In detailed description of socioeconomic status(SES) of family, variables of SES, scale to measure SES and impact of SES on health

1. Good Morning

2. Socioeconomic factors in Health & Diseases
 Guided by:
Dr. NagaNandini S.
Professor & HOD
Public Health Dentistry
• Prepared by:
Jahanvi Kapadiya
PG 1st Year

3. Content
 Introduction
 Definition
 Variables of SES
 SES scales
 Factors affecting Different SES people and Health
 SES and oral health
 How to prevent SE disparities in Health
 References

4. Introduction
 For health services to deliver effective treatment and
prevention a detailed understanding of the factors
influencing health is critical.(1)
 Failure to address the underlying causes of diseases
in society will mean that improvement in the health
of the population and a reduction in health will never
be achieved.(1)

5. Definition
 Socioeconomic status:
It has been defined as the position that an individual
or family occupies with references to the prevailing
average standards of culture and material possessions,
income, and participation in group activity of the
community. (2)

6. Variables of SES
• Education
• Occupation
• Income
• Family type

7. Education
 Education typically lead to better jobs, more money
and benefits like health insurance, which leads to
better quality health care.
 It also provide knowledge and life skills that allow to
gain more ready access to information and resources
to promote health
 Education is key to decrease health inequalities.

8. International Standard Classification of
Education (ISCED)
 The International Standard Classificationof Education (ISCED) is the
official framework used to facilitate international comparisons of
education systems.
 It was developed in 1976 by the United Nations Educational, Scientific
and Cultural Organization (UNESCO) and was revised in 1997 and
2011. EdStats uses indicators based on the ISCED 2011 classifications
listed below:
 ISCED 0 = Early childhood education
 ISCED 1 = Primary Education
 ISCED 2 = Lower Secondary Education
 ISCED 3 = Upper Secondary Education
 ISCED 4 = Post-secondary non-Tertiary Education
 ISCED 5 = Short-cycle tertiary education
 ISCED 6 = Bachelors degree or equivalent tertiary education level
 ISCED 7 = Masters degree or equivalent tertiary education level
 ISCED 8 = Doctoral degree or equivalent tertiary education level

9. occupation
 It is very complex variable.
 Depending on
 Since employed have better health than the
unemployed have.
 Being unemployed and the length of unemployed
affect mental health status.
employed.
unemployed

10. Occupational classification
 The international standard classification of occupation
(ISCO) is an international labour organization (ILO)
classification structure for organizing information on
labour and jobs.
 ISCO -08 classification under 10 major groups:
1) Managers
2) Professionals
3) Technician and associate professionals
4) Clerical support worker
5) Service and sales worker
6) Skilled agriculture, forestry, fishery worker
7) Craft and related trade worker
8) Plant and machine operator and assemblers
9) Elementary occupations
10) Armed force occupation

11. Limitations of occupational classification
1) Heterogeneous grouping:
each social classes is a heterogeneous grouping of a wide
variety of occupations. There is a assumption that these
occupations are related to each other which in fact is not so.
2) Occupational mobility:
people sometimes change their occupations. This
occupation mobility can lead to discrepancies in using social
classes correctly over a period of time. Certain occupations
are promoted in social hierarchy and some demoted. Such
changes invalidated their comparison over period of time .
3) Gender:
some occupations are exclusively occupied by males and
some are females

12.  Among the employed, occupation differ in their
prestige, qualification, rewards, job characteristics
all are linked to mortality risk.
• While Lower status jobs expose worker to both
physical and psychosocial risk.
 They carry high risk occupation injury and exposures
to toxic substance and job strain , lack of control over
work are greater.

13. Income
 Higher income can provide better nutrition, housing,
schooling and recreation.(3)
 Inequality of income in society affect the health of
people widely.
 Although the association between income and health
is stronger
 At lower income , health status is absolute deprivate
and higher income , mortality rate among children ,
adult is less due to getting health services.

14. Poverty
 Definition : it is a state or condition in which a
person or community lacks the financial resources
and essential for a minimum standard of living.
 Income level is very low that basic human needs cant
be met.
 Poverty wields its destructive influence at every stage
of human life from the moment of conception to the
grave.(2)
 Poverty is main reason why babies are not
vaccinated, clean water and sanitation are not
provided, curative drugs and treatment are
unavailable (2)

15. Poverty is main cause of following diseases (2)
 Low life expectancy
 Low birth weight
 Higher maternal mortality
 Handicap and disability
 Mental illness
 Stress
 Suicide
 Family disintegration
 Abuse
 Malnutrition

16.  The number of people living in extreme poverty in
the world has increased.
 Statistics :
Estimated that worlds population living below
$1.90 a day is projected to rise 8.8% (689 million)
in 2020 which was 8.2 in 2019
(sustainable developmental goals report by U.N Department Of
Economic and Social Affairs )
In India 88million people out of 1.2billions
Indian roughly equal to 6.7% of India's population
lived below poverty line of $1.25 in 2018-19
(united nations Milennium Developmental Goals)

17.  Malnutrition and the legacy of past illness mean
that they are more likely to fall in and slower to
recover, especially if they have little access to health
care.
 When family’s breadwinner becomes ill, other
members of the household may at first cope by
working harder themselves and by reducing
consumption, even of food.
 Both adjustment can harm health of the family.
 The poor are forced into occupations that harm
their health, lack of access to health care and
education, live shorter life and in general lack
access to resources and means to improve their
lives.

18. Income classification by B.G Prasad

20. New income value = Old income value (Base
2016=100) × 4.93 × 4.63× 2.75 × MF
where 4.93 (to convert the value from base year 1960 to 1982) and 4.63 (to convert
the value from base year 1982 to 2001) and 2.75(to convert the base year 2001 to
2016) are the linking factors given by the Labour Bureau and the multiplication
factor is used to calculate the income ranges for different socioeconomic classes
considering the base year 2016(to convert the income value from base year 2016 to
current time, here May 2020).
Calculation of current income ranges for B. G. Prasad Socioeconomic Classes:
MF=
𝑪𝒖𝒓𝒓𝒆𝒏𝒕 𝑰𝒏𝒅𝒆𝒙 𝑽𝒂𝒍𝒖𝒆
𝑩𝒂𝒔𝒆 𝑰𝒏𝒅𝒆𝒙 𝑽𝒂𝒍𝒖𝒆
=
𝟏𝟏𝟗.𝟓 (𝒐𝒄𝒕𝒐𝒃𝒆𝒓𝟐𝟎𝟐𝟎)
𝟏𝟎𝟎 (𝟐𝟎𝟏𝟔)
= 𝟏. 𝟏𝟗𝟓
Social class per capita monthly income (2020)
Class I = ≥ 7501
Class II = 3751 - 7501
Class III = 2250 - 3751
Class IV = 1122 - 2250
Class V = <1122
𝟏𝟏𝟗. 𝟓 (𝒐𝒄𝒕𝒐𝒃𝒆𝒓𝟐𝟎𝟐𝟎) according to labour bureau of india

21. Global hunger
 Hunger is distress related to lack of food.
 It is major social problem facing by world related to
health
 Which lead to health problems:
malnutrition
Undernutrition
Micronutrient deficiency
Undernourishment

22. Global hunger index
 It is tool designed to comprehensively measure and track
hunger globally, by region and country.
 It is calculated each year by the International Food Policy
Research Institute.
 𝐺𝐻𝐼 =
𝑝𝑟𝑜𝑝𝑜𝑟𝑡𝑖𝑜𝑛 𝑜𝑓 𝑢𝑛𝑑𝑒𝑟𝑛𝑜𝑢𝑟𝑖𝑠ℎ𝑒𝑑 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛+
𝑝𝑟𝑜𝑝𝑜𝑟𝑡𝑖𝑜𝑛 𝑜𝑓 𝑐ℎ𝑖𝑙𝑑𝑟𝑒𝑛 <5𝑦𝑒𝑎𝑟𝑠 +
𝑐ℎ𝑖𝑙𝑑 <5𝑦𝑒𝑎𝑟𝑠 𝑚𝑜𝑟𝑡𝑎𝑙𝑖𝑡𝑦 𝑖𝑛 %
3

23. • The calculation result in a 100 scale on which 0 is the
best score (no hunger) and 100 the worst.
• India GHI score is 27.2 (2020 report)
 GHI 2020 report placed India 94th position among
107 countries.

24. Hidden hunger
 Hidden hunger is a form of undernutrition that occurs
when intake and absorption of vitamins and minerals
are too low to sustain good health and development in
children and normal physical and mental function in
adult.
 Why called hidden hunger?
clinical signs such as blindness from vitamin A
deficiency and goiter from inadequate iodine intake
become visible once deficiency become severe.
• It afflict one in three people globally.

25.  Factors contributing are:
Poor diet
Pregnancy
Lactation
Disease, infection or parasites
• Its effects are:
Mental impairment
Poor health
Low productivity
Even death

26.  In addition to affecting human health hidden hunger can
curtail socioeconomic development particularly
in low and middle income countries.
• Correlation of hidden hunger and SES:
1) Developing countries are moving from traditional diet
to minimal or highly processed food, energy-dense,
micronutrient poor food and drinks. So developing
countries faces phenomenon “ triple burden “ (
malnutrition – undernourishment, micronutrition
deficiency, obesity )
1) In higher income , more urbanized courtiers
hidden hunger co-exist with overweight/obesity when
person consumes too much dietary energy from fats and
carbohydrates.

27. Family type
 Family is primary unit of society.
 Social scientists have described three main types:
1. Nuclear family
2. Joint family
3. Three generation family

28. 1. Nuclear family
 This family is universal in
all human societies.
 Consists of the married
couple and their children.
 The husband usually plays
a dominant role in the
household.
 Absence of grandparent,
uncle, aunt places a greater
burden in terms of child
rearing.

29. 2. Joint family
 Characteristics:
1. Number of married
couple and their children.
All men are related by
blood & woman are their
wives, unmarried girls
and widows of the family
kinsmen.
2. Common family purse.
3. Authority to senior male
member. Control all
internal & external affairs.
4. The family relations enjoy
primacy over marital
relations.

30.  Motto of joint family is “union is strength”.
 Sharing responsibilities practically in all matters
which gives the family a greater economic &
social security.
 It provides economic & social security to the old,
helpless and unemployed.

31. 3. Three generation family
 Household where generation are living together.
 It occurs usually when young couples are unable to
find separate housing accommodation and continue
live with their parents and have their own children.

32. Family in health and disease
1. Child rearing:
• One of the important functions of the family with
which medical and community health workers are
concerned.
• It is important to note that pattern of child care in
mean by feeding, nutrition, hygiene, sleep, clothing,
discipline, habit training.

33. 2. Socialization:
• The 2nd responsibility of the family is to socialize the
stream of new born barbarians.
• By socialization is meant teaching the young the values
of society and transmitting the information.
• The young are persuaded, given punishment, rewards
for good behavior.

34. 3. Personality formation:
• It is an area which sociology comes closest to
psychology.
• The capacity of an individual to withstand stress and
strain and the way in which he interacts with other
people is to large extent determined by early
experience in the family mainly with father, mother,
siblings who provided the earliest and most immediate
component of child’s external environment.
• The family plays important role in child’s physical,
mental, social health.

35. 4. Care of dependent adults:
I. care of sick and injured
II. Care of woman during pregnancy and child birth
III. Care of the aged and handicapped

36. 5. Stabilization of adult personality
• The family is like a shock absorber to the stress and
strain of life.
• The stress of modern lives increase the importance of
mental illness as public health problem.
• Alcoholism and narcotic addiction are also reflection
of this trend.
• Certain chronic illness as peptic ulcer, colitis, high
blood pressure, rheumatism, skin diseases are
accepted as “stress diseases”.

37. 6. Family susceptibility to disease.
• The members of family share a pool of genes and a
common environment and together, these decide
their susceptibility of disease.
• Hemophilia, colorblindness, diabetes, mental illness
like schizophrenia, psychoneurosis.
• The family is often the playground also for such
communicable disease as tuberculosis, common
cold, scabies, diphtheria, measles, mumps, rubella,
chickenpox, dysentery, diarrhea and enteric fever.

38. 7. Broken family:
• A broken family is one where the parents have
separated or where death has occurred of one or both
parents.
• Separation of the child from father and separation
from both parents are important factor in child
development.
• Later have been found psychopathic behavior,
immature personality, retardation of growth, speech,
and intellect.

39. 8. Problem family:
• Are those which lag behind the rest of the
community.
• In these families the standard of life are generally far
below the accepted minimum and parents are unable
to meet the physical and emotional need of their
children.
• Commonly in lower social class
•

40. Socioeconomic status scale
 In India
1) Kupuswammy prepared scale based on education,
occupation and income which are the three major
variables contributing to socio-economic status in
urban areas.
2) Pareek and kulshrestha prepared similar for ruler
and urban areas.

42. 4

44. Factors affecting in social class differences in
health and diseases
1) Physical environment:
• Differences in mortality and morbidity due to
differences in physical environment.
e.g., housing
Safe water
Access to clean air
• People In upper hierarchy enjoy better facilities.

45. 2) Differences in service provided:
• There are differences in availability of service for
different social groups.
• Example: some areas are relatively undoctored as
compared to other.
3) Material resources:
• Income, wealth and possession of tools which promote
or help achieve better health also intervene in the
occurrence of disease or in the maintenance of health
status in different social groups.

46. 4) Genetic endowment:
• People in one social class tend to marry in the same social
class.
• The differences in genetic endowment may also influence
one’s liability of disease.
5) Educational:
• The educational level varies in different social classes
• The illiterate are likely to have much difficulty in pursuing
measures which may conduct to good health
6) Attitude to diseases:
• Attitude of people to health and sickness may vary in
different social class.
• There are people who regard that illness is punishment and
there are who regard that illness is due to natural causes.
• There are people who diagnose illness themselves and seek
early medical aid.

47. Socioeconomic status and Oral Health
 For higher socioeconomic status
Hygiene
Follow plaque
control
method
good
periodontal
status
1.
2.
Diet
Sticky food
(candies,
chocolates)
Increase
dental
caries
Dairy food like
cheese,
milk(calcium)
Decrease
Dental
caries

48. Utilize health
care serive
Preventive
care pit and
fissure
sealants
Less
incidence of
dental caries
3.

49. For lower socioeconomic status
• Poor nutrition
• Deficiency may cause mouth ulcer
Diet
• Weaker immune system
• periodontitis
stress
• Poor oral hygiene maintenance
• Periodontal diseases
Hygiene
• Habituate due to work load
• Oral precancerous and cancerous lesion
Tobacco
• risky Occupation
• Trauma to teeth and jaw bone
Injuries
• Also lead to accident/truama to teeth and jaw bone
• Increase free radicals which may increase chances of cancer.
Alcohol

50. How to prevent SE disparities in Health
1. Policies and priorities:
Eliminating health disparities will require attention
to all SES components and the pathway by which they
influence health.

51. 2. In civilized societies the
government or state
assumes responsibility
to safeguard or
promote health and
welfare of citizen:
• Provision of health
constitution in India;
directive principles of
state policy of constitution
of India states:
 Policy toward securing:

52. Conclusion
 Health is fundamental right of every human being, it
has to be earned by individual effort.
 The responsibility of health rests not only on the
individual but also upon community or state.
 Individual responsibility: must accept or exercise in
order to achieve optimum health
 Private health worker: must treat patient according
to need
 Community health worker: diagnose community
health condition and treat the disease

54. References
1) Essential dental public health; Blanaid daly, richard
watt, pual batchelor, elizabeth treasure; oxford; ch-2
determinants of health
2) Park’s textbook preventive and social medicine; K PARK;
25th edition; ch-12 medicine and social science.
3) Socioeconomic disparities in health: pathway and
policies by Nancy E Alder, Katherine Newman
4) Revised socioeconomic status scale for urban and rural
India- revision for 2015; Socioeconomica- the scientific
journal for theory and practice of socio-economic
development; Guru Raj M.S, Shilpa S., Maheshwaran R.

55. 5) Modified Kuppuswamy socioeconomic scale updated for the year
2020 Sheikh Mohd Saleem , Demonstrator, Dept. of Community
Medicine, Government Medical College, Srinagar, J&K, India
*Corresponding Author: Sheikh Mohd Saleem