Essays on culture and disease

• Main Author: Mohanty, Aatishya
• Other Authors: Akshar Saxena
• Format: Thesis-Doctor of Philosophy
• Language: English
• Published: Nanyang Technological University 2023
• Subjects: Social sciences::Economic development
• Online Access: https://hdl.handle.net/10356/164544
• Institution: Nanyang Technological University

This thesis contains three independent essays that explore the association between culture and disease. The persistence of cultural complexities, especially the individualism-collectivism divergence across regions plays a key role in influencing the beliefs, behavior and societal norms of modern times and has been found to be an important determinant of long-run economic development. The essays in this thesis contribute to this line of inquiry by empirically examining questions pertaining to the individualism-collectivism dichotomy and its subsequent link to health outcomes. The first chapter studies the origins of individualism. We test the hypothesis that areas exposed long-term to more ultraviolet radiation (UV-R) exhibit a greater degree of collectivism. The incidence of the eye disease cataract may be a mechanism. With a higher probability of developing blindness or reduced eyesight from cataract, the level of risk aversion rises. Families and kin groups form closer bonds as an insurance mechanism, leading to collectivism. Moreover, reduced eyesight may have been taken as a cue for the presence of pathogens, contributing to uncertainty avoidance and risk aversion, in turn encouraging isolation, aversion to out-groups, and conformism. These are established behaviors in collectivistic societies. The second chapter explores the legacy of agricultural practices on health outcomes in India. The historical variation in agricultural practices can lead to divergence in cultural orientation across regions. This, in turn, can influence individual behavior as well as community-led actions to act as either a deterrent or aid in the spread of an infectious disease. This essay elucidates how the divergence along the individualism-collectivism dimension leads to differences across regions in the prevalence of diarrhea in India. Using subnational data on rice suitability to measure collectivism, we provide evidence that collectivism is negatively associated with the prevalence of childhood diarrhea across 618 Indian districts. We find that the mechanism works through improvements in water and sanitation. Collectivism propagates values of interdependence, cooperation and collective action which increases safe water and sanitation practices, thereby reducing the prevalence of diarrhea in children. Given the motivation that this thesis was written in the midst of a pandemic, in the third chapter, we study the wide spatial variation in the spread of COVID-19 and hypothesize that the individualism-collectivism cleavage explains the disparity in COVID-19 cases observed across sub-national units in the United States. Using data on children’s names from the U.S. Social security administration database to construct a measure for individualism, our estimates provide strong support to the notion that individualism is positively associated with the number of COVID-19 cases across the U.S.