Cultural Considerations in Public Health

Table of Contents

Introduction

Consanguinity is the kinship of two individuals defined by the sharing of biological ancestors. In other words, it refers to a reproductive relationship or marriage between two closely kindred persons (Koellner et al., 2018). In many countries, this phenomenon is a typical feature, and marriages, especially between first cousins, take place frequently. The descendants of consanguineous couples are at enlarged risk for autosomal recessive conditions because of their increased chance for homozygosity by descent.

Main body

Individuals who are blood relatives will share a more significant proportion of the identical genes compared to unrelated people. This, in turn, increases the possibility of having a child with a congenital disability or defect. For example, if parents are not kindred, the risk of having a child with a birth disability accounts for 2-3 percent, while in the case of first cousins, this risk grows to 5-6 percent (“Fact sheet 18,” 2016). This is due to the higher possibility of having the same autosomal recessive mutation in parents passed down via the family.

In contrast to conventional opinion, consanguineous marriages are widespread enough throughout the globe. The total number of consanguineous representatives consists of 10 percent of the world’s population or approximately 500–800 million people globally (Oniya et al., 2019). In particular, the countries that have the highest rates are Kuwait (68%), Saudi Arabia (56%), Pakistan (55-59%), Qatar (54%), and Oman (52%) (Oniya et al., 2019). It is worth noting, in recent decades, the incidence of consanguineous marriages is mostly increasing in the world. Concerning the USA, consanguineous practice is primarily adopted in immigrant communities, especially those who come from Pakistan and North Africa.

The main factors contributing to consanguinity in particular communities are mainly of a social and religious nature. They include strengthening the family bonds, ease of finding a suitable marriage partner, and retention of property within a family. In this context, in the Middle East countries, consanguineous unions are considered to be tighter and more secure in maintaining family ties. Besides, some religions, including Judaism, Islam, and Buddhism, are more predisposed to consanguineous unions (Oniya et al., 2019). Shared religious principles and common ethnic, cultural, and community traditions promote consanguinity significantly.

On the other hand, some factors reduce consanguineous practices among people. The first factor is the increased educational level of society, which promotes awareness about the higher risk that consanguineous parents may have malformed children (Oniya et al., 2019). Additionally, education impacts an age when females prefer to marry, which is usually higher. Finally, the most contributing factor is the legal prohibition on consanguineous unions in many countries, especially in developed states such as the US and the UK.

An individual’s desire not to disclose her or his risk of obtaining a genetic disorder to a family may cause perplexity in the healthcare clinician. In this case, the clinician has to opt between legal requirements to respect the patient’s privacy and ethical obligations to inform the at-risk party. Nevertheless, in some situations, the clinician can ignore the patient’s preferences, especially when the family member is disposed to severe, dangerous conditions or harm that can be prevented or adequately treated (Gallo et al., 2009). Clinicians who hold that a patient’s wish concerning notification must be overridden should consult a legal counsel or ethics committee.

Conclusion

In conclusion, I believe that the government should respect and protect patients’ privacy concerning genetic risks to prevent active genetic discrimination, particularly in employment and health insurance regards. According to the Genetic Information Nondiscrimination Act of 2008, discrimination of an individual based on the genetic information of enrollees is prohibited (“Genetic discrimination,” n.d). In particular, health insurers cannot use genetic information to define somebody’s eligibility for insurance. Besides, GINA prohibits employers from using genetic information to decide regarding hiring, pay, and promotion, as well as segregate or mistreat employees (“GINA & you,” n.d.). However, genetic information can be revealed when a person is disposed to severe, dangerous conditions or harm that can be prevented or adequately treated.

References

(2016). Centre for Genetic Education. Web.

Gallo, A. M., Angst, D. B., & Knafl, K. A. (2009). The American Journal of Nursing, 109(4), 65-69. Web.

(n.d.). National Human Genome Research Institute. Web.

GINA & You. (n.d.). The Genetic Information Nondiscrimination Act. Web.

Koellner, C. M., Mensink, K. A., & Highsmith Jr, W. E. (2018). Basic concepts in human molecular genetics. In W. B. Coleman & G. J. Tsongalis (Eds.), Molecular pathology: The molecular basis of human disease (pp. 99-120). Academic Press.

Oniya, O., Neves, K., Ahmed, B., & Konje, J. C. (2019). A review of the reproductive consequences of consanguinity. European Journal of Obstetrics & Gynecology and Reproductive Biology, 232, 87-96.

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