Perceiving Risks which people experience them( 30, 31). Different groups of people appear to identify differ- ent risks, as well as different attributes, depending on the form of social organization and the wider political culture to which they belong (32) Although it is widely accepted that the political and economic situation at a macrolevel is a strong determinant for many risk factors, microlevel studies can examine how such factors are perceived and interpreted rationally within a given local context. Microlevel studies can also be very useful in explaining certain apparent behaviours that do not appear to be rational to the"external"public health observer For instance, although lay people may be well aware of risk factors for coronary heart disease, they also have their own"good"and rational reasons for not following expert advice on prevention(33). Thus the context in which people find themselves also largely determines the constraints they face in trying to avoid risks and the length of time over which risk can be discounted. It is an irony, however, that people living in wealthy and safer societies, with their high living standards and longer life expectancy, appear to be even more highly concerned about risks to health than people living in poorer and less safe communities. This is particularly the case with highly uncertain and highly dreaded risks From the cultural perspective, therefore, the type and kind of risks, as well as a ability to cope with them, will vary according to the individuals wider context. For instance, risk perceptions and their importance can vary between developing and developed countries, as well as with such variables as sex, age, household income, faith and cultural groups, urban and rural areas, and geographical location and climate(for example, see Box 3. 4) PERCEPTIONS OF HEALTH RISKS I DEVELOPING COUNTRIES Risks to health, as an area for further study, have only recently begun to receive attention in developing countries. The need to view such risks in their local context is obvious when analysing perceptions of risk in these countries, especially when risk factors are considered alongside life-threatening diseases such as tuberculosis, malaria and HVIAIDS.There are also other daily threats, such as poverty, food insecurity and lack of income. In addition, families may face many other important"external"risks, such as political instability, violence, atural disasters and wars. Thus every day there is a whole array of risks that have to be considered by individuals and families Models of individual risk perception and behaviour were, however, mainly developed industrialized countries where people have considerably higher personal autonomy and freedom to act, better access to health information, and more scope for making choices for better health. These models may be less appropriate in low and middle income countries, where illnesses and deaths are closely associated with poverty and infectious and communicable diseases(35). In industrialized countries, studies of HivIAIDS and to a lesser extent, noncommunicable diseases such as cancer(5) and coronary heart disease (33)have been carried out using the perspectives of applied medical anthropology and sociology(36). However, in developing countries where communicable diseases still cause a high proportion of the avoidable mortality, these disciplines have most frequently been coopted to help evaluate the effectiveness of disease control programmes. Perceptions of disease, use of health services and reasons for non-compliance are some areas often studie For communicable diseases, it is important to differentiate perceptions of the disease from those concerned with the risk of acquiring the infection, particularly as not allPerceiving Risks 37 which people experience them (30, 31). Different groups of people appear to identify differ￾ent risks, as well as different attributes, depending on the form of social organization and the wider political culture to which they belong (32). Although it is widely accepted that the political and economic situation at a macrolevel is a strong determinant for many risk factors, microlevel studies can examine how such factors are perceived and interpreted rationally within a given local context. Microlevel studies can also be very useful in explaining certain apparent behaviours that do not appear to be rational to the “external” public health observer. For instance, although lay people may be well aware of risk factors for coronary heart disease, they also have their own “good” and rational reasons for not following expert advice on prevention (33). Thus the context in which people find themselves also largely determines the constraints they face in trying to avoid risks and the length of time over which risk can be discounted. It is an irony, however, that people living in wealthy and safer societies, with their high living standards and longer life expectancy, appear to be even more highly concerned about risks to health than people living in poorer and less safe communities. This is particularly the case with highly uncertain and highly dreaded risks. From the cultural perspective, therefore, the type and kind of risks, as well as a person’s ability to cope with them, will vary according to the individual’s wider context. For instance, risk perceptions and their importance can vary between developing and developed countries, as well as with such variables as sex, age, household income, faith and cultural groups, urban and rural areas, and geographical location and climate (for example, see Box 3.4). PERCEPTIONS OF HEALTH RISKS IN DEVELOPING COUNTRIES Risks to health, as an area for further study, have only recently begun to receive attention in developing countries. The need to view such risks in their local context is obvious when analysing perceptions of risk in these countries, especially when risk factors are considered alongside life-threatening diseases such as tuberculosis, malaria and HIV/AIDS. There are also other daily threats, such as poverty, food insecurity and lack of income. In addition, families may face many other important “external”risks, such as political instability, violence, natural disasters and wars. Thus every day there is a whole array of risks that have to be considered by individuals and families. Models of individual risk perception and behaviour were, however, mainly developed in industrialized countries where people have considerably higher personal autonomy and freedom to act, better access to health information, and more scope for making choices for better health. These models may be less appropriate in low and middle income countries, where illnesses and deaths are closely associated with poverty and infectious and communicable diseases (35). In industrialized countries, studies of HIV/AIDS and, to a lesser extent, noncommunicable diseases such as cancer (5) and coronary heart disease (33) have been carried out using the perspectives of applied medical anthropology and sociology (36). However, in developing countries where communicable diseases still cause a high proportion of the avoidable mortality, these disciplines have most frequently been coopted to help evaluate the effectiveness of disease control programmes. Perceptions of disease, use of health services and reasons for non-compliance are some areas often studied (37). For communicable diseases, it is important to differentiate perceptions of the risk of a disease from those concerned with the risk of acquiring the infection, particularly as not all