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through degraded physical functions that make them more prone to disease. But
the effect was not uniform. This association between the social environment and
telomere length (TL) was also moderated by the extent of genetic variation in the
subjects within the neurotransmitter pathways of the serotonin and dopamine genes
that control the extent of pleasure and excitement responses. So some of the sub-
jects had a genetically influenced higher likelihood of sensitivity. It was shown that
those with highest sensitivity levels were more affected by their environment, hav-
ing the shortest TL when exposed to these stressful environments. But they had the
longest TL when exposed to advantaged environments. The researchers suggest that
this points to the presence of a genetic predisposition in the responses to the social
environment. The children with high sensitivity levels get even worse off from the
poor nurturing and environment, but have greater benefits from better conditions.
Yet those with limited genetic sensitivity may not be so affected by the negative
social environment, which may explain why some people survive the highly dis-
advantaged area and their resilience enables them to subsequently flourish. Yet the
general effect is that the children have their biological structure damaged by the
stressful social environment of their upbringing, leading to future health problems.
These findings mean that children in these areas are not simply disadvantaged be-
cause of locally poor educational opportunities to improve their life. Their negative
environment effectively ages them and makes them more liable to ill-health. This
recent research provides justification for early childhood interventions providing
effective nurturing, creating less stressful environments to reduce the probability of
what amounts to physical damage in epigenetic processes. The research has moved
the known correlations between childhood disadvantage and future ill-health to
causal relationships, although not all will be affected to the same extent.
13.5.7
Cultural Contexts and Interrelations
A final domain of influential factors affecting health is more wide-ranging in the
sense that it shows the cultural context-health connection, illustrating how the cul-
ture of societies—which includes political power and relationships—affects all of
the other determinants. Figure
13.1
shows that cultural factors can impede or im-
prove each of the various health determinant categories. For example, there have
been many cases where a religious or sub-cultural group in countries or cities have
refused to believe in particular medical treatments, while new medical advances
have also been resisted by some practitioners. The adoption of malaria nets over
beds in East Africa is a good example of the former. The uptake of nets supplied by
international agencies in the 1990s was extremely slow at first despite overwhelm-
ing evidence showing their effectiveness. The white nets, however, were deemed
too similar to the shrouds used to cover the dead, so they were not used. When the
colour was changed from white to green they were quickly adopted by the local
population. There is also a cultural-political background to the level of medical
facilities. Governments may provide less or more money for medical care. In terms
