Culture, Health Disparities, and Healthcare in Africa

Social Status and Its Determinants

The social status of an individual refers to the rank one holds within a group or community, and requires conformance to such rights, lifestyle, and duties as understood by prestige and social hierarchy (Encyclopedia Britannica, 2016). Status may be attained or ascribed in different ways. One may, for instance, inherit such status at birth, as happens in monarchies and kingships. This kind of status has nothing to do with one's innate abilities or skills. Ascribed status is based on factors such as age, family relations, lineage, birth, and sex, while acquired status is earned. It may be based on factors such as level of education, marital status, occupation, and similar accomplishments that require practical effort.

Status is about social stratification. The notion of a high position in society is based on one's ability to control other people's lives in some way — whether by law, order, or influence. Relative status is a strong influence on people's behavior toward each other, and generally varies with social context. For example, one's position within the family often determines how others in the wider community perceive that person. Occupational standing is also an important factor. In industrial economies, the ability to consume certain categories of goods, hold a respected occupation, dress well, and maintain proper etiquette have increasingly become yardsticks for determining status — a departure from traditional cultures rooted in lineage. In most modern societies, status has become closely linked with wealth (Encyclopedia Britannica, 2016).

In many African societies, a host of factors — including place of origin and family relations — historically determined an individual's social status. If one was born into a wealthy family, or one with close ties to an influential or powerful family, that person's social status would be higher than those from lesser families. The converse was equally true for those born into poverty.

Furthermore, being male traditionally carried a superior status to being female. While such perceptions still hold to a certain extent, they are now blended with Western influences such as Western education and shifting perceptions of status. Therefore, in addition to sex, age, and wealth, factors such as level of education and occupation have become strong markers of status. Personal accomplishments are also increasingly significant under these newer considerations.

African culture is passed from one generation to the next. It is important to note that Africa is not a single monolithic entity with identical cultures and peoples — the cultural content of the continent is diverse, as are its people, societies, and identities. Nevertheless, the majority of African cultures share a belief in the existence of a supreme being who created humans and endowed them with resources such as land, rivers, and animals — all critical for survival. This supreme being is known by different names across communities, but the shared belief is that this creator provides for humanity and governs life and death. African cultures have also been subject to Western influences, and the crystallization of belief in a single supreme being — now widely referred to as God — reflects that interaction.

Cultural Habits and Health in African Societies

People's cultural practices and habits affect not only their health but also their social relationships, their contribution to the health of their communities, and those communities' overall functioning. Different communities and races hold unique cultural inclinations and beliefs regarding disease and health. These ways of approaching life also shape how people view, respond to, and manage health challenges (Asu, Gever & Joshua, 2013).

Traditional cultural practices and values remain at the heart of many African societies. Analysis of African culture often presents two versions — traditional and hybrid. Among the most conspicuous and resilient symbols of African culture are naming practices for children, as well as marriage and initiation ceremonies. According to Asu, Gever & Joshua (2013), attitudes toward health and community practices influence the way people make use of healthcare facilities.

Factors that influence how people receive healthcare services in Africa vary from community to community and country to country, yielding different results and different patterns of disease spread. Key observable factors include the following:

Religious beliefs: Moral issues, religious practices, and beliefs significantly affect health. In cases where a person suffers from a serious illness, it is commonly attributed to the wrath of gods or ancestral spirits. African traditional religion incorporates ancestral spirits as a central element, and many African communities hold that all living things are harmoniously connected with both spirits and gods. When harmony exists with the environment, the spirits, and the gods, a state of peace prevails. These beliefs are shared not only among adherents of African traditional religion but also among many Muslims and Christians. Misfortune and illness that defies modern medicine are often attributed to spiritual forces controlled by sorcerers, wizards, or witches — or simply interpreted as the ancestors' displeasure with the community.

According to African belief, one does not simply fall ill without cause. Serious illnesses are nearly always understood to have a supernatural dimension. Viral, parasitic, or bacterial causes of illness are generally viewed as secondary to the true, spiritual root of the problem (Asu, Gever & Joshua, 2013).

Traditional African Medicine (TAM): Traditional African Medicine has long been the primary healthcare resource for rural communities. Conventional medicine is often in short supply, counterfeit, or prohibitively expensive for ordinary people in these areas. As a result, people's health is largely anchored in TAM, which is easily accessible and carries little stigma. Many African people strongly believe in the effectiveness of TAM, and these beliefs have had a significant influence on personal attitudes toward modern medicine. Generally, a rural dweller will call on TAM for the treatment and management of fractures, malaria, poisoning, mysterious ailments, and infertility, among other conditions.

The spread of education and modernization has increased the patronage of modern medicine among African populations, yet studies continue to demonstrate significant usage of TAM. Nevertheless, TAM faces challenges related to standardization, efficacy, and complications. Some TAM practitioners have made sweeping claims about the panacea-like effects of their medicines, and there have been deaths recorded among rural populations — the largest clientele for TAM — when those claims went unmet. It is often only after TAM fails to deliver on its promises that patients seek help from conventional medicine providers. The practice of TAM includes divination, ritual sacrifice, confession, and the use of plant and animal-based medicines. These elements are intended to restore the patient's harmony with the environment, the spirits, and the gods, and to repel the forces of evil believed to be at work. The most fundamental reason for relying on TAM is that nearly every health condition is believed to have a spiritual dimension, and therefore requires traditional healing (Asu, Gever & Joshua, 2013).

Denying reality: Many rural dwellers in Africa appear to be in conflict with the realities of treating chronic illnesses such as asthma, bronchitis, diabetes mellitus, arthritis, epilepsy, and hypertension. After several checkups and rounds of follow-up treatment, many conclude that orthodox medicine fails to provide a lasting solution and opt for TAM. It has also been observed that when people perceive a dead end in treatment — particularly for conditions such as coma, tetanus, and terminal cancer — they withdraw from formal healthcare and seek intervention from TAM practitioners (Asu, Gever & Joshua, 2013).