geographic and cultural attitudes towards tuberculosis

TUBERCULOSIS

TUBERCULOSIS 2

Tuberculosis: A Cultural and Geographic Perspective

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Introduction

Culture, religion, and geography all play a strong role in perceptions of health and illness. Health-seeking behaviors and lifestyle choices may also impact health-related outcomes and quality of life. Therefore, it is important to understand how socio-cultural variables like religion and worldview affect views towards specific diseases. An anthropological perspective on infectious diseases like tuberculosis helps public health advocates and nurses alike improve their responses to patient needs, tailor their heath outreach programs and campaigns to specific individuals or communities, and ensure better health outcomes.

Cultural Beliefs and Influences

Tuberculosis itself is not socially constructed, but beliefs about how the disease is contracted and how it spreads are. For example, cultural beliefs about social hierarchies, power, and subordination perceive tuberculosis as a product of hegemonic “Western” infrastructure that leads to environmental toxins causing the disease (Edginton, Sekatane & Goldestein, 2002, p. 1075). Stigma against the disease and those who have it also have a cultural context, and impact patient attitudes towards care and health-seeking behaviors. Cultural beliefs will also influence attitudes towards healthcare workers, and perceptions of educational materials distributed by local healthcare institutions (Moschetta, 2003). Mistrust of the healthcare system or the government may lead to a mistrust in the content of health education literature, challenging health educators and advocates to change the way they present these materials and educate their patients.

Religious and Spiritual Beliefs and Values

Religious and spiritual beliefs have a strong impact on attitudes towards how tuberculosis is contracted and how it spreads. For example, in some rural regions of South Africa, patients believe that tuberculosis results from “breaking cultural rules that demand abstinence from sex after the death of a family member and after a woman has a spontaneous abortion,” (Edginton, Sekatane & Goldstein, 2002, p. 1075). Perceived disease etiology will vary depending on culture and geographic context. In Cameroon, for example, infection may be attributed to possession by a spirit or the placing of a curse by a sorcerer (Grietens, Toomer, Um Boock, 2012).

Influence in Addressing the Issue

Religious and spiritual beliefs have generally hindered progress in treating, preventing, and eliminating tuberculosis in the most affected regions. When patients and their communities uphold religious beliefs about tuberculosis, it affects how, when, and whether they will seek medical care. For example, patients who believe that the disease has a spiritual cause, they will be more likely to seek help from a traditional faith healer than from a physician (Edginton, Sekatane & Goldstein, 2002). Rather than fight or disparage traditional religious and spiritual beliefs, healthcare workers would do better to engage faith healers in the community, involving them in the information and education process to reach more patients and encourage them to seek medical tests and treatments in conjunction with their traditional healing modalities (Viney, Johnson, Tagaro, et al., 2014). Beliefs about the religious or spiritual origins of a disease will impact how a patient or a community will interpret medical literature outlining the scientific causes and solutions to the disease. Most importantly, the religious beliefs may impact how the community stigmatizes patients. Many tuberculosis patients become social outcasts, thereby exacerbating problems like poverty and depression (Mathew & Takalkar, 2007). Some beliefs about tuberculosis are not religious per se, but simple misinformation such as the belief that the disease is caused by sharing food or shaking hands (Mathew & Takalkar, 2007).

Ideologies, Politics, and Geography

Political Parties

Political affiliations are correlated with attitudes towards tuberculosis because of the connection between ethnicity, religiosity or religious affiliations, and political affiliations. Because of the connection between variables like poverty, illiteracy, and disenfranchisement with political party affiliations, it is important to embed public health discourse into political agendas. Throughout the globe, the panoply of political party affiliations lead to no direct causal relationship between any one party and healthcare attitudes and beliefs. However, socioeconomic variables and geographic issues such as rural versus urban residency would have a strong bearing on health behaviors. Political party affiliation has far less a role to play in the dissemination of misinformation than the overarching cultural and religious institutions that guide the worldviews, attitudes, beliefs, and behaviors of at-rick populations.

Geographic Regions

Within the United States, tuberculosis is most common in areas with high percentages of foreign-born populations from at-risk nations or geographic regions (Moschetta, 2003). It is important also to differentiate between the areas of origin of foreign-born populations to identify the most at-risk communities. Tuberculosis interventions, outreach, and education materials need to be written in the appropriate languages and with the appropriate cultural conventions to appeal to target audiences.

Countries

Tuberculosis is most prevalent in developing nations, with India, China, and Indonesia bearing the heaviest burdens (World Health Organization, n.d.). The disease is also prevalent in Africa. In wealthy nations, outbreaks are mainly concentrated among immigrant populations from these at-risk countries. Country-specific health data should better inform public health and outreach strategies, which can be funded by the highest burden nations and more relevant to their populations (Pai, 2018).

Conclusion

Geography, political affiliations, religion, and culture all impact attitudes and outlooks on health and wellness, with tremendous implications for public health policy and localized outreach services. How nurses choose to identify contextual variables will also have a strong bearing on patient perceptions, quality of care, and health outcomes. Tuberculosis is a persistent but preventable infectious disease with strong connections to geography, socioeconomic class status, and lifestyle factors. Understanding tuberculosis from a broader perspective that takes into account culture and context can help nurses and policy analysts come up with more effective solutions for containing and eliminating the disease in each affected region.