SOC 572 The Health Transition in the Developing World

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SOC 572 The Health Transition in the Developing
World

• James G. Anderson, Ph.D.
• Purdue University

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Health Transition

• Decline in acute illness
• Increase in chronic illness
• Increase in behavioral pathology
• Increase in life expectancy

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Cause of the Transition

• Urbanization
• Economic development
• Mass communication
• Education
• Biomedical interventions

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Mediated Process

• The effect of both modernizing social changer and
  biomedical intervention upon health status in the
  developing world is mediated by local-level
  processes and culture.

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Illness Behavior

• Recognizing and interpreting symptoms
• Help-seeking process
• Seeking lay or professional help
• Compliance with therapeutic advice
• Changes in treatment regimens

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Healer Choice in Medically Pluralistic Cultural
Settings

• Care is sought from several types of providers
  concurrently or sequentially
• Modern health services may not be seen as more
  effective than traditional medicine
• In East Asia traditional medicine is often viewed
  as more effective (e.g., In Benin, traditional
  birth attendants are perceived as more effective)

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Inadequacies of Modern Medicine in Developing
Countries

• Typical patient-provider encounter may lat less
  than two minutes
• Descriptions of symptoms may be limited to a
  sentence
• Physical or laboratory exams my be cursory or
  nonexistence
• Potentially toxic medications may be prescribed
• Primary health care center staff are frequently
  absent while performing private practices
• Staff may be inadequately trained

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Other Factors in Choosing a Source of Care

• In Ecuador the home is regarded as a refuge from
  illness. Indian mothers avoid care delivered
  outside the home.
• In a Mexican village the decision not to see a
  physician was based on
• Preference for folk treatment considered to be
  more efficacious
• Lack of money and transportation
• Experience of failure to achieve a cure after
  seeing a doctor

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Other Factors in Choosing a Source of Care

• A study of physician use in northern Nigeria
  found that per capita utilization of local
  government health dispensaries declined at a
  rate of 25 per kilometer.
• In Bangladesh, 95 of patients living within one
  mile of a clinic visited it when they experienced
  an episode of diarrhea.
• Only 35 of females and 70 of males visited a
  clinic locate 2-3 miles away when they
  experienced diarrhea.
• A study in Guatemala found that patients living
  more than 3.5 km from a health post only
  accounted for 15 of visits.

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Other Factors in Choosing a Source of Care

• Availability of practitioners is another factor.
  In rural Brazilian communities the ratio of
  traditional healers was 1150 biomedical
  physicians was 12000.
• In Bangladesh the ratio of traditional healers
  was 1240 biomedical physicians was 1400.

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Other Factors in Choosing a Source of Care

• Perceived cause of disease frequently determines
  the choice of healers. In Ghana diseases are
  classified by natural agent, supernatural agent
  or both. Diseases such as TB, insanity, leprosy,
  asthma, epilepsy, and pneumonia were were
  perceived as having supernatural causes.
  Effective therapies are limited or nonexistent
  for these diseases and the patient often seeks a
  biomedical practitioner.
• Diseases that have effective therapies are often
  treated by traditional healers.

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Other Factors in Choosing a Source of Care

• The use of health services is often influenced by
  a childs gender. In India the 2nd and 3rd female
  child receives much less expert attention when
  ill.
• If medical attention has to be sought outside of
  the village, boys are much likely to receive
  expert care.

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Socioeconomic Change Modifies Illness Behavior

• Maternal education is the single most significant
  determinant of child mortality. Each one year
  increment in education results in 7-9 decline in
  death of children under 5 years of age.
• Domestic behavior rather than western medicine
  appears to be the key to decreased infant/child
  mortality.
• In developing countries girls receive only 1-6
  years of primary education.
• With some education, women are more likely to
  postpone marriage and to marry a wealthier man.

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Socioeconomic Change Modifies Illness Behavior

• Educated women are less fatalistic about disease
  and death.
• Maternal education influences the help-seeking
  process symptom recognition, treatment action,
  adherence to treatment, lay consultation, social
  support networks.

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Changing Patterns of Illness Behavior with the
Health Transition

• Widespread distribution of western
  pharmacies/pharmaceuticals has had an impact on
  illness behavior.
• For many rural and urban poor,in developing
  countries the pharmacy is the only contact they
  have with western health care. In El Salvador,
  55 of poor families and 23 of upper-class
  families relied on commercial pharmaceutical
  practitioners as their primary source of health
  care.
• Pharmacists in developing countries offer medical
  advice and function as comprehensive health care
  providers. In urban Mexico many people routinely
  consult the local pharmacist.

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Changing Patterns of Illness Behavior with the
Health Transition

• Pharmacist are preferred providers for some of
  the same reasons that folk healers are preferred.
  In Guatemala, pharmacists treat patients with
  respect, are more convenient, provide faster
  service, are familiar to local people, and extend
  credit.
• Frequently pharmacists serve as interpreters
  different the different medical traditions.

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Misuse of Pharmaceuticals

• In Brazil and the Philippines antibiotics are
  applied as crushed powder to wounds.
• In El Salvador mothers give babies a teaspoon of
  tetracycline daily for prevention.
• In developing countries, pills are frequently
  packaged and sold individually.
• Injections are highly regarded creating a new
  health care provider, the itinerant injectionist.

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Misuse of Pharmaceuticals

• Traditional healers are increasingly using
  western drugs. In Bangladesh, 30 of homeopaths
  and 3 of traditional healers were dispensing
  drugs 44 and 3, respectively, were giving
  injections.
• Self-medication is the most common way of using
  western medicines in developing countries.
• In developing countries biomedicine is yielding
  control of pharmaceuticals to local pharmacists,
  traditional healers, and patients themselves.

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Convergence of Traditional and Biomedical Practice

• In Sri Lanka, a study found that Ayurvedic
  vaidyas and biomedical practitioners found that
  doctor-patient interactions, physical diagnosis
  techniques and prescribing patterns were
  remarkably similar.
• Contemporary Vietnamese medicine is a harmonious
  blending of Chinese, Vietnamese and Western
  medical systems.
• Chinese medicine utilizes traditional and Western
  practitioners often in the same practice setting.
• In the U.S. there is a much grader use of
  alternative medicine by the public.

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Health Policy Implications

• To fully understand how biomedicine is practiced
  in developing countries requires an ethnographic
  perspective.
• The effect socioeconomic changes such as
  education requires further study.
• Non biomedical approaches to health care survive
  and are merging with biomedical approaches even
  in industrialized countries.
• Health care programs need to promote lay
  recognition of disease states so that appropriate
  action can be taken.

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Health Policy Implications

• Social networks need to be fostered to promote
  the referral of patients to appropriate health
  care providers.
• Barriers to health care such as transportation
  and cost need to be reduced.
• The misuse of pharmaceuticals needs to be reduced.

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Reference

• N. A. Christakis, N. C. Ware, and A. Kleinman,
  Illness Behavior in the Health Transition in the
  Developing World, In D. A. Matcha (ed.),
  Readings in Medical Sociology. Boston Allyn and
  Bacon, pp. 143-159.