a number of factors such as: The presence of diseases – Usually, illness occurs because the body has an underlying disease eg bacterium, virus. However, a person may also have a disease but not feel unwell months or years before the progress of the disease. Hypochondriasis – “feeling ill” even without a disease. This refers to the abnormal or moderate to severe anxiety of having a disease. Stress – The body is designed to trigger a response (fight-or-flight mode) when in a stressful situation that can increase the heart rate, blood pressure leading to the production of hormone (cortisol) which can make a person ill when stress becomes chronic. Malnutrition – The body needs different kinds of enzymes, vitamins, minerals, and other macro and micronutrients to function properly. If the body becomes deficient in any of these, it can feel ill.

102. Importance of culture to Health Perception of good and bad health including health threats and problems are culturally constructed. Different ethnic groups and cultures recognize illnesses, symptoms and causes differently and thus develop different health-care systems and treatment strategies. When it comes to illness, cultural beliefs and values affect greatly a patient's behavior in seeking healthcare. Illness perception may either promote health-enhancing behaviors, or it can lead to health lowering behaviors and practices.

103. A lack of knowledge about or sensitivity to health beliefs and practices of different cultures can limit one’s ability to provide quality healthcare

104. Concept of Disease and Theories of Disease Causation The principles of achieving optimal health is driven by combined biological and cultural factors of life. However, there are myths and divergent views about the real cause of disease(s) consequently there are variations in approach towards the prevention, control and treatment of disease when it occurs.

105. The germ theory of disease assumes that every disease has a specific cause which its treatment could best be accomplished by removing or controlling the cause with a biomedical framework. Culture-Bound Theory of Disease: on the other hand, attributes to the role of socio-cultural factors in the aetiology (causes and manner of causation) and prognosis (future course of recovery) disease.

106. Theories of Disease Theories about health and illness deal with the ideas people use to explain how to maintain a healthy state and why people become ill. Medical Model of Disease: This model argues that disease is a function of biological discontinuity, and such a discontinuity can be linked to the malfunctioning of a part of the human organism. Psychological Theory of Disease: Explains the role of psychology in the aetiology of mental diseases by analyzing the unconscious drives in human-beings. Socio-environmental Theory of Disease: The social factors such as income, education, occupation, behavioural patterns and environmental conditions within which man lives and functions can to a large extent account for the aetiology of health and disease.

107. Foster and Anderson (1978), classified theories about the causes of illness into three; personalistic , naturalistic and emotionalistic . African traditional conception of illness and disease causation are often multi-causal (complex)

108. T Personalist Disease Theories Personalist disease theories blame illness on agents (often malicious) such as sorcerers, witches, ghosts or ancestral spirits. According to personalistic theories of illness, illness may be linked to transgressions of a moral and spiritual nature. If someone has violated a social norm or breached a religious taboo, he or she may invoke the wrath of a deity, and sickness - as a form of divine punishment.

109. Recovery from an illness arising from personalistic causes usually involves the use of ritual and symbolism, most often by practitioners who are specially trained in these arts.

110. Naturalistic Disease Theories Naturalistic disease theories explain illness in impersonal terms. Western medicine attributes illness to organisms (e.g. bacteria, viruses, fungi or parasites), accidents or toxic materials. Other naturalistic ethno-medical systems blame poor health on unbalanced body fluids. People believe their health suffer when they make contact with environmental factors e.g. drinking polluted water, eat or drink hot or cold substances together or under inappropriate conditions.

111. Emotional Disease Theories Emotional disease theories assume that emotional experiences cause illness (mental state – thoughts, feelings, behavioral responses, pleasure and displeasure; mood, temperament, personality, disposition motivation).

112. Cultural Competence Cultural competence can be defined as: “The knowledge and interpersonal skills that allow providers to understand, appreciate, and work with individuals from cultures other than their own. It involves an awareness and acceptance of cultural differences; knowledge of the patient’s culture; and adaptation of linguistic skills to that of the patient.”

113. Conceptions of Cultural Competence The term cultural competence was first used by Terry L. Cross and colleagues ( Bazron , B. J; Dennis, K. W; Isaacs, M. R) in 1989.

114. Goals of Cultural Competence: To reduce health disparities and to provide optimal care to patients regardless of their race , ethnic background, native languages spoken, and religious or cultural beliefs. To learn about the tolerance of other's beliefs and remember that healthcare is about meeting patients' needs even if they do not align with our personal beliefs.

115. To discover our own beliefs and why we have them so we can understand what is believed and actions of others with different beliefs. To recognize the differences as well as cultural sensitivities in other to provide holistic care for the patients.

116. To understand the manner in which people of diverse culture and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. To develop adaptations to service delivery reflecting an understanding of cultural diversity (differences in race, ethnicity, age, gender, size, religion, sexual orientation, and physical and mental ability).

117. Challenges to Cultural Competence Language barriers Linguistic competence involves communicating effectively with diverse populations, including individuals with limited English proficiency, low literacy skills or are not literate, disabilities, and individuals with any degree of hearing loss

118. Dissatisfaction If the providers, organizations, and systems are not working together to provide culturally competent care, patients are at higher risk of having negative health consequences, receiving poor quality care, or being dissatisfied with their care and less participation in medical decisions

119. Guidelines for Cultural Competence Acknowledge people as individuals. While people are products of their background and cultures, we are individuals with particular wants and needs. Putting the individual first in all of your interactions is a critical step to avoiding stereotypes and other cultural competence pitfalls. Don’t be afraid to ask questions. There’s no way to know another person’s mind or heart. Asking questions gives you direct insight into what another person is thinking or feeling in order to foster the most positive, mutually beneficial interactions.

120. Explore different perspectives, accept and embrace differences without being judgmental

121. Strategies for Improving cultural competency Provide interpreter services Recruit and retain staff that are ethnically similar to the community Train and increase cultural awareness, knowledge, and skills Coordinate with traditional healers Use community health workers Incorporate culture-specific attitudes and values into health promotion tools

122. Engage communities in the planning, design and delivery of healthcare facilities and services Locate intervention in geographic areas that are easily accessible for certain populations Expand hours of operation Provide linguistic competency verbal, non-verbal and other written materials Increase knowledge about various groups, common health beliefs, behaviors, and key "dos" and "don'ts.“

123. Cultural Competency Skills/Attitude Skills in communication Medical history-taking techniques Curiosity Empathy Respect Humility Recognize and appropriately address racial and gender biases in yourself and in others

124. Traditional Medical Technology and Practice Traditional medicine had evolved their own medical technology before the coming of the “white man” (Arab and Europeans). Vegetable medicine: Traditional medicines have used plants as curatives and palliatives for various ailments sometimes with prescriptions of correct methods of preparation and dosage. This arises from a thorough knowledge of the medicinal properties of plants and the pharmaceutical steps necessary in turning such plants into drugs. Although ingredients and the manner of preparation vary with the ailment but the significant point is that in many cases, patients were cured of their physical or psychological ailments. Drugless therapy: “Massaging” as a therapeutic system has been employed for the treatment of ailments of the nervous, muscular systems as well as treating gynecological problems in many cultural systems.

125. Hydrotherapy: This involves the use of cold, hot, compresses and steamed vapour baths. Cold and hot baths are used for the treatment of different diseases after the addition of some herbs. The fusion is then used for ailments such as fever, headache, rheumatism and general body pains. The hot bath not only makes the skin capillaries to relax but also increases the activity of the sweat glands. Blood-letting as a therapy. Fasting as a therapy. Traditional anesthetic drugs Surgery Traditional medical practitioners in Africa are proficient in the performance of intricate operation to remove bullets and poisonous arrows from wounded traditional fighters.

126. Traditional bone setter, uses his hands and fingers to feel and assess the type and extent of the damage to a broken bone. Common practice for mothers to breastfeed their children for a long time. Common practice for women who just delivered to be placed on special diets. This they believe helps the woman to regain lost nutrients during pregnancy and delivery. Sexual abstinence during lactation It is widely practiced because of the belief that a woman is not fully pure at this time. This practice helps in child-spacing and family planning. Common practice for people to embark on wrestling combat when it is not farming season; this promotes physical activity and healthy life

127. Environmental Sanitation: This is practiced virtually in every Nigerian society. Early morning sweeping of the house and compound by both men and women is encouraged to promote health.

128. Generally speaking, traditional healers apply methods which are similar everywhere, however, the plants used and the therapeutic values attributed to them, are also dependent on various factors. Some of these factors are geographical, sociological and economic that surpass ethnic, national and political boundaries. Cultural medical heritage of every society is reflected in it’s indigenous medical practice which is founded on rational and coherent body of knowledge or belief relating to various diseases and ailments as well as their remedies. Traditional medical technology in Sub-Saharan Africa, has not only developed drugs and surgical skills for fighting ailments but also packed with reputable body of knowledge for the training of specialists in the healing of various diseases and disorders of various complications such as setting of bones, trepanning, healing mental disorders and even conducting complicating operations like those of the caesarean section.

129. Anthropology in Public Health

130. Public health programs aim to replace ‘false’ beliefs with ‘accurate’ knowledge. By changing community knowledge, it is assumed, behavior will also be changed. Understanding health and disease is a dynamic, adaptive, population-based process that involve the use of systematic, descriptive, and qualitative methods

131. Health anthropology studies: The relationship between the biological and cultural determinants of disease, health and health care, The basis and effectiveness of traditional health care systems and suggests ways to integrate modern medicine into traditional societies. Health anthropology does not study the relationship of individual person to disease but studies the relationship between the biological and cultural characteristics of a group (ethnic or racial).

132. It helps to understand the disease prevalence and susceptibility to the genetic make-up of a man belonging to a particular race or ethnicity. It helps to understand the impact of inherent ethnic and racial differences on the functioning and acceptability of healthcare.

133. Anthropology in Public Health Anthropology as well as Public health is concerned about the population or community as its patient. Anthropology primarily focuses on the study of people in groups especially in local communities. Anthropology brings to public health its theoretical and methodological perspectives

134. Example of Theoretical Perspective: Cultural Interpretative approach Understanding that social and cultural behaviors are important factors in the causation, prevalence and distribution of many diseases is crucial. Anthropologists argue that how people live, the way they behave, what and how they eat, what they believe and practice, what they value and what technology they own and use, etc , are significant determinants of their individual and collective health

135. Anthropologists also argue that diseases and mortality vary among cultures and types of economic activity. E.g. certain infectious diseases such as malaria, typhoid and cholera, etc. are more common in sedentary societies (peasants and urban communities).

136. Diseases such as schistosomiasis are related to certain economic activities; they are highly prevalent in societies which practice irrigation systems.

137. Diseases, particularly sexually transmitted ones, including the HIV/AIDS pandemic, are more common in urban than rural cultures, and along highways. Rural people also get infected via various means of contact with towns

138. Critical Perspective approach Those in power and dominance enjoy better health and the marginalized groups suffer from the burden of diseases

139. Methodological Perspective Qualitative Method in Health Anthropology Participant observation: active involvement in community life while studying all relevant events, actions, places, objects, etc. and recording them. It involves maintaining rapport with the people, face to face conversation with informants, interview.

140. Key informant Identification and interviewing “ Key informant” refers to anyone respected within a community who can provide detailed information and opinions based on his or her knowledge of a particular practice, event or issue. A highly respected local midwife would be a key informant on childbirth practices

141. Life histories: In-depth investigation on the life histories of the individuals or groups. Life histories reveal how specific people perceive, react to and contribute to changes that affect their lives.

142. The genealogical method: gathering information on principles of kinship, descent, and marriage. Everyone is related to every other person; and rules of behavior attached to particular kinship relationships are basic to everyday life.

143. Emic and Etic approach: Emic approach focuses on the native’s or the community’s points of view, trying to understand the world from the perspectives of the natives. Etic view is observer-oriented approach which tries to bring an objective and comprehensive viewpoint to the study of the community’s life.

144. Longitudinal: A long-term study of a community, region, society, culture or other unit, usually based on repeated visits. Such kind of method reveals important insights on the dynamic and complex factors that affect the lives of people over longer periods of time.

145. Problem-Based Ethnography : consulting documents, archives, measure and record data on various phenomena like the environment, weather, diet, land use, etc.

146. Survey (Quantitative approach) This involves the use of structured questionnaire and or interviews

147. Principles of anthropological methods Building “rapport” It refers to establishing relationships based on trust and mutual respect with the group or community where you are conducting research. Demonstrate thoughtfulness and respect for local beliefs, traditions, and practices. be a good listener, and show willingness to learn from the group or community

148. Self-reflexivity Identify own biases or assumptions and how own values and experiences shape perceptions of the culture you are studying.

149. Understanding “context” Context refers to the conditions in which something exists or occurs. With elements of culture, whether rituals, performances, oral narratives, or artifacts, a more holistic understanding of these elements are seen in relation to the broader historical, environmental, and cultural context.

150. Open ended questions Learning about a topic or cultural practice, interview questions are usually “open-ended” or “unstructured.” Open-ended questions are those that begin with “how,” “why,” or “tell me about.” ( e.g Would you tell me more about...? Can you help me understand...?). They can not be answered with a “yes” or “no” response Open-ended questions encourage informants to “tell their own stories” and give their own interpretations of cultural phenomena and events.

151. Listening for diverse local voices and points of view. Cultures are not “monolithic” – they are not static or uniform. People who share the same culture (language, ethnic background, nation or territory) very often have different viewpoints about the meaning and value of cultural beliefs and practices. These differences of viewpoint are often a reflection of age group, ethnicity, gender, educational background and social class.

152. In Summary Anthropological knowledge of cross-cultural variability can be used to improve the development and measurement of epidemiologic variables. Anthropologists provide crucial understandings of public health problems from the perspectives of the populations in which the problems occur. Anthropologists help to develop and implement interventions to address particular public health problems working in collaboration with local participants.

153. Patients have competing knowledge and value systems. Anthropology's role is to translate local concepts of illness and treatment, and adapt biomedical knowledge to fit local aetiologies . Anthropology examines the local context of disease diagnosis, prevention and treatment, the structural as well as conceptual barriers to improved health status.

154. Anthropology helps the national and international health organizations by providing data on the cultures of peoples of the world. Works with epidemiologists in identifying-the effects of cultural practices and beliefs on the transmission of disease.

155. Helps in the fields of general health education efforts relating to family planning, maternal and child health, improving community sanitation and nutritional counseling. Helps in enhancing community participation in disease prevention. Helps people understand psychological and social factors affecting prevention, participation in case identification and treatment.

156. Help health workers in overcoming the constraints in mass drug administration or vaccination as well as in overcoming and dealing with cultural constraints on programs of health education. It sees health as a process in human development and states that it cannot be achieved in isolation without associated socio-economic development.

157. Socio-cultural determinants of health

158. Many factors combine to affect the health of individuals and communities. Whether people are healthy or not, is determined by their cultural circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family, all have considerable impacts on health.

159. Physical Factors Natural environment – bushy, swampy Built environment – buildings or transportation Environment of Worksites, schools, and recreational settings Living conditions: Housing, homes, and neighborhoods Exposure to physical hazards especially in industrialized and mining areas Exposures to contaminants in air, water, food and soil

160. Chemical Factors People in urban centers do not enjoy good air quality. Indoor air may contain constituents such as asbestos, moulds , carbon monoxide and methane that affect health. Living or working in closed buildings with poor air quality. Poor air quality can worsen asthma symptoms, especially in children. Tobacco smoke, especially for children living in the homes of smokers.

161. Social Factors Social norms and attitudes – discrimination Exposure to crime, violence, and social disorder Exposure to mass media and emerging technologies – Internet or cell phones Culture - customs and traditions Access to and utilization of health services

162. Socioeconomic Status Income and social status – the greater the gap between the richest and poorest people, the greater the differences in health. Education - Low education levels are linked with poor health Occupation - Work-related diseases Lifestyle – eating, drinking, attitude to life eg happiness or worry Poverty - inadequate resources to meet basic needs for shelter, nutritious food, clothing, and education.

163. Social Support Network Support from families, friends and communities is linked to better health. It is a source of emotional reassurance and provides a safe place for a person to discuss his problems, which helps him to cope with adversity. Spirituality/religion – belief and practices

164. Family Inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Gender - Men and women suffer from different types of diseases at different ages. Traditions and beliefs of the family. Early life exposure to risk factors – FGM, passage rights, lacerations, all forms of abuse

165. CONTEMPORARY ISSUES IMPACTING GLOBAL AGENDA ON HEALTH OF MINORITY GROUPS

166. Globalization and Anthropology Definition: Globalization is the process of international integration arising from the interchange of world views, products, ideas, and other aspects of culture. It is a process of social change in which geographical and cultural barriers are reduced.

167. Major factors in globalization: Advances in transportation Telecommunications infrastructure Rise of electronic communication - the Internet. Cultural diffusion and emerging global consciousness.

168. Threats of Globalization and Human Health Availability of Toxic Goods – Tobacco, Alcohol and Addictive Drugs Poor working conditions Political instability Increase in travel leading to transmission and spread of infectious diseases

169. Burden of Diseases - Lower Respiratory Infections, Heart Disease, Diarrhea, Depression, Road Traffic Accidents, Cerebral-Vascular Disease, Chronic Obstructive Pulmonary Disease, TB, Measles, HIV, etc. Socio-Economic Inequality - Inequality is based on geographic, historical, social and cultural grounds.

170. Population - Population growth puts increasing pressure on natural resources, including water, food, fuel, raw materials and on the earth’s atmosphere Environmental Threats – Deforestation, Excessive use of carbon-based fuels which creates CO2 emissions that impacts global warming.

171. Expansion of Western Culture and Values - US/British culture: including pop culture, movies, TV, videos, music, news, literature, plastic and performing arts, fast food syndrome, role of women, marriage, sexual freedom and preferences, the role of the family. Erosion of traditional culture e.g. childcare Globalization of Assisted Reproductive Technologies - In vitro fertilization (IVF) Commercial Surrogacy

172. Pharmaceutical product trials and drugs trafficking Transnational trade of body parts Trade in embryos, sperm, babies

173. Globalization and Disease Process Speed While disease incubation times for infectious diseases have remained constant, average distance and speed of human travel have increased a thousand-fold. Historically small, localized outbreaks can now develop in a matter of days into a large, worldwide epidemic.

174. Open borders and international travel Each year millions of people leave their homes temporarily or permanently in search of work or an improved quality of life; other millions are forcibly displaced by war. Emergence and reemergence of infectious diseases are frequently linked to the massive influx of immigrants from poor countries with a higher prevalence of such diseases. The airplanes, cruise ships on which they travel and the cargo that accompanies them also serve as potential sources of vector introduction.

175. Global spread of capitalism and free market Rapidly changing nature of the global marketplace, the ease with which food, commodities, capital, and economic and political decisions are being passed around the world increase disease emergence and control.

176. Contemporary Health Debates-

177. Female cutting and ill-health leakages and Infection Female Genital Mutilation: girls and women are considered beautiful, acceptable, or clean and as a passage to womanhood. Effects: Urinary tract infections, emotional damage, loss of sexual sensation or ability to have sex as an adult, and long, unproductive labors which can lead to death of the baby or the mother, bleeding and infection

178. Breastfeeding Exclusive breastfeeding – giving an infant breast-milk for the first 6 months of life (no other food or water). it includes initiation within one hour of life and continued breastfeeding for up to 2 years of age or beyond (WHO, 2014). Breastfeeding is perceived as essential to baby's health. It strengthens the physical and spiritual bond between mothers and their children. Breastfeeding provides infants with superior nutritional content that is capable of improving infant immunity and possible reduction in future health care spending

179. A woman understands her breasts and their functions in everyday life based on culture and the way the media portray breasts and breastfeeding. Debates Visible versus hidden breastfeeding at public places such as restaurants Nurturing versus sexuality: function of breast Wet-nursing or kin’smilk : the common practice of hiring a recent mother to breastfeed the child of a family usually of a higher social status, meant that breastfeeding was a job, and source of income for many women, and a source of pride. Decency: A woman should cover her body and dress in a way that does not draw sexual attention to her

180. Media portrays breast milk as the best but also talks of equality of formula milk; HIV transmission through breast milk. Some feminists see breastfeeding as a sexually oppressive burden on women (reduced to biological traditional role in family); they believe that formula-feeding is a form of physical liberation for mothers; Equal opportunity between mothers and fathers to provide for their children. Breastfeeding as a social and moral conduct defines a mother Traditional nursing of a child for long periods reduces cancer risks.

181. Euthanasia - physician-assisted suicide Proponents: Autonomy and relief from suffering of the individual Death with dignity: that life with profound disability is lacking in dignity - (cultural prejudice towards the disabled in our culture). Removal of social burdens, including psychological, emotional, and/or financial burdens imposed by the chronically or terminally ill - (save cost) Opponents: Sanctity of life, and the appropriate role of physicians. Cultural expectations: individual's life is rigorously governed by the customs of the society - (suicide is shame)

182. Health Inequalities Social class differences in health – high social classes living and faring better than lower ones. Health is not equally distributed among groups in society Proponents Health is merely a 'natural characteristic' or a 'natural good‘; Very few people are doomed by their genetic make-up to live in disease or to die prematurely. Most of us have the potential to be healthy and live a long life, given the most beneficial combination of circumstances.

183. Is long and fairly healthy life for the mass population reasonable and achievable? Opponents: Health is a human 'right‘ - equal right ; fundamental human value; more important than wealth Health: A human resource, enabling a person to fulfil ambitions and goals in life. Health policy today tends to focus on economic or managerial issues -the cost of providing medical services, rather than the effect these services will have on the health of the population. Good health contributes to social achievements Health is a resource in national and international development

184. Medical egalitarianism: Proponents Poor people make choices different from those of the rich - Rational poor person to adjust his or her level of medical care downward from what the middle class selects in order to balance out his or her health-care needs with other important goals. Opponents Health - Functional need of the individual members of society There is always 'a right place' for waste disposal or a nuclear power plant, which on the whole will bring fewer health risks than other places.

185. Policies supporting women’s health & fertility Family planning: Positive effect:- slows population growth and increase economic development Improved women’s health Reduction of childbearing among unmarried youth Unwanted pregnancies may lead to unsafe abortions Reduce maternal mortality Healthy timing and spacing of births improves health of children and risk of infant death

186. Adolescent Sexual and Reproductive Health Offer age-appropriate comprehensive sex education Pregnancy outcomes: Adolescents ages 15–19 years are twice as likely to die during pregnancy and childbirth than women older than age 20 years; those under age 15 years are five times more likely to die during pregnancy or childbirth (WHO 2011). Social outcomes of adolescent pregnancy – the girl’s potential remain unfulfilled and basic human rights denied Complications of pregnancy and childbirth are the leading cause of death for adolescent girls ages 15–19 years

187. Unsafe abortion does not only cause death and disabilities, there are also social and financial costs to women, families, communities and health system. Interventions to Reduce Unsafe Abortion: Comprehensive sexuality education; provision of safe and legal abortions; prevention of unintended preganancy through use of effective contraceptive Contraceptive methods do fail; women often become pregnant in circumstances in which the use of contraception may not be possible or where sex is nonconsensual.

188. Violence against women Primary prevention of violence by facilitating disclosure, offering support and referral, gathering forensic evidence Provide care and support for the many women who already face violence Identifying and supporting the children of women who suffer domestic violence