Socio-economic disparities and well-being.

Culture is affected by the ecological environment, but at the same time culture also changes the environment in ways that affect both physical and mental health. Population increases in developing nations have created many challenges to ensure adequate nutrition for people and affects infant survival rates. The population of the world is increasing, especially in developing countries, stressing the world’s resources, economic relations between rich and poor countries, and ultimately socio-economic stability. One reason for the larger fertility rate in developing nations is the inability of these societies to provide social security for people reaching old age, and the need of parents to have children provide essential psychological and material support. Cultural values play an important role as women who are socialized with traditional gender values tend to have larger families perpetuating the limited social roles of females in traditional cultures.

Population increases are not benign as they typically are also related to industrialization of society, larger cities and socioeconomic disparity between rich and poor. In terms of physical health the stress caused by industrialization produce hypertension and many associated illnesses including heart disease. Whether the result of industrialization is positive or negative appear directly related to wealth disparity. Where there is a relative equitable distribution of wealth and health related resources the outcome is better overall health and increased longevity of the population (Wilkinson, 1996). The key to better health is not the overall wealth of a nation, but the degree to which the wealth is distributed in egalitarian ways. For example in the U.S. mortality rates vary directly between the states as a function of the inequality of income (Kaplan, Pamuk, Lynch, Cohen, & Balfour, 1996). The resource injustice is also present between nations varying in wealth, and the differences in health related expenditures differ widely between countries with the people needing services the most getting the least help (Aboud, 1998).

The economically disadvantaged whether within or between countries suffer more malnutrition. A major concern is the relationship between malnutrition and psychological functioning (Aboud, 1998). This is an issue of catastrophic impact and likely to get worse with a growing world population. Malnutrition that has very negative consequences on physical and psychological development and in developing countries a full 46 percent of the children suffer from inadequate nutrition (UNICEF, 1996). The causes for malnutrition are complex involving cultural practice, limitations of the environment, and economic and social organization. Nevertheless there is sufficient food in the world as a whole if political will and organization would permit nutrition to reach those that suffer (Barba, Guthrie, & Guthrie, 1982).

Psychologically the greatest impact of malnutrition is on cognitive development especially as the earliest years are of greatest significance for intellectual development (Martrell, 1997). Children suffer a severe decline in intellectual functioning of about 10 IQ points when they need hospitalization to recover from malnutrition or suffer malnutrition that persist over a period of months in the first two years of life (Gorman, 1995). There is some evidence that even milder forms of malnutrition may affect intelligence and increase infant mortality (Bedi, 1987; Pelto, Dickin, & Engle, 1999). Not having sufficient nutrition also causes passivity in children and removes the normal intellectual stimulation that children experience through exploration activities when well nourished. Typically, malnutrition does not occur in isolation, but is present in conjunction with other adverse environmental conditions including exposure to disease, unhygienic surroundings, and substandard housing. These are the negative health-related effects of unjust economic distribution both within and also between cultures. Traditional cultures with many adverse environmental conditions and where resources are inadequate produce additional population stress by the presence of large families. It is clear that the adverse affects of malnutrition goes far beyond mere intellectual functioning as it may for example contribute to an acceptance of the status quo in people who lack the individual and social energy to work for change. Given the critical period of early childhood the general rule is that earlier nutrition intervention is better in the child’s life. International intervention includes emergency food, but also teaching the skills that optimizes child development to the community (Pelto, Dickin, & Engle, 1999).

12.1.2 Mental health among ethnic minorities: Injustice in the United States.

Cultural genocide by European invaders produced poverty and discrimination as the outcome for Native Americans. The disruptions of the traditional economic lives of Native Americans and their forced resettlement into socio-economically dysfunctional reservations created stress, poverty and alcoholism. Compared to other ethnic groups Native Americans suffer the highest level of anxiety-based disorders (Smith, Stinson, & Dawson, 2006). The marginalization of Native American communities has translated into fundamental mental health disorders including depression (Nelson, McCoy, Stetter, & Vanderwagen, 1992). The social and economic base for a healthy life is missing from many Native American communities and that in turn produces mental ill health and destroys hope for the future (Organista, Organista, & Kurasaki, 2003).

Another group suffering from historical discrimination and cultural genocide are the African Americans brought to the U.S. as slaves centuries ago. The humiliating slave tradition and subsequent discrimination still affects Blacks psychologically with the principal socio-economic heritage of poverty and social dysfunction. Research has shown that mental disorders are significantly higher among African Americans compared to European Americans (Regier, Farmer, Rae, Myers, Kramer, Robins, George, Karno, & Locke, 1993a). Again these results appear the direct outcome of poverty, inadequate physical and mental health services, and an economy that channels many young Black people into crime as the only utilitarian way to escape economic deprivation. The socio-economic disparities between European and African Americans are so high that rate differences in mental disorder cannot be unrelated. For example when socio-economic differences are controlled in research, the mental health differences between the two groups largely disappear with African Americans suffering similar rates as whites in mental disorder. However, these socioeconomic disparities remain today and African Americans suffer disproportionately much higher rates of Schizophrenia, depression, and anti-social personality disorders (McCracken, Matthews, Tang, & Cuba, 2001). Other studies also report higher rate of bipolar disorders among African Americans (Smith et al., 2006).

Latin Americans are the fastest growing ethnic group in the U.S.. A very large base of social and cultural support exists for individuals suffering stressful events in that sub-culture. Members of some Latin groups integrate very readily into the broader society and do not suffer socio-economic deprivations. However, between Latin groups there are significant differences in health-related rates that can be attributed to varying socio-economic status, experience with discrimination from the broader community, and the cultural support available (Guarnaccia, Martinez, & Acosta, 2005). For example, to undermine Cuban society and encourage defections, the United States have treated Cuban immigrants preferentially with immediate socio-economic support and permanent residence, while discriminating against more needy groups like migrants arriving from Haiti. Cubans as a group have a relative high socio-economic status and are less likely to report symptoms of mental disorder.

Likewise while Asian Americans have typically a strong cultural base there are significant differences between different ethnic Asian groups in socio-economic status and mental disorders. The Asian immigrant groups that suffer most from socio-economic disparities also report the higher rates of mental health related symptoms. Those living with poor socio-economic circumstances and/or have refugee status have higher rates of mental disorder (Uehara, Takeuchi, & Smukler, 1994). We can conclude that the differences in mental health between European Americans and other ethnic groups in the U.S. can primarily be attributed to unfavorable socio-economic circumstances among the minorities.

12.1.3 Migrants, refugees and stress: Mental health outcomes.

We live in the times of globalization and people are moving legally and illegally in large numbers to new cultural societies. The adaptation to a new culture is stressful and creates mental health problems for many immigrants as they seek to adapt to new languages and cultural ways different from their former communities (Sam, 2000). The effect of migration on mental health is complex as some immigrant groups rate better in overall mental health than even the host population whereas members of other groups fare poorly by comparison (Berry, Phinney, Sam, & Vedder, 2006). It is thought that migrants with better mental health probably had stronger support from local ethnic communities and family structures. Further, to have the personal courage to immigrate to a foreign land takes to start with a robust personality and healthy ego. A critical factor in mental health is how well the immigrant adapts to the host culture. Immigrants who find it difficult to accept new ways are more likely to report mental disorder, than individuals who adapt well (Eschbach, Ostir, Patel, Markides, & Goodwin, 2004). Another factor is the disparity between the original culture and the new host society. The more divergent the two cultures the greater the challenge for adaptation and the greater the stress experienced by the migrant.

Because we live during times of bitter conflict there are also many refugees from violence seeking new homes abroad. Many of these refuges have experienced very traumatic conditions linked to their flights from the homeland that predisposes them to a variety of enduring mental disorders (Bhui, Craig, & Muhamud, 2006; Marshall, Schell, Elliott, Berthold, & Chun, 2005). Of great importance to well-being is the network of support in the new host society. Refugees are faced with significant stress in starting life over, for example by the need to build a home and otherwise live a meaningful life. Many refugees had standing and status in the old society, but arrive without a meaningful social role in the land of refuge. Problems of adaptation produce additional stress reactions that compound the original trauma and contribute to psychological disorders. However, when the refugees have the support of their ethnic group these symptoms are ameliorated and a better outcome can be expected.

Date: 2015-01-11; view: 982