You've previously heard about many of the socioeconomic determinants, and you're familiar with the Dahlgren and Whitehead policy rainbow. But I want to talk about the social and cultural factors, which can affect many of the ways we decide things and act. Why do we behave the way that we do? There are a number of individual level theories which try to describe the way people behave. The health belief model places value on individual judgment and the likely outcome of a behavior. For example, the choice of being vaccinated, or the teenage risk-taking behavior. Other theories such as the theory of reasoned action and theory of planned behavior, or the social cognitive theory have an individual focus, but also bring in a discussion about societal norms. Thinking about the theories you've already seen and what you know about behavior, let's take a step back. What are the differences between knowledge, intention, and behavior? In a very theoretical way, knowledge leads to intent which leads to behavior, a linear process. Yet, you realize upon reflection that there are many things you should do and yet you don't and in fact, you might not even try. That is the knowledge intention gap. There may be some things you try to do and yet you don't achieve. This is the intention behavior gap. So why is it that we don't think we achieve these things? If I ask you, you'll come up with a large range of explanations. You don't have time, none of your friends are doing it. You had something else that distracted you, perhaps all of these. You've now come to the conclusion there is little about our behavior that truly is linear, based on both your experiences and these lectures. Instead, there's a wide range of other influences that frustrate even the best of intentions. Social influences or what your friends and peers are doing are among the most powerful. You're more likely to exercise regularly if you're in a culture where everyone goes to the gym after work. On a heavier note, young girls might be more likely to be pulled from school so that they can be married if society deems marriage central to preserving social status, and if child marriage is culturally acceptable. These are just two examples of where what we term "social norms" affect behavior. So what are social norms? Norms refer to a shared group of expectation. Social norms are rules that are developed about how people should and should not behave in certain situations. In essence, a set of rules by which we all live, whether we explicitly or implicitly agree to them. These social norms can be formal as with laws or more informal, manners. These informal norms can be classified as descriptive norms doing what others do, or injunctive norms, doing what others think one should do. In either case, it is clear that the behavior can be influenced by what is deemed to be acceptable. A number of different disciplines explores societal norms and behavior. Regardless of the discipline, our behavior is inextricably linked to our social climate. According to Gertz, "Culture is the means by which people communicate, perpetuate and develop their knowledge and attitudes about life. Culture is the fabric of meanings." By this, he means not only is culture the way people interact, but also the way they perceive and internalize social approval and disapproval. Disapproval or approval from the group often maintains the social norm. Sanctions can be positive or negative. Admiration and praise or contempt and ostracization. The way in which mental health is interpreted in different cultures is a prime example of this. Different countries have or may not have words to describe the state mental health problems, and may attribute the existence on a variety of factors like biomedical neurophysiological imbalances or alternatively, witchcraft. In Sierra Leone, the word for depression, [inaudible] literally translates to a spoiled heart. Whereas depression is defined by a mood disorder causing persistent feelings of sadness and loss of interest by the medical community. Interestingly and perhaps unsurprisingly, symptoms are similar, but described in different ways. Thus, the conception of what depression is, how it manifests, how to treat it, and how to treat those who have symptoms is dependent on culture, as are many other behaviors and ways of understanding the world. So where does that leave us in terms of how people behave? There's no easy answer. Individuals have personal attitudes or dispositions towards certain behaviors or thoughts and personal autonomy, or the ability to make decisions on their own. But ultimately, you cannot negate the consequence of your social structures. While this is just a brief introduction to some of the discussions around how societal and interpersonal level factors affect behavior, the key is that it's complicated and everything links in one way or another.
