The field of medical anthropology is concerned with how culture influences human health and disease as well as the role of health care system in determining health and disease.  Cultural and ethnic influences are considered as far as health status of different populations is considered whether in the prehistoric era or in the contemporary days (McElroy, 2002).  Among the cultural factors that have an influence on the development and outcome of disease across different cultures are poverty and inequality. Different diseases will affect different cultures differently depending on the level of poverty and different aspects of inequalities such as income inequality, inequality in education and gender inequality among other disparities.
This paper argues that poverty and social inequality are great determinants in patterns and types of disease in different cultures.  A variety of examples and illustrations are provided to support the argument.
Poverty and disease in different cultures 
Poverty is considered as among the greatest factors that influence health (Murali  Oyebode, 2004). Poverty is a phenomenon that can be viewed through many faces but it Murali and Oyebode (2004) basically defines poverty as covering three main aspects being unable to meet basic needs, having no control over resources as well as lacking in education and good health. Low levels of education lead to social exclusion and disparities in health status. Health status is also influenced by differences in race, gender, ethnicity as well as occupation with political process also being central to poverty determination (World Bank Group, 2004). The consumption levels as well as income levels of individuals is taken to determine the level of poverty thus people are regarded poor if they are living below poverty line i.e. they can barely meet their basic needs as determined in different societies. Absolute poverty has a far reaching effect in determining disease and types and patterns. Abject poverty is defined as a life state whereby individuals face malnutrition, illiteracy, disease, squalid surroundings, high infant mortality rates and low life expectancy as to be beneath any reasonable definition of human decency (Laurent, 2010, para 6). Although a poor person is considered to be living on less than one U.S. dollar per day (absolute poverty), it is also possible to have relative poverty whereby a person earns more than a dollar per day but they are still highly unequal compared to other members of the society (WHO, 2006).
Poverty and social inequality contribute to not only infectious diseases but has been linked to other forms of diseases such as cardiovascular and psychiatric diseases. Different explanations are provided for each of these cases as elaborated later in this paper. 
Non-communicable diseases are also influenced by poverty and social inequality. According to World Health Organisation (WHO), Western Pacific Region, non communicable diseases (NCD) are prevalent among the poor in developed countries and have a marked increase in the developing world. The main most common of the NCDs in the Western Pacific Region are cancers, diabetes and cardiovascular diseases. Poverty among the populations in the Western Pacific Region is associated with smoking and unhealthy diet, and physical inactivity, the levels of non communicable diseases have risen significantly. Non communicable diseases are more prevalent among persons with low education levels whether in the developed or developing world.  WHO (2006) notes that the increase in prevalence of NCDs has been due to the earlier misconception that these are diseases of the affluent.  Since the NCDs are now known to affect even the poor, WHO (2006) indicate that the poor suffer most from these diseases as treatment and preventive services are expensive to establish or even afford where they are available. Other than the poor being unable to access and afford treatment and preventive measures for NCDs, the poor are also vulnerably to discrimination in terms of quality of services received.
It is worrying that the non communicable diseases, which were initially diseases of the wealth, are increasing among the low-income populations to levels of high income populations. Obesity is for instance on the rise among poor populations with South Africa recording a high of 50 percent overweight individuals in the population and Morocco having a 40 percent overweight population (Stevens, 2004). Diseases such as diabetes and stroke that come in association with obesity are also more common. The rise in obesity and cardiovascular diseases among the low-income populations is attributed to availability of low quality foods that are rich in calories and fats. As much as inaccessibility to treatment may be leading to deaths associated with the non communicable diseases, poor access to the accurate information regarding the risks of changing lifestyles is also a major factor (Ezzati et al, 2005).
Stelmach et al (2009) showed that low income and education level are contributors to cardiovascular diseases. In the study carried out in Lodz, Poland amongst elderly formerly communists these authors found out that cardiovascular disease were more common among less educated. For instance, smoking was found to be more common amongst younger and less educated single adults and this increased the risk of cardiovascular conditions such as hypertension. Diabetes and obesity was also more common among the less educated compared to higher levels of education.
Hunger, the want and scarcity of food in a country is considered as a poverty factor that enhances disease (World Hunger, 2009, para 1). Poverty is the number one cause of hunger and levels of poverty are almost equivalent to the global estimate of undernourished persons.  Whereas there are an estimated 982 million poor persons in developing countries, the estimated number of undernourished people is 1.2 billion. Hunger is associated with malnutrition whereby a person lacks part or all of the nutritional elements. The malnutrition may be in form of lack of proteins and energy giving foods or malnutrition in form of lack of micronutrients such as vitamins and minerals. When the body lacks the essential nutrients, an array of diseases is likely to set in. developing countries experience the greatest impact of malnourishment and hence development of nutrition deficiency diseases. World Hunger (2009) estimates that undernutrition is very prevalent amongst children with children suffering from sickness for 160 days in every year. Undernutrition exacerbates almost all diseases and especially malaria and measles. With Asia and Africa recording the highest number of malnourished children (70 and 26 respectively), it is no wonder that these continents experience highest child morbidity and mortality rates from infectious diseases. For instance, undernutrition leads to 57 percent of deaths from malaria and 52 percent deaths from pneumonia. Worse still is that malnutrition affects the health of the pregnant mother leading to learning disabilities, retardation and blindness among other health problems.
Deficiencies in specific micronutrients lead to nutritional deficiency diseases. Developing countries which are struck by poverty suffer most from nutritional deficiency syndromes. Deficiency in vitamin A leads to night blindness and immunosuppression and it is estimated that up 500,000 vitamin A deficient children become blind every year. Whereas it is cheap to supplement vitamin A in the diet, the poor cannot afford such or they are misinformed on proper diet. A deficiency in iron has led to more than 30 percent of anaemic conditions in the world with developing countries suffering most as malaria and worm infections exacerbate the condition. As a result of iron deficiency, children usually suffer from developmental disorders, infections and the risk of death. Asia and Africa still tend to suffer most from iodine deficiency with mental and congenital abnormalities such as cretinism being the most prevalent (World Hunger, 2009).
Poverty and social inequality is linked to several psychological disorders. This is because poverty leads to social withdrawal and alienation and distress which consequently affect alter the emotional state of a person.  Jeopardised mental health as a result of poverty-related distress then leads to the development of psychiatric disorders. If for instance a person is receiving income which has a great inequality measure, they are likely to suffer from psychosocial stress thus affecting health negatively. According to Murali and Oyebode (2004), the poor are not only exposed to dangerous working environments but they are also under constant stress having to labour for less rewarding jobs. In addition, the poor also face isolation from the rest of the society since they may enter into maladaptive behaviours as a means of dealing with stressful situations. Poverty and social inequality therefore acts as stressors which have the capacity to initiate or worsen psychiatric disorders.
Although poverty is not always positively correlated to psychiatric disorders, the relationship between these two is mainly a positive one for several psychiatrist disorders that have been studied. Psychiatric disorders are more prevalent in low social class societies with high prevalence of mental disorders being associated with high levels of unemployment. Murali and Oyebode (2004) particularly mention that psychosis is more prevalent in social class V which is a low social class in the UK. Although genetic predisposition to schizophrenia is a contributing factor to development of schizophrenia, low class persons tend to have this predisposition exacerbated by these stressful conditions. It is also observed that schizophrenic symptoms such as hallucinations and delusions are more severe in the low social class persons compared to middle and high social class persons. It is though that the symptoms are exacerbated in lower social class individuals since most of them cannot access health care services or are ignorant of the existence of any help (Hodes, 2002).
Prevalence of childhood mental disorders is higher in children from poor family backgrounds. It is for instance estimated that children from poor households have a three times likelihood of developing mental illnesses compared to children in well to do families. The persistent stressors in the life of children seem to impair the cognitive skills of a child as well as hinder their educational achievements which exacerbate poverty and stress. Persistent poverty seems to affect the development of psychiatric disorders in children with children living in persistent poverty experiencing lower cognitive functions in adulthood (Brown et al, 2000). Children facing social economic deprivation also experience conduct disorder at a higher rate than children from well to do families.
Reproductive health is also among the health issues that affect different populations depending on poverty and inequality levels. It is identified that poor families rarely use birth control measures due to ignorance of the existence of such, inability to access such services as well as unavailability of the services (Khan, 2001). In Africa for instance, the percentage of poor women not using contraceptives is very high compared to wealthier women who do not use contraception. As such, poor families tend to have a higher reproductive rate than wealthier families and this increases reproduction-related problems. Maternal mortality rates are found to be higher among poor women since poverty causes the women to lack access to health care facilities. Often, the pregnant mothers in the poor family settings are attended by unskilled and unprofessional health workers which increase risks of unsafe motherhood. The higher maternal mortality rate in Africa may be attributed to the low number of skilled birth attendants (46.5 percent) with low income families being hard hit by this phenomenon (UNFPA, 2009).
Distribution of infectious diseases such as malaria and HIVAIDS clearly shows a link between poverty, inequality and disease patterns. The high prevalence in HIV in Africa is highly attributed to poverty and various social inequalities. The distribution of HIV in Africa follows a poverty trend as demonstrated by socio-economic distribution. Poverty in Africa tends to follow a gender inequality dimension with females being hard stricken by poverty and subsequent HIV prevalence (Anabwani  Navario, 2005). The sub-Saharan Africa is the most affected by poverty and HIV infection with about two-thirds of all global HIV infections as in 1997 being localised to sub-Saharan Africa. Women are generally more affected by HIV infection whether directly or indirectly. Whereas poverty per se is not an obvious factor towards HIV infection in Africa, its role cannot be ignored since poverty worsens the coping ability of the infected individuals. Since HIV infection is hest tackled by informing the public on the preventative measures, it is expected that the less informed (probably due to alienation) end up experiencing more infections (Shelton, Cassell  Adetunji, 2005). With poor communities facing the hardship of accessing health facilities or being politically as well as socially marginalized, they are less likely to learn appropriate sexual conduct. As such, the poor get predisposed to factors that increase the likelihood of HIV infection. For instance, sexually transmitted diseases are likely to persist among the poor which in effect increases the likelihood of HIV infection (Cohen, 2010).
Lopman et al (2007) attempted to find out whether HIV has gained the trend of the disease of the poor in Manicaland, Zimbabwe. The study concluded that higher socioeconomic status was associated with lower HIV incidence and mortality.  Even though the high economic status men were found to have more sexual partners, the infection rates were still low since they reduced infection risks through use of condoms. Although this study identified a decrease in HIV infection in Zimbabwe, it acknowledged the fact that the decrease was more significant among the small population of wealthy individuals thus associating the disease with poverty. The poor in Manicaland have lower educational status in addition to lower social status which makes them less empowered in changing risky sexual behaviours. For instance, whereas the better-off women had less sexual partners in addition to being less likely involved in transactional sex, the poor women on the contrary get involved in risky sexual behaviours.
The high prevalence of HIV infections in sub-Saharan Africa is also associated with the fact that the poor are usually neglected socially and politically. Rarely do HIV intervention programmes focus on the interests of the poor in the society. Failure to have programmes that address the socio-economic status of the poor further make the poor to be exposed to that increase the risk of HIV infection (Singer  Boer, 2007). For instance, women in sub-Saharan Africa who are the household heads and are among the poorest are likely to get involved in commercial sex which predisposes them to HIV infection. A poor HIV infected mother is then likely to transmit the infection to the child either in utero or during breastfeeding. This is because these women can rarely afford the antiretrovirals that help in prevention of mother-to-child transmission. Most of the HIV infected mothers end up breastfeeding their babies since they cannot afford the baby formula as an alternative (Cohen, 2010). Worse about HIV infection is that it exacerbates poverty thus exposing individuals to other poverty-related diseases.
Poverty and social inequality are related to malaria infection in that malaria is more common in poor developing countries than in developed countries. While malaria can easily be prevented through the spraying of dwellings with insecticides, use of insecticide treated nets, prophylactic drug administration and taking measures to eradicate the disease causing vector, malaria is still a challenge to the developing countries (Calisher, 2007). This is because these poor countries are not able to effectively incorporate preventive programs with the poor populations being severely affected. Likewise, tuberculosis is a killer disease among the poor who are unable to afford good housing conditions, nutrition and prompt therapy (European Research, 2002). In particular, tuberculosis infection is very prevalent in overcrowded places such as in refugee camps and slums. It is disheartening that the poor cannot afford vaccines for diseases that were eliminated in developed countries long time back. For instance, diseases such as polio and measles have vaccines yet the diseases contribute 5.2 of Disability Adjusted Life years in low-income countries.

Sub-Saharan Africa was still lagging behind (53 percent) in the number of children immunized against diphtheria-tetanus and pertussis by 2000. Poverty also goes hand in hand with poor sanitation which increases incidence of diarrhoeal diseases. Despite the fact that such diarrhoeal diseases can be treated cheaply, they still kill up to 1.8 million people per year in the poor societies due to poverty and health inequality (Stevens, 2004).
Poverty has far reaching effects on human health considering that poverty takes different dimensions such as income, education and social inequality. Poverty distribution across different cultures leads to development of various diseases as well as patterns of disease distribution. In essence, the role of poverty and inequality in disease patterns in different cultures differs variably. However, it is no doubt that poor populations are mainly affected by non communicable diseases, psychiatric disorders and infectious diseases. In essence, poor cultures are generally unable to afford proper health care they have low education status and hence poorly empowered to counter common diseases. Conclusively, the low income countries particularly sub-Saharan Africa and Asia are most affected by almost all forms of diseases with poverty and social, economic, health and political inequality being the central cause. 


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