Social and Behavioral sciences

BEHAVIORAL
SCIENCES
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 Introduction
 Social and behavioral sciences
 Sociology
- Structural aspects of society
- Functional aspects of society
- Type of social relationships
- Family
- Community
 Social stratification

 Social psychology
- Behavior
- Personality
- Motivation
- Learning
- Emotions
 Cultural anthropology
 Impact
- Impact SES and oral health & disease
- Family in health and disease
- Cultural factors in health and disease
 Conclusion
 References

Why study social and behavioral
factors in public health?
 Mid 18’th century- smallpox, cholera, tuberculosis –
moral and spiritual depravity.
 19’th century- same disease widespread- foul air
emitted.
 20’th century- germs – water purification,
immunization.
 Kinds of disease prevalent changed dramatically,
etiology changed and public health action expanded
enormously in scope and complexity.

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 With emergence of chronic diseases, injury,
substance abuse focus shifted to social and
behavioral approaches to disease prevention and
health promotion.
 Referred to as New Public Health.
 Now view individuals health as shaped by complex
interacting systems of biological, social and
environmental factors. J Coreil, CA Bryant, JN Henderson. Social
and behavioral foundations of public health,
Sage publications-California.

 Social environment as important as physical and
biological environments.
 Effect clearly reflected in the differences in morbidity
patterns - rural vs. urban areas, developing vs.
developed countries.
 Public health problems are closely related to the
lifestyles of people

 Socioeconomic and political factors are
important determinants of health.
 "We have astronauts flying in space ships, but
we don't have enough wheel chairs". (Naina)
 USA - family planning and immunisation
services not available free, as in India.

 Term social environment denotes the complex of
psychosocial factors.
 Includes cultural, values, customs, habits, beliefs,
attitudes, morals, religion, education, income,
occupation, standard of living, community life and the
social and political organisation.
 Multiple nature of factors involved - psycho
socioeconomic environment.

Social factors influencing health of people

Interest of different disciplines

1. Community health:
 Workers faced with the problem of why people who
need a particular service are least likely to use it.
 The question is why do people behave as they do?
 Western countries - mental health, hospital
organisation, social class difference in disease,
rehabilitation, and professional roles and
relationships.
 Many community health problems are social
problems and vice versa.

2. Clinical Medicine:
 Social scientists investigate life situations of
the patients - linkages between specific life
situations and specific types and cases of
illness.
 Clinicians have also shown interest in what is
known as “illness behavior” of patients.
 Present medical sciences insufficient to train
physician to cope with sociocultural aspects.

3. Epidemiology
 Epidemiologists - close alliance with social
scientists - studying distribution of health and
disease in human population, and factors that
cause the distribution.
 Disease studied in relationship to factors such
as social status, income, occupation, housing,
overcrowding, social customs, habits and
behaviour.

 ‘Social Sciences’ applied to disciplines which are
committed to the scientific examination of human
behavior.
 These are Economics, Political science,
Sociology, Social psychology and Social
anthropology.
 ‘Behavioral Sciences' is applied to Sociology,
Social psychology and Social anthropology,
because they deal directly with human behavior.

Economics:
 Field of economics -very close relationship with
sociology. Parent discipline from which sociology has
emerged.
 Economics deals with human relationships in context
of production, distribution, consumption and
ownership of scarce resources, goods and services.
 Sociology and economics overlap in many senses;
both are concerned with interdependence in human
relations.

Political Science
 Historically economics and political science tended
to be a single discipline.
 Political science is concerned with the study of the
system of laws and institutions which constitute
government of whole societies.

 Sociology derived from the Latin socio - society and
the Greek logos- science.
 Society is derived from the root words socius -
individual and societa - group.
 Society is a group of individuals who have organised
themselves and follow a given way of life.
 Sociology is the study of individuals as well as
groups in a society.

 Sociology can be viewed from two angles:
A) It can be seen as the study of relationships
between human beings.
B) The other part of sociology is concerned with the
study of human behaviour.
Sociologists are interested in the study of the sociaL
determinants of human behaviour.

Sociological schools of thought
Consensus theory: It emphasizes the contributions (functions) that
each part of a society makes to it.
 Assumes that most members of a society have a consensus on values
and interests.
Conflict theory:
Focus on the inheritable disagreements among people in groups, and
individuals and groups compete (conflicts) with one another to preserve and
promote their own special values and interest.

Interactionism:
 Interactionists are concerned with how people
interpret the social situations they are participating
in.
 Attempts to understand social life from viewpoint of
individual
Petersen PK. Society and oral health. In. Pine
CM. Community oral health. 1997.ed. Mumbai.
Km Varghese company. 20-37

Can be divided in 2 types:
Structural aspects of society
Functional aspects of society
Gupta MC, Mahajan BK Textbook of preventive and
social medicine. 2003 3rd ed. Jaypee medical
publishers 109-120.

Structural aspects of society
A. Social Institutions: Structure through which human
society organises, directs and executes the activities
required to satisfy human needs. E.g., family, school,
hospital, parliament.
B. Community: Group, small or large, living together
in such away that the members share not one or
more specific interests but rather the basic
conditions of a common life.

C. Associations: Groups of people, united for a
specific purpose or a limited number of purposes
and are based on utilitarian interest, e.g., Junior
Doctors Association.
When an association serves a broad interest and
does so in an accepted, orderly and enduring way, it
may be called an institution. E.g., Indian Medial
Association.

Functional aspects of society
A. Social Norms:
 Society is an organisation made by man for himself.
 Every living organism has some basic requirements
and tries its best to satisfy them.
 In animals, these needs give rise to the basic desires
or instincts which the animal tries to satisfy without
inhibition.

 In man, biological forces trigger the desires but,
contrary to animals, there are social standards which
guide man.
 Every society specifies certain rules of conduct to be
followed by its members in certain situations.
 These specified rules of conduct are technically
known as social norms.
 Folkways, Mores, Laws.

Folkways:
 Customary ways of behaviour - obligatory in the
proper situation.
 Enforced by informal social controls like gossip and
ridicule. e.g., ways of eating, dressing, greeting.
 Folkways vary from society to society and culture to
culture. Certain folkways may be common, but
otherwise they lend uniqueness to a culture.
 They are necessary for the group solidarity.

Mores
 Socially acceptable ways of behaviour that involve
moral standards.
 There is greater feeling of horror about violating
mores and greater unwillingness to see them
violated.
 Believed to be essential for social welfare. Sanctions
are informal and the reactions of group are
spontaneous rather then official action.

Taboos:
Specific types of mores expressed in negative.
Examples are abstinence from beef, pork and
smoking in Hindus, Muslims and Sikhs.

Laws
 Some important mores are converted into law in
order to ensure implementation.
 Last step in the formulation of rules of conduct in a
society.
 Laws are not only prescribed in written form but are
enforced.

Social Norms and their origin
Gupta MC, Mahajan BK Textbook of preventive and
social medicine. 2003 3rd ed. Jaypee medical
publishers 109-120.

B. Customs and Habits
 Custom is a broad term embracing all the norms
classified as folkways and mores.
 It refers primarily to practices that have been repeated
by a number of generations.
 Customs have a traditional, automatic, mass character.

 Habit is a purely personal affair, not entailing any
obligation.
e.g., cup of bed tea, bathing daily, etc.
 When habits are shared for their necessity and are
sanctioned by the society, they are converted into
customs in due course of time.

C. Etiquettes and Conventions
 Etiquettes are concerned with choice of the proper
form for doing something in relation to other people.
 Convention is merely an agreed upon procedure.
Thus entering a bus from the rear with exit from front
is a convention.
 When a procedure is adopted and repeated time and
again, it may become a rule.

D. Social Values
 Constitute important part of the selective behaviour
of man.
 Standards of judgement by which things and actions
are evaluated as good or bad, moral or immoral,
beautiful or ugly.
 Norms and values are not the same things. Values
are directive principles of human action.
 Norms are the enactment of social values.

 Society is a group of individuals drawn together by a
common bond of nearness who act together in
general for the achievement of certain common
goals.
 Individual needs the group - not necessarily a
particular group or always the same group or the
same group for all needs.
 Different groups are needed for different purposes;
these groups comprise social organisation.

 Social groups to which people belong are the family,
and caste, religion, village, town or city and the state.
 Other functional groups also there such as the
panchayat, the club and various associations.

1. The Family: Basic unit in all societies. Most powerful
example of social cohesion.
2. Religion and Caste: The caste system in India is an
example of a “closed class”. Each caste is governed
by certain rules and sanctions relating to endogamy,
food taboos, ritual purity, etc.
 Each caste group within a village expected to give
certain standardized services to families of other
castes.

3. Temporary Social Groups
(A) The Crowd: When a group of people come together
temporarily, for a short period, motivated by a
common interest curiosity.
Lacks internal organisation and leadership. Interest
over, the crowd disperses.
(B) The Mob: Essentially a crowd, but has a leader
who forces the members into action.
Is unstable and without internal organisation.
Purpose is achieved, the group disperses.

(C) The Herd: Also a crowd with a leader. Here the
members of the group have to follow the orders of
the leader without question.
e.g., tourist group under a guide.

4. Permanent Spatial Groups
1) The Band: Most elementary community of a few families
living together. Here the group has organised itself and
follows a pattern of life e.g., gypsies.
2) Village: Is a small collection of people permanently
settled down in a locality with their homes and cultural
equipments. Village has constituted a basic unit in India.
According to the 2001 census, there were 6,38,000
villages in India. Average population of village estimated
to be 550.

(3) The Towns and Cities: Relatively large, dense and
permanent settlement of socially heterogeneous
individuals.
The community is subdivided into smaller groups on
the basis of wealth and social class.
The 2001 Census enumerated 5,545 towns and
cities in India.
There were only 107 cities in India at the time of
1961 census.

(4) The State: Ecological social group based on
territory. It is more stabilised and formalised.
It is heterogeneous in nature. The Indian Union is a
large State.

5. Government and political organisation
 Some form of government is detectable even among
primitive societies.
 Government is an association of which law is the
institutional activity.
 There is no society which lacks government.
 Supreme agent authorised to regulate the balanced
social life in the interests of the public.

(1) Democracy : This is government of the people, by the people
and for the people e.g., India and USA.
(2) Autocracy : The ruler is absolute in his power e.g., Jordan and
Ethiopia.
(3) Monarchy: The head of the State is a monarch e.g., UK, and
Nepal.
(4} Socialistic: The production and wealth are owned and
controlled by the State. E.g., China and Poland.
(5) Oligarchy: The country is ruled by a family group e.g.,
Thailand, Cambodia, Saudi Arabia.

 In Capitalist countries, medical service is given to the
population by various agencies in various ways.
 State medicine, insurance medicine, charity
medicine and private medicine exist side by side.
 Medicine has developed into a trade - a service that
is purchased by the patient and sold by the physician
under a competitive system.

 In socialist countries, medicine, like education, is not
a trade; it is a public function of society.
 All health activities are directed and controlled by
central bodies.
 Medical service is free and therefore available to all -
socialized medicine.
Park. Social sciences and health. In: Park.
Social & preventive medicine. 2007. 19th
ed.500-501.

 Social relationship is defined as “sets and patterns of
sequences of social interactions”.
 While describing social relationship we consider two
aspects : dimensions and types.
 There are two dimensions of social relationship.
They are quantitative and qualitative dimensions.
Kulkarni AP. Textbook of community
Medicine. 2002. 2nd ed. Mumbai.
Vora medical publication. 28-35.

Types of social relationship :
Kingsley Davis has described two types of social
relationships.
I) Primary relationship: Individuals involved are small in
number.
 Live in spatial proximity and the duration of the
interaction is long.
 Persons involved have intimate knowledge of each
other.

ii) Secondary relationship :
 Number of individuals involved is large - live at
distance from each other - duration of contact is
short.
 Limited and specialized knowledge of each other.
 Feeling of external constraints in the relations and
likelihood of disparity of goals.

Primary and Secondary Relationship

Doctor Patient Relationship - An Example of
Primary Social Relationship:
 All the quantitative ingredients required for a primary
social relationship.
 The number of individuals involved in the relationship
is small, in close proximity and the duration of
contact can be lifelong.
 Yet the relationship is drifting to secondary type.

 Some of the measures on the part of the doctors to improve
the situation.
A) Give more time for the patient to narrate his complaints.
B) Widen the scope of exchanges. Include family life, hobbies etc.
- will help diagnosis and assist management.
C) Respect the emotions of the patient.
D) Regard patient as a patient and not as a customer.
E) Consider patient welfare above self. Embedded in the welfare
of the patient is welfare of doctor.
Medicine. 2002. 2nd ed. Mumbai. Vora
medical publication. 28-35.

Models of doctor patient relationship
Paternalistic model:
 Presents selective information.
 Patient gives consent to treatment.
 Doctor acts as parents/ guardian.
Informative model:
 Presents all relevant information.
 Patient free to weigh pros and cons.
 Patients values, attitude determine what treatment to
be given.

Interpretive model:
 Doctor aims at elucidating patients values and wishes.
 Helps to select from possible alternative interventions one
which will help the patient to realize values.
 Doctor does not dictate anything.
 Joint process with final decision resting with the patient.
Deliberative model:
 Doctor acts as a guide and teacher – active part.
 Can indicate which course of action patient should follow.

Dentist patient relationship - Crandell
 Friend
 Saviour
 Parent
 Servant
 Provider
 Adversary
Sathe PV and Sathe AP.
Social sciences. 2nd ed.
Mumbai. Popular prakashan.

What is a group?
 A human group in sociological sense is any number
of persons who:
I) Interact with one another in a given situation or
context more than they interact with any one else.
ii) Are psychologically aware of one another.
iii) Perceive or are conscious of themselves as a
group.
Bhaskar Rao. Textbook of community
medicine.2004 1st ed. Paras medical
publishers 29-71.

Why do the individuals form groups?
I) Proximity : Individuals affiliate due to spatial or
geographic closeness. - Small groups only.
ii) Homan’s Theory: George Homan.
Individuals have problems and tensions. They
want to attain certain goals. They feel necessity
of co-operation of others. These factors create a
need to come together.

4. Tibut and Kelly’s Theory
Depends on four factors:
 Reward - Activity resulting in gratification of needs.
 Cost - Cost of engaging in activity with other person including
cost of punishment.
 Outcome - Difference between the reward and cost.
 Comparison - It is the minimum level of outcome based on
comparison with identical/similar situation in past.
publishers 29-71.

 Primary unit in all societies. A group of biologically
related individuals living together and eating from
common kitchen.
 Term family differs from household in that all the
members of a household may not be blood relations,
e.g., servants.

 As a biological unit - share a pool of genes.
 As a social unit - share common physical and social
environment.
 As a cultural unit - family reflects the culture of the
wider society.

 The family is also an epidemiological unit and a unit
for providing social services as well as
comprehensive medical care.
 To avoid confusion, social scientists have used the
term:
(1) Family of origin - the family into which one is born.
(2) Family of procreation - family which one sets up
after marriage.

Types of Families
 Family units throughout the world are not the same.
Industrialization, urbanisation, democratization and
acculturation have affected the family structure and
life.
 Social scientists have described three main types of
families.
1. Nuclear Family
2. Joint Family
3. Three Generation Family

1. Nuclear Family
 The nuclear or elementary family is universal in all
human societies.
 Married couple and their children while they are still
regarded as dependents.
 Same dwelling space. Husband usually plays a
dominant role in the household.
 “New Families“ - applied to those under 10 years
duration

2. Joint Family
 Common in India, Africa, the Far East and the
Middle East.
 More common in agricultural areas than in urban
areas.
 The orthodox Hindu family in India is a joint family.

 Consists of number of married couples and their
children living together in the same household.
 All the property is held in common.
 All the authority Is vested in the senior male member
of the family. He is the most dominant member and
controls the internal and external affairs.
 The merit of the joint family system is that it is based
on the motto: "union is strength”. There is a sharing
of responsibilities.

3. Three Generation Family
 Confused with the joint family. It is fairly common in
the west.
 Household where there are representatives of three
generations.
 Young couples are unable to find separate housing
accommodation and continue to live with their
parents and have their own children.
 Thus, representatives of three generations live
together.

Functions of family
1. Residence
2. Division of labour
3. Reproduction and bringing up of children.
4. Socialization
5. Economic functions
6. Social care

Characteristics of community
 Geographic delimitation
 Objective of group formation
 Self reliance
 Presence of institutions
 Social structure

Differentiation of communities
 Size and dependence
 Major functions
 Rural-Urban

Major functions (Cokin Clark)
On the basis of economic functions of the majority of
inhabitants.
i) Primary: Extractive nature. Individuals are exposed directly to
the physical environmental and raw material are extracted from
it. E.g., agriculture, forestry, fishing, mining etc.
ii) Secondary: Raw materials are processed and altered. E.g.,
fabricating, auto industry etc.
iii) Tertiary: Activities mainly consist of services. E.g., distribution
of raw processed goods, services like finance, communication,
defense, recreation, education etc.
I

Urban-Rural
i) Urban area : a community is called urban if –
a) Population is above 5000
b) At least 75% of male working population is
engaged in non-agricultural and allied occupational
activities
c) Population density is at least 400 person per
square kilometer
d) Declared as urban area by Govt. of India,

ii) Urban agglomeration: An urban agglomeration may
constitute –
a) A city with a continuous outgrowth (the part of
outgrowth being outside the statutory limits but)
within the boundaries of adjoining village or
villages.
b) One town with similar outgrowth.
c) A city and one or more adjoining towns with their
outgrowth all of which form a continuous spread.

iii) Standard Urban Area (SUA) : This has following essential
requirements-
a) A core town of minimum population of 50000.
b) Continuous areas made up of other urban as well as
rural administrative units which have mutual socio-
economic links with the core town.
c) In all probabilities the entire area should get fully
urbanized within span of 2-3 decades.
iv) Village : Basic unit of rural area. It is a recognized unit
having definite boundaries and separate land records.

Community & Society – Difference?
1. Community sentiment.
2. Definite locality.
3. Community is the species of the society.
4. Community is concrete, society is abstract.

Social Stress
 Condition of tension or feeling of uneasiness
or dissatisfaction in some sections or groups
of society.
 Causes:
- Urbanisation
- Stratification
- Acculturation

Methods in Sociology
1. KAP studies
2. Social survey
- Measure social pathology
- Establish association
between social factors and
health problem.
3. Case study

Case study: Social and behavioral
dimensions of public health problem
The Exxon Valdez oil spill:
 Grounding of tanker released 11 million
gallons crude oil- Native Alaska.
 Damage from oil spill along with efforts to
clean up area set up events with profound
social, cultural and psychological impacts.
Coreil .J, CA Bryant, JN Henderson. Social and
behavioral foundations of public health,
Sage publications-California

Social Stratification/ Social inequality
 In every society inequity exists in some or other
forms.
Why societies encourage inequity?
 Functional requirements
 Power

Consequences of stratification
 Life chances
 Lifestyle
 Personality
Society and oral health. In. Pine CM.
Community oral health. 1997.ed. Mumbai.
K.M Varghese company. 20-37.

Approaches
 Reputational
 Self-location
 Objective

Black Report - 1980
Theories of Social inequalities in oral health
 Artefact
 Natural or social selection
 Cultural explanations
 Material explanations
 Social capital
Society and oral health. In. Pine CM. Community
oral health. 1997.ed. Mumbai. K. M. Varghese
company. 20-37.

Characteristics used for social stratification
 Three major systems
- Slavery- race – American society
- Caste –India – closed society
- Class –UK – occupation- open society

 Occupation
- Urbanized & industrialized communities
- Major determinant of
Economic rewards
Extent of authority
Extent of obligations
Degree of status
Values & lifestyles

Registrar general’s classification
(UK)
Social class Occupation
I Professionals
II Managerial
III Clerk & skilled
IV Semiskilled
V Unskilled

Limitations
 Heterogenous grouping
 Occupational mobility
 Women
 Occupational hazards
 Two occupations at same time

 Education
 Income
 Purchasing power
 Religion
 Residence(rural/urban)
 Area of residence (material deprivation)
 Type of house ( kuccha/pucca)
 Material possessions, expenditure, loan etc.

Socioeconomic status
The position that an individual or family occupies
with reference to the prevailing average standards
of cultural and material possessions, income and
participation in group activity of the community.
 Social status –inherited
 Modern society – achieved on basis of occupation,
income, type of housing, neighbourhood,
memberships, material possesions.

 Various countries – different
 UK – occupation
 UK – material deprivation (area & neighborhood
based)
 US- Income & Years of Education
 India

India
For individual or family
 Kuppuswamy’s scale – urban
 Pareek’s – Rural family
 Tiwari’s scale 2004 – Urban and rural communities
 Prasad classification
 WHO
 Modified versions

 Bharadwaj scale on students
 Srivastava scale, Kulshrestha scale, Jalota scale –
Urban families.
 Shirpurkar scale, Radhukar scale – Farm families.

Kuppuswamy’s scale - 1976
Kulkarni AP. Textbook of community Medicine.
2002. 2nd ed. Mumbai. Vora medical

 ALL – India consumer price index (CPI)– industrial
workers
 Conversion factor – 1976
 July 2007- 7.578
Disadvantage
SES of family
Family size

Prasad’s classification
 Based on per capita income of family

Pareek’s scale - 1975
 Rural family
 Based upon nine items
1. Caste
2. Occupation of head of family
3. Education of head of family
4. Level of social participation of the head of the family
5. Land holding
6. Housing

7. Farm power (draught animals like bullock, prestige animals
like camel, elephant, horse and mechanical power)
8. Material possessions
9. Family (type of family, family size and distinctive features of
family in respect of persons other than the head of family).
Five SES categories
Upper, Upper middle, Middle, Upper lower, and Lower
Medicine. 2002. 2nd ed. Mumbai. Vora
medical publication. 28-35.

Tiwari,s scale - 2004
Seven indicators selected – Urban and rural.
- House: Land area, house type
- Materials possession
- Education
- Occupation
- Monthly income
- Land
- Social participation and understanding
Five SES categories
Upper, Upper middle, Middle, Lower middle, Lower
S.C. Tiwari, Aditya Kumar & Ambrish Kumar. Development and Standardization
of a scale to measure socio economic status in urban and rural communities in India.
Indian J Med Res 122, October2005, pp309- 314.

WHO classification - 2004
Occupation
0 – non-skilled worker (peon, labourer)
1- skilled worker (carpenter, masion)
2- Professional
3- Business
4- House-wife
5- school-going child
6- non school going child
7- farmers/local occupation
8- non-employed
9- no available information

Deprivation & oral health
 Black report – material standards of living
 Conventional measures difficult to apply
Area-based measures
 Socially homogenous – small areas
 Post code required
 Allow for geographic targeting of resources, services or
health promotion activities. Locker D. Deprivation and oral health: a
review. CDOE 2000; 28: 161-9.

Used as:
 Substitute for individual or household level data on SES
of individual.
 Supplements to individual or household data –
explanatory power to health inequalities research.
 Replace conventional measures such as social class.
 Surrogate indicators of needs for health care in small
geographic areas.

Index Description
Jarman (1983)
Townsend et al (1988)
Carstairs & Morris (1991)
Welsh underpriviliged area
score (1977)
Elderly living alone
Population aged under 5
One-parent families
Lowest social class unemployed
Overcrowded
Changed address within last year
Ethnic minorities
Economically active unemployed
Households with no car
Households not owner occupied
Households overcrowded
Overcrowding
Male unemployment
Lower social class: residents in
households headed by unskilled
No car
Based on Jarman index adjusted for
housing conditions & standardized
mortality ratios

Use of social class
 Generalizations – lifestyles, behavior and attitudes of
others upon pattern for that group behavior.

Upper Middle class
 Professional, business executive – well educated
 Living in preferred area
 Value their teeth
 Preventive dentistry
 Desire to have teeth as long as possible
Lower Middle class
 Small business, minor executives, white collar workers
 high school education
 Well maintained neighborhood
 Compulsive dental care
 Socially presentable
 Dentist - authority
126 men, women and children Mid Western community

Upper Lower class
 Group – educational efforts
 Behavioral & attitudinal changes
 Skilled , semi skilled
 Limited education, modest neighbourhoods
 Resigned attitude to disease
 Care from clinic
Lower class
 Underpriviliged or disadvantaged
 Unskilled
 Limited education, slum areas
 Neglect of teeth

Trithart 1968 – attitude of underprivileged toward
health care
 Castration complex
 Contradiction of common sense
 Coming in crowds
 Last ditch effort
 If it hurts, you are a quack
 Unclean or dirty feeling
 Clinic built there not here
 Cold professional attitude
 Pain threshold
 Complication of unknown
Pills don’t work
Appointments not important
Teeth lost anyhow
Traditions
Peter S. social sciences in dentistry. In: Peter S.
Essentials of preventive and community
dentistry. ed. 2001. New Delhi. Arya Publishing
house. 733-741.

Socioeconomic indicators –
Economics Country level
 Gross national income (GNI) per capita (US$)
 Gross domestic product per capita growth rate
 Avg annual change in CPI%
 Human development index
 Dependency ratio
 Adult literacy rate
 Gross primary & secondary school enrolment

Health & Socioeconomic status
 Health promotes
- increased productivity
- decreased loss due to disease/death
- Decreased dependent population

 Socioeconomic development
- decreases load of disease
- increase health care
- demographic effects
Social sciences and health. Park. Social &
preventive medicine. 2005. 19th ed.506-518

Psychology – Study of behaviour.
Social Psychology - Study of behaviour of society.
1) Psychological perspective: Concerned with the ways
in which individual behaviour and personality are
influenced by his social characteristics.
2) Sociological perspective: Concerned with the ways
in which individual’s psychological characteristics
influence social process.

Behaviour
 Divided in 3 components:
Stimulus
Response – Overt: observable activity, Covert:
Unobservable activity.
Goals – “ Ultimate desired end, towards which
responses are directed”.
short term, long term

Factors affecting behaviour
 Genetic core
 Past experiences (learned behaviour)
 Needs (biological, psychological)
 Influence of the society
 Tagets and goals

Types of behaviour
 Active or purposeful
 Reflex behaviour
 Unconscious behaviour
 Health behaviour
 Illness behaviour
 Treatment behaviour

Personality
 Physical and mental traits which are characteristic of
a given individual.
 Determine to some extent the individuals behaviour
or adjustment to its surroundings.
 Psychology – study of human personality
 Personality of doctor affects well being of patient.

Components of personality
1. External organization
a) Physical
b) Behaviour
2. Internal organization
a) Intelligence
b) Emotions – fear, anger, jealousy, irritability
c) Desires, attitudes, interest, behaviour
 Basic traits develop by 6 years of age.

Personality traits
 Cheerfulness
 Good manners
 Sportsmanship
 Honesty
 Kindliness
 Doctor- kindliness, honesty, patience, tolerance,
presevarance, consciousness, thoroughness and
initiative.
•Loyality
•Reliability
•Sense of humor
•Tactfulness
•Willing to help others

Theories of personality
Carl Jung (1875 – 1961): Extrovert, Introvert.
Feud’s Psychoanalytic theory: Id, Ego, Superego
Carl Roger’s self theory: concept of I, me, myself.
Dollard’s and Miller’s learning theory of personality.
medicine.2004 1st ed. Paras medical publishers.

Intelligence
 “Is aggregate capacity of an individual to act
purposefully, to think rationally, and to deal effectively
with his environment”.
 Maximum by age of 16 – 20 years
 Concept of IQ by Binet and Simon, revised by Terman.

 “ Is the ratio of mental age and chronological age.
 Consist of four factors: Motor ability, Adoptive
behaviour, Language development, Personal-social
behaviour.
 141 and above – Genius, 91-110 – average
 Assessment of intelligence – Verbal test,
performance test

Learning
 Important aspect of behaviour and
personality formation.
 “defined as a process which brings relatively
permanent changes in behaviour of a learner
through experience or practice”.

Characteristics of learning
 Process not a product – never ending.
 Involves experience and training of individual which
help to produce changes in his behaviour.
 Includes 3 domains of human behaviour:
Cognitive ( learning of knowledge like concepts,
principles, problem solving)
Affective (learning of habits, interest, feeling etc.)
Conative (walking, jumping, climbing etc.)

 Prepares an individual for the necessary adjustment
and adaptation.
 Purposeful and goal oriented.
 Changes behaviour but not permanent.
 Does not include changes in behaviour due to
senility, illness, drug, fatigue etc.
 Universal and a continuous process.

Types of learning
 Verbal (sign, pictures, symbols, words, sounds etc.)
 Cognitive (knowledge)
 Affective (habits, Interests, attitude etc)
 Conative (motor)
 Serial
 Paired – associate

Theories of learning
Psychodynamic theories
1.Classical Psychoanalytical – Sigmund Freud (1905)
2. Developmental task theory – Erik Erikson (1963)
3. Hierarchy of needs – Abraham Maslow
Behaviour learning theories
1. Classical conditioning theory – Ivan Pavlov (1927)
2. Operant conditioning – Skinner (1938)
3. Social learning theory – Albert Bandura (1963)
4. Theory of Cognitive Development – Jean Piaget (1952)

Others
1. Learning by conditioned reflex
2. Trial and error (Thorndike’s theory)
3. Learning by observation and imitation
4. Learning by doing
5. Learning by remembering
6. Learning by insight.

Motivation
 Motivation is the desire to gratify the needs
and any activity or response directed or
oriented to such gratification.
 The response/activity is overt and hence can
be seen.
 But the desire cannot be seen and hence has
to be inferred from observable behaviour only.

(1) Achievement Motivation
Drive to pursue and attain goals. - Wishes to achieve objectives
and advance up on the ladder of success.
(2) Affiliation Motivation
Drive to relate to people on a social basis. - Work better when
complimented for their favorable attitudes and co-operation.
(3) Competence Motivation
Drive to be good at something, allowing the individual to perform
high quality work.

(4) Power Motivation
Drive to influence people and change situations. - Wish to
create an impact on their organization and are willing to take
risks to do so.
(5) Attitude Motivation
Attitude motivation is how people think and feel. It is their self
confidence, their belief in themselves, their attitude to life.

(6) Incentive Motivation
Person or a team reaps a reward from an activity. It
is “You do this and you get that”, attitude.
(7) Fear Motivation
Person to act against will. It is instantaneous and
gets the job done quickly. It is helpful in the short
run.
www. laynetworks.com

Emotions
 “Sudden force surfacing in the mind”. It is a response
to a stimulus or situation. Emotion is also called
affective state.
 Emotions are of two types
1) Positive emotions :- Create a feeling of pleasure,
joy, love, mothering.
2) Negative emotion : Create a feeling of sadness,
sorrow, anger, hate, fear.

 Appropriateness of emotion depends on situation.
Anger is a negative emotion.
 ‘Moral wrong’, then it will be considered appropriate.
 Emotion can be a major barrier to communication.
Arrival of patient creates an emotion of sympathy -
development of doctor patient relationship.
publishers.

Cultural Anthropology
 Anthropology is the study of man and his works.
 It is the study of physical, social and cultural history
of man.
 Two broad divisions.
Physical anthropology: is the study of man as a
biological organism.
Cultural anthropology: is the branch dealing with
man's behaviour and products.

 It is defined as Learned, non-random, systematic
behavior and knowledge that is transmitted from
person to person and from generation to generation.
 It changes through time and is main contributor to
human adaptability.
 Culture is learned and not biologically determined or
coded by hereditary material.

 Survival strategies and other behaviors and thoughts
are learned from parents, other relatives, teachers,
friends, peers and so on.
 Culture is non-random i.e. specific actions and
thoughts are usually the same in similar situation
within a society.
 These specific behavior patterns in societies in a
particular situation are called Norms.

 Culture is patterned i.e. it is systematic, wherein one
aspect of behavior is related to all others. It is part of
a system.
 A system is a collection of parts that are interrelated
so that a change in any one part brings about
specific changes in others.

 Oxford dictionary defines culture as, "the training and
refinement of mind, tastes and manners, the
condition of being thus trained and refined".
 Man is distinguished from animals by virtue of the
fact that he possesses a culture, i.e. he can speak,
can frame ideas.

 Culture has three parts. It is an experience which is
learned, shared and transmitted.
 Culture is a social heritage, a product of specific and
unique history.
 Civilization, on the other hand, is the whole
machinery or system of devices developed by man.

Branches of cultural Anthropology
Ethnology: Comparative study of cultures.
Archeology: Study of past cultures and civilizations and uses
their remain as principal source of information.
Linguistics: Study of speech patterns of man-language and
dialects.
Social anthropology: Comparative study of kinship and non
kinship organization patterns in different societies.

Acculturation
 Means "culture contact."
 Contact between two people with different types of
culture, there is diffusion of culture both ways.
 Culture contact takes place - (1) trade and commerce, (2)
industrialisation, (3) propagation of religion, (4) education
and (5) conquest.
 Introduction of scientific medicine is through culture
-contact.

Barriers of Acculturation
1. Resistance to cultural change:
- Mores and taboos
- Sense of superiority
- General cultural inertia
2. Adaptation
3. Physical isolation

Impact
 SES and oral health & disease
 Family in health and disease
 Cultural factors in health and disease

 Gilbert GH et al., 2003
Florida dental care study > 45 years
African –Americans & lower SES – strong determinants
of tooth loss
 Sanders AE et al., 2004
3678 adults 18-91yrs Australia
Low household income, blue-collar occupation & high
residential area disadvantage - + pathological tooth loss
Tooth loss
Gilbert GH et al. Social determinants of tooth loss.
Health Serv Res. 2003 Dec;38:1843-62.
Sanders AE et al. Social inequality in perceived oral health among adults
in Australia. Aust N Z J Public Health. 2004 Apr;28(2):159-66

Burt. Dentistry, dental practice
and community. 2005. 6th ed.

Edentulism
 Related to SES
 DCI – 2002-2003 – no significant differences – urban/rural
Burt. Dentistry, dental practice and
community. 2005. 6th ed.

 Disease of poverty or deprivation
 Klein (1930 -1940 )– lower SES – higher value for D &
M, lower values of F .
 Higher SES groups –decline in caries experience
Dental caries

 Vary with different measures of SES ( private
housing, mother , father’s education, overcrowding,
employment, income & consistent results in
industrialized & non-industrialized countries
 Inverse relation caries experience & SES – primary &
permanent teeth

 DCI – no difference – urban/rural – in all age
groups (2002-2003)
National fluoride mapping by DCI 2002-2003

Periodontal disease
 Historically - lower SES
 Gingivitis & poor oral hygiene related to lower
SES
 Periodontitis & SES less direct

Burt. Dentistry, dental practice and community.

0
10
20
30
40
50
60
70
80
90
100
12 15 35-44 65-74
rural
urban
Periodontal disease - % prevalence - DCI
National fluoride mapping by DCI 2002-2003

1. Childrearing
 Physical care of the dependent young in order that
they may survive to adulthood.
 Differs enormously from society to society, and from
time to time.
 Depending upon factors such as capital resources,
level of knowledge, state of technology and system
of values.

2. Socialization
 The second responsibility of the family is to socialize the
"stream of new-born barbarians."
 Refers to the process where by individuals develop
qualities essential for functioning effectively in the society
in which they live.
 It is a latent function. By socialization is meant teaching
the young the values of society and transmitting
information, culture, beliefs, general codes of conduct.

3. Personality formation
 This is even a more latent function.
 It is an area in which sociology comes closest to
psychology.
 The family acts as a "placenta" excluding various
influences, modifying others that pass through it and
contributes some of its own.

4. Care of dependent adults
(a) Care of the sick and injured
(b) Care of women during pregnancy and child birth
(c) Care of the aged and handicapped

5. Stabilization of adult personality
 The family is like a "shock absorber" to the stress
and strains of life.
 The stress could be injury, illness, births, deaths,
tension, emotional upsets. worry, anxiety, economic
insecurity.
 Certain chronic illnesses such as peptic ulcer, colitis,
high blood pressure, rheumatism, skin diseases are
accepted as "stress diseases" having a prominent
emotional element in their development.

6. Familial susceptibility to disease
 Members of a family share a pool of genes and a
common environment and together, these decide
their susceptibility to disease.
 Haemophilia, colour blindness, diabetes and mental
illness are known to run through families.
 Schizophrenia, psychoneurosis and some forms of
mental deficiency are also known to have a familial
incidence.

7. Broken Family
 Broken family is one where the parents have
separated, or where death has occurred of one or
both the parents.
 “Mental deprivation" as one of the most dangerous
pathogenic factors.
 Display in later years psychopathic behaviour,
immature personality, retardation of growth, speech
and intellect.

8. Problem Families
 Problem families are those which lag behind the rest
of the community.
 In these families, the standards of life are generally
far below the accepted minimum.
 Parents unable to meet the physical and emotional
needs of their children.
Park. Social sciences and health. In: Park. Social
& preventive medicine. 2005. 19th ed.506-518.

Cultural Factors
in
Health & Disease

 People, have their own beliefs and practices
concerning health and disease.
 Widely recognised that cultural factors deeply
involved in all the affairs of man, including health and
sickness.
 Not all customs and beliefs are bad.
 Some of these cultural factors, hallowed by centuries
of practice, have stood in the way of implementing
health programmes.

1. Concept of aetiology and cure
A. Supernatural:
1. Wrath of gods and godess
2. Breach of taboo
3. Past sins
4. Evil eye
B. Physical causes:
1. Effects of weather
2. Water
3. Impure blood Social sciences and health. Park. Social &
preventive medicine. 2005. 19th ed.

2. Enviornmental Sanitation
a. Disposal of human excreta.
b. Disposal of human wastes
c. Water supply
d. Housing

3. Food Habits
 The diet of the people is influenced by local
conditions (e.g., soil, climate) religious customs and
beliefs.
 Vegetarianism is given a place of honour in Hindu
society.
 Alcoholic drinks are tabooed by Muslims and high
-caste Hindus.
 Ganja, bhang and charas are, frequently consumed
by sadhus.

4. Mother and child health
1. Good
2. Bad
3. Unimportant
4. Uncertain

5. Personal Hygiene
1. Oral hygiene
2. Shaving
3. Smoking
4. Purdah
5. Wearing shoes

6. Sex and Marriage
 Mean marriage age: 24 –M, 19 – F
 Monogamy
 Polygamy
 Polyandry – Todas of Nilgiri hills, Jaunsar Bawar in
UP, Nayars in Malbar coast.
Social sciences and health. Park. Social &
preventive medicine. 2005. 19th ed.

Mutilation of teeth
 Since prehistoric
times.
 Most- tropical
regions.

 Alteration in shape of crown by filling or chipping.
 Staining of teeth
 Placement of gold crowns for adornment purpose

 According to Waarusha and Masal people of
Tanzania practice removal of central incisor.
 Space left provide the route allowing passage of fluid
in the event that the person is not able to open the
mouth.

 Enucleation of unerupted deciduous teeth is confined
to certain regions of Africa considered as therapeutic
benefit upon children.
 Blackening of teeth among Jivero Indian, people of
Peru and Ecuador- to prevent dental caries.

Dental inlays and crowns
 Adornment purpose
 Purpose
• Beautification
• Signify wealth.

In India
 Important people like Maharaja’s- inlayed with glass
or pearls.
 Ancient Roman civilization- dental restorations of
gold.
 Muslims- gold crown in front tooth signify wearer has
visited Mecca.

Tattoing
 Popular practice in tropical and non-tropical areas of
world.
 Tattooing done on
- Skin
- Lip
- Gingiva
- Teeth

Other forms of soft tissue mutilation
 Piercing of lips and peri-oral soft tissues and
the insertion of materials such as wood, ivory
or metal.

Popular beliefs in India
 No extractions- eye sight!
 Patient demand dentists to show worms in decayed
teeth as they believe that dental decay is caused by
worms.

 Exfoliated Deciduous teeth
• Under rock
• Throw on top of roof.
• Teeth in a rat hole.

 Cultural practices like breast feeding and sugar
based substances extended up to 3-4 yrs- unusual
caries pattern.
 Scaling- tooth becomes loose.
 Child with neo-natal teeth- danger to grand parents.

 Public health workers face difficulties in program
planning- because of long standing tradition and
misconceptions.
 To overcome culture barriers- patient education.
 Social scientist have been called to aid in adapting
new health programmes.

Conclusion
 Medicine and social sciences – human behaviour.
 Specialists seeking cooperation of social scientists.
 Health cannot be isolated from its social context.

References
 Park. Social sciences and health. In: Park. Social &
preventive medicine. 2005. 19th
ed.506-518.
 Petersen PK. Society and oral health. In. Pine CM.
Community oral health. 1997.ed. Mumbai. Km Varghese
company. 20-37.
 Kulkarni AP. Textbook of community Medicine. 2002. 2nd
ed. Mumbai. Vora medical publication. 28-35.

 Bhaskar Rao. Textbook of community medicine.2004 1st
ed.
Paras medical publishers 29-71.
 Gupta MC, Mahajan BK Textbook of preventive and social
medicine. 2003 3rd
ed. Jaypee medical publishers 109-120.
 Burt. Dentistry, dental practice and community. 2005. 6th
ed.

 Peter S. social sciences in dentistry. In: Peter S. Essentials
of preventive and community dentistry. ed. 2001. New
Delhi. Arya Publishing house. 733-741.
 Locker D. Deprivation and oral health: a review. CDOE
2000; 28: 161-9.
 Klinge B et al. A socioeconomic perspective on
periodontal disease.- a systematic review. J clin
periodontol 2005; 32(s6): 314-25.

 Sathe PV and Sathe AP. Evolution of health care system
in India. In: Sathe PV and Sathe AP. Epidemiology and
management for health care for all. 2nd ed. Mumbai.
Popular prakashan. 2003. pp3-42.
 Http://www.ucel.ac.uk/shield/docs/notes_black.doc

 S.C. Tiwari, Aditya Kumar & Ambrish Kumar. Development and
Standardization of a scale to measure socio economic status in
urban and rural communities in India. Indian J Med Res 122,
October2005, pp309- 314.
 Prabhu, Wilson, Daftrary & Johnson. Oral Diseases in the
Tropics. 1993 ed. Delhi. Oxford university press.
 www. laynetworks.com
 National fluoride mapping by DCI 2002-2003

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