Social Determinants of Health

The silent killers of society: How health illiteracy and cultural stigmas affect thousands of rural communities worldwide

In the U.S., we teach our kids from an early age to make healthy choices in life—I recall how many of my elementary school days were spent learning about “go/slow/whoa” foods, the “fuel up to play 60” campaign, and the healthy-eating pyramid. As much as I may have disliked their dull repetitiveness at the time, these catchy slogans had made my class aware of the dangers of poor health choices. By doing so, they instilled in us a compass to do what’s best for us even as we grew older. Earlier today, my parents were reminiscing about their childhoods in rural India, and I was initially surprised by their descriptions of their own first years in school—they were so different from my own. During their childhoods, limited knowledge was available about best health practices, and this affected the choices they made in food selection, exercise habits, and other lifestyle choices. How does health literacy affect one’s quality of life in our world today?

On a global scale, health awareness influences widespread societal perceptions about public health, which is why it can be influential in disease occurrences and outcomes; people with accurate and up-to-date information on disease symptoms are more likely to visit a clinic to diagnose themselves, which may help them prevent an early condition from worsening. This effect extends onto a communal level: the more people are aware of a disease, the more can take actions to prevent it, and the less prevalent it will become in that community. Sometimes, however, the underlying problems are broader than a single disease, which can hurt disadvantaged groups in numerous ways.

For instance, in Indonesia, a U.N. study found that children from poor families were more than three times more likely to die before the age of 5 than their wealthier counterparts. This stark health disparity is prevalent due to a variety of reasons, but one of the most significant is the lack of awareness about sanitation in low-income households. Only 12% of children regularly use water and soap to clean their hands after using the restroom, and only 14% before meals. This lack of sanitation can contribute to a myriad of health conditions, such as viral infections, diarrhea, and diseases, leading to a poorer quality of life.

Sanitary sources of clean water can drastically reduce the spread of infection and disease.

Of course, the lack of awareness about sanitation isn’t the only factor responsible for the greater mortality rates in low-income children—like all social determinants, sanitation is one node in a broader network of factors. Sometimes, access to (rather than awareness about) sanitation is the first barrier that needs to be overcome. Other nodes in this societal network, such as access to safe drinking water and improved housing conditions, need to be addressed simultaneously. 

In addition to sanitation, health literacy (e.g. nutritional literacy) is another crucial facet of public health, since nutritional choices that children are proven to stay with them throughout adulthood. From my mother’s upbringing in India, I learned that her school hadn’t taught her about the importance of eating a balanced diet, so she didn’t have the opportunity to learn this until a much later age. On a global scale, this can increase the occurrence of nutritional disorders, such as malnutrition or obesity, contributing to the deeply-rooted “pandemics” that have affected human societies for centuries. However, were nutritional literacy to improve, families would have improved access to resources and programs that ensure their well-being throughout their lifetimes. As an example of this positive impact, organizations such as Rise Against Hunger India and the Global Alliance for Improved Nutrition are focusing their efforts to address the disproportionate concentration of nutritional disorders in Northern India.

HIV/AIDS is widely stigmatized in rural communities, especially in Africa, where it’s the most prevalent.

Finally, health literacy and awareness are deeply interconnected with cultural stigmas that surround disease. People suffering from “taboo” conditions, such as mental disorders, HIV/AIDS, and skin conditions, are often ostracized by society. This problem especially occurs in rural communities due to the lack of available medical information. Due to the fear of ostracization, less people are likely to visit health clinics to diagnose their health conditions, creating a cycle that allows conditions to worsen without treatment. Unfortunately, this positive feedback loop amplifies the struggles experienced by ill individuals and families.

However, constructive reforms are taking place. Returning to my parent’s early days in school, their village has since urbanized, and nutritional practices have significantly improved in the past few decades. In addition, throughout India, many local universities are partnering with communities in promoting health awareness.

Although these programs are a step in the right direction, much more progress is needed to achieve equity in health literacy and removing cultural stigma surrounding certain conditions. There are still thousands of rural towns who have yet to experience change, and these are often the most affected by such issues. From the U.S., there are many ways we can contribute to the cause: spreading awareness, supporting global health charities, and starting our own initiatives to contribute to the cause. The path ahead points us to a problem of a greater magnitude than any other, but with our combined efforts, we may gradually be able to enact change.

Author’s note: This is the fourth post of the social determinants of health series, in which I discuss international public health disparities and societal factors contributing to public health. In these posts, I’ll delve into my journey into the field of public health, specifically focusing on eye care/visual impairments in underprivileged communities, while describing my experiences along the way.

Further reading

Bonner, Adrian, editor. Social Determinants of Health: An Interdisciplinary Approach to Social Inequality and Wellbeing. 1st ed., Bristol University Press, 2018. JSTOR, Accessed 27 May 2020.

Baker, David W. “The meaning and the measure of health literacy.” Journal of general internal medicine vol. 21,8 (2006): 878-83. doi:10.1111/j.1525-1497.2006.00540.x

Institute of Medicine (US) Committee on Health Literacy; Nielsen-Bohlman L, Panzer AM, Kindig DA, editors. Health Literacy: A Prescription to End Confusion. Washington (DC): National Academies Press (US); 2004. 2, What Is Health Literacy? Available from:

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