By Paul Andrew Bourne



One writer forward the perspective that "studies that have examined the health-seeking behaviour of elderly people in developing countries reveal several important determinants: age, sex and poverty (18); expectations about aging (19); interpretation and experience of symptoms (20); and the degree of social integration into community (21) among other" (Ahmed, et al., 2005) Although this research is not fashioned with the ambits of the former, the determinants were factors in determining health-care seeking behaviour of particular age cohorts; and so this research will apply those same variables but for individuals between 15 and 99 years old.

According to the writers Kazanjian, Morettin and Cho (2004) who did a study on the utilization of health care by Canadian women, women are twice as likely as men to report a regular family physician, but that proportion could be regarded as insignificant.

The researchers stated that women are more regular users of health services than men in Canada. Sex differences in health services utilization is disease specific, reflecting the biomedical approach to exploring health and illness. The researchers identified data from Statistics Canada which show that while 81.3% of the population, 12 years and older, had contact with medical doctors in the preceding 12 months, 87.2% of the female population reported such contact in the same period. On the other hand, women and girls were less likely to have had no contact with medical providers than men and boys.

There is a significant probability for women than men to present themselves for medical care or consultation. Women are dependent on the health care system to guarantee, control or terminate their fertility. Healthy women are expected to have their regular female related check ups, as a result they could be regarded as over users of the system relative to men.

The writers Kazanjian, Morettin and Cho (2004) postulated that there is a greater expectation for women than men to present themselves for medical care or consultation. Although women’s passage through the life cycle is both social and biological processes, in medical terms the focus is on the biological process. Medical management of men occurs only in the military and sometimes at the beginning of employment.

Cost is yet another factor discouraging utilization of mental health services. Minority persons are less likely than whites to have private health insurance, but this factor alone may have little bearing on access. Public sources of insurance and publicly supported treatment programs fill some of the gap. Even among working class and middle-class African Americans who have private health insurance, there is under representation of African Americans in outpatient treatment. Yet studies focusing only on poor women, most of whom were members of minority groups, have found cost and lack of insurance to be barriers to treatment. The discrepancies in findings suggest that much research remains to be performed on the relative importance of cost, cultural, and organizational barriers, and poverty and income limitations across the spectrum of racial and ethnic and minority groups.

The World Health Organization’s (WHO) (2005) "Poverty and social exclusion are the greatest threats to their well-being (10). Elderly women are especially disadvantaged due to their marginal position in the society (11)" perspective clearly indicates that the problematic framework of low-income people concerning social exclusion in relation to health care seeking behaviour is ideographic of the difficulties that they interface continuous in their daily lives. Steinman (2004) postulated that African Americans with low incomes and low literacy levels disproportionately suffer poor health outcomes from many preventable diseases. Low functional literacy and low health literacy impede millions of Americans from successfully accessing health information. These problems are compounded for African Americans by cultural insensitivity in health materials. Inaccessible health information also contributes to a higher burden of disease. Many groups encounter obstacles in accessing health information. Low socioeconomic status (SES) African Americans with substandard literacy skills has been shown to suffer excessively from preventable complications of diseases such as breast cancer and diabetes.

In survey in Bangladesh and Vietnam, Ahmed, Tomson, Petzold, & Kabir (2005) conducted a research to elicit information on the health-seeking behaviour of household members over 20 years. It was discovered that socioeconomic indicators were the single most pervasive determinant of health-seeking behaviour among the study population, overriding age and sex, and in case of health-care expenditure, and types of illness. It was discovered that no major differences in health-seeking behaviour between elderly people and younger adults. On average about 35% of those who reported having been ill during the previous 15 days in both age groups chose self-care/self treatment; for both age groups the most commonly consulted type of provider was a paraprofessional such as a village doctor, a medical assistant or a community health worker. Patients’ level of education affected whether they avoided self-care/self-treatment and drugstore salespeople and instead chose a formal allopathic practitioner. Despite the advanced statistical technique (i.e. logistic regression) that used the researcher, they admitted that the findings lack external validity. The sample was particular district in which four localities were chosen. The selected villages were within one district; and these were selected because of the close proximity (3 miles) to a starting point. The findings on the sampled population, therefore, cannot be used to generalized on the population (i.e. Bangladesh); but this research unearth valuable information that forms the basis of for a study in other topologies within the context of the use of probability sampling techniques on the nation (i.e. country).

Case, Menendez, & Ardington, (2005) cited that at older ages, fewer individuals sought treatment at public medical facilities. The use of traditional healers increases among persons who died in their late twenties, of whom almost 60 percent sought care from a traditional healer. Traditional care declines at older ages, and there is a small downward trend in the use of non-prescribed treatment with age. It is therefore evident that care seeking declined above age 60.

Case, Menendez, & Ardington, (2005) examined patterns of health seeking behaviour of some individuals who lived in the Northen KwaZulu-Natal prior to their death. It was discovered that significant positive associations between individuals’ socioeconomic status, measured using household ownership of a variety of durable goods, and their use of medical services. The researchers found out that asset ownership correlate significant to health status and health seeking behavior. Individuals with greater economic resources are significantly more likely to seek treatment from private doctors, and spend considerably more for all types of health services. Individuals who are ill for a longer period before death are reported to see a greater number of health providers. While almost everyone interacts with Western medicine, those who are ill longer also see traditional healers and take non-prescribed medication. According to Jimba (2002) research when rural Nepalese feel sick, they seek healthcare only when the sickness is moderate and severe. Mild illnesses are treated at home. When the villagers seek health care, they preferred to visit traditional healers first, before visiting other health workers.


Latin America and Caribbean perspectives
Social health must receive focus and intervention. Changing social norms related to violence, avoidable injuries, responsible sexual behaviour, and a clean environment, for example, will become more critical. Use of appropriate interventions: information, communication, legal and fiscal measures and persuasion, will necessitate new ways of working and new partners with whom to work, in the public and private sector (Caribbean Epidemiology Centre, 2000).

The Caribbean Epidemiology Centre’s monograph in its "Annual Report, 2000"is a summation of number of the socio-demographic factors that are of importance in the social research within the context of health. This setting is primarily so because health is beyond the tradition definition of physical ill-health to social and psychological wellbeing of the individual, which include many social conditions that continuously interface the people in their environ. This organization has laid the foundation for an investigation of determinants of health-seeking behaviour of Caribbean nationals. In a study on Jamaican elderly Eldermire highlights a number of socio-economics conditions that determine health seeking behaviour (Eldemire, 1997). She forwards the perspective that access to health insurance is aids the health-care behaviour of elderly, which concurs with the findings of Ahmed et al. (2005). Eldemire argues that
The situation of older person in developing countries is largely due to the consequences of social and cultural change in all countries of the third world (Eldemire, 1997, p.76).

The perspective of Eldemire is an illustration of the Caribbean Epidemiology Centre’s stance of the social conditions that are imperative determinants of health-seeking behaviour of Caribbean nationals. Those positions were always uttered by Ahmed et al. and other non-Caribbean researchers. On like the former authors, the latter’s findings are external validity, and so are usable for generalizability of the Jamaican populace. I will apply the conditions that exist in determining health-seeking behaviour of the elderly as a proxy for all other age categorizations.
A research that was done in Mexico which was sponsored by the World Bank revealed a number of findings that were similar to those unearth by Eldemire and Ahmed et al, and other writer, that
Education is likely to increase demand for health services as it raises the
productivity of health production, the household's appreciation of the benefits of better health care, and its potential labor market earnings (Although theoretically education could reduce health service utilization by increasing the opportunity cost of time devoted to health care, most studies show that education have a positive effect, implying that its opportunity cost effect is less than the other putative effects of education.);
The time (distance) it takes to access a health service reduces the use of that service; it may, however, increase the use of other health services, depending on whether they are substitutes or complements;
Health insurance increases demand for health care, since it reduces the price of health service use;

The demand for preventive, curative and other health services can then be expressed as a function of household wealth, the price of health services, the environmental health threats, and other exogenous factors such as education, age and culture that either affect the production function, the resource constraint, or the household's utility function.
. . .health insurance, education, urban-rural residence, and wealth
appear to be significantly positive determinants of perceived health status.


The research carried out in Mexico used probabilistic sampling frame and so is external validity as a tool of generalizability of the people’s social setting. In a critical perusal of findings of the World Bank study on Mexicans, information obtained were on all people, which highlight the issue that the determinants of health-seeking behaviour for adults are those for all concerned. Pan American Health Organization (PAHO) (2003) in one of its presentations concurs with the World Bank, Eldemire, Ahmed et al. and other writers that:

The family is the key social institution that joins individuals related by birth or by choice into a household or a domestic unit. The family is the setting where health behavior and health decisions are first established. In the Americas, cultural factors in families impact significantly on access to, and on health- seeking behavior; for example, women may assign a lower level of priority to their health needs giving preference to other family needs such as food and education. This priority setting may adversely affect the health of the family; however, it is in the context of the family that this behavior is best modified;


Families are often a reflection of the community and provide the first level of education for its members about healthy behaviors that should be followed, unhealthy behaviors to be avoided or changed, and their roles and responsibilities to themselves and to society. Sometimes elements in the family setting are not conducive to promoting or protecting the health of some of its members. It is therefore important that the community
have family support systems in place in cases where the health of family members is threatened by violence, abuse, neglect, or abandonment.

Within the perspective of PAHO, the determinants of health-seeking behaviour are social, economic and cultural. It should be noted from the viewpoint of PAHO that culture begins the socialization of health-seeking behaviour, and it is through this medium that social and other variables are introduced. With this perspective, the determinants of health-care seeking behaviour of the elderly are the same for other age cohorts. All the writers have agreed with each other that education, access to health care, duration of illnesses, income, social class, and cultural factors determine health-care seeking behaviour of ‘people’.


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