Social stratification and Health

SOCIAL STRATIFICATION
AND HEALTH
Presented By:
Dr Suranjana J Hazarika
2nd year pg trainee
Department of Public Health Dentistry
Kalinga Institute Of Dental Sciences
2

1.Introduction
2.Terminologies
3.History
• Social stratification in the Age of capitalism
•Social exploitation
• Social stratification in pre and post Independent India
4.Sociology- Branches and Applications
5.What is Social stratification?
• Theories
• Principles
• Systems
1. Slavery
2. Class
3. Caste
4. Estate
• Gender and stratification
6.Socioeconomic status and scales-
• BG Prasad scale Bharadwaj scale
•Kuppuswamy scale Uday Pareek scale
•S C Tiwari scale Sataya Priya scale
•Srivastava scale
C
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T
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1. SOCIETY: Society is a group of individuals who have organized themselves and
follow a given way of life.
2. RURAL SOCIETIES: This comprises of the population living in the villages. The
villages are self sufficient units for most of the routine requirements of its
people.
3. URBAN SOCIETIES: Towns and cities comprise the urban societies. They are
relatively large, dense and permanent settlements of people.
4. FAMILY: The family is a primary unit in all societies. It is a group of biologically
related individuals living together and eating from a common kitchen.
5. COMMUNITY: A community is a social group determined by geographical
boundaries and/or common values and interests.
Park’s textbook of preventive and social medicine. K Park. 23rd edition.Medicine and Social Sciences.
6

6. SOCIALIZATION: It is the process by which an individual gradually acquires culture
and becomes a member of the social group.
7. MEDICAL SOCIOLOGY: It is a specialization within the field of sociology. Its main
interest is in the study of health, health behaviour and medical institutions.
8. SOCIOLOGY: Sociology deals with the study of human relationships and of human
behaviour for a better understanding of the pattern of human life. Sociology is the
study of individuals as well as groups in a society.
9. EDUCATION: It measures the inculcation of values, knowledge and achievements of
an individual.
7

10. SOCIAL STRATIFICATION: Social stratification is a kind of social differentiation whereby
members of society are grouped into socioeconomic strata, based upon their
occupation and income, wealth and social status, or derived power.
11. SOCIAL STRUCTURE: Social structure refers to the pattern of inter relations between
persons. Every society has a social structure- a complex of major institutions, groups,
power structure and status heirarchy.
12. SOCIAL MOBILITY: Indian society is rigidly based on caste system. There is little social
mobility, i.e., people do not change their caste or religion. In other words, Indian
society is a "closed-class" system.
13. SOCIOECONOMIC STATUS: It has been defined as 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.
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HISTORY OF
SOCIAL
STRATIFICATION
9

SLAVERY IN THE UNITED STATES
10

SOCIAL STRATIFICATION IN
INDIA
11

MODERN SOCIETY
BOURGEOISE
PROLETARIA
T
14

WEBERIAN THEORY
• Max Weber(1864-1920)
• Neglected the materialistic concept of history
• Human motivation and ideas were the real forces of change.
• Weber believed that sociology should focus on social action and not
preoccupy itself with structures.
15

DAVIS and MOORE
THEORY
• Proposed in the year 1945
• Somewhat amended in 1948.
• Perspective that considers society as an organism
• This theory argued that this organism has needs that
must be met if it is to remain healthy.
• Important positions or jobs in the society.
16

•Sociology deals with the study of human relationships and of human behaviour for a better
understanding of the pattern of human life.
• Sociology is the study of individuals as well as groups in a society.
• Major fields of specialization-
1. Urban sociology
2. Rural sociology
3. Industrial sociology
4. Medical sociology
5. Sociology of religion
6. Sociology of education
7. Criminology
8. Hospital sociology
9. Demography
17

Evolution of
sociology
 Phase 1(Before 1700AD)- Based on traditional beliefs,
myths and religion.
 Phase 2(18th- 19th century)- Based on systematic study
and objective scientific theories.
 Phase 3(20th century onwards)- Modern sociological
concepts based on new technology.
• Diversity of theoretical approaches.
• No universal agreements in studying human behaviour.
Textbook of preventive and social medicine. Piyush Ghai. Social and behavioural sciences in health: 623-629
18

Applications of
sociology
• Sociology enables one to see and analyse the social world from viewpoints other than
one’s own.
• Sociological research is a guide to assessing the results of policy initiatives.
• Sociology empowers individuals and groups with unbiased understanding.
• Self enlightened groups can benefit from sociological research and respond in appropriate
ways to influence government policies or form policy initiatives on their own.
19

SOCIAL
STRATIFICATION
•Social stratification is a kind of social differentiation whereby members of society are grouped
into socioeconomic strata, based upon their occupation and income, wealth and social status, or
derived power.
•Rankings of people based on wealth and other resources as society values.
- Andy Schmitz. Social stratification. Sociology: Comprehensive edition
•It is a comprehensive concept encompassing the positioning of people in the social structure by
their social status.
- Eero Lahelma. Health and Social stratification
•It refers to the division of the society into layers(strata) whose occupants have unequal access
to social opportunities and rewards.
- Syed Amin Tabish. Social class and health status. JK Practitioner 2006;13(4):242-247
•The structure and process of allocation and distribution of resources and the rationale of
decision making about the allocation of high and low positions in the society.
- K L Sharma, Social stratification and change in contemporary India
-Park’s textbook of preventive and social medicine. K Park. 23rd edition.Medicine and Social Sciences.
20

Principles of social
stratification
• Social stratification is a trait of the society and not simply a reflection of individual
differences.
• Social stratification carries over from generation to generation.
• Social stratification is universal but variable.
• Social stratification involves not just inequality but beliefs.
21

Systems of social
stratification
•Systems vary on their degree of vertical mobility, or the chances of rising up or falling
down the stratification ladder.
•In some so-called closed societies, an individual has virtually no chance of moving up or
down.
• Open societies have more vertical mobility, as some people, and perhaps many people,
can move up or even down.
1. SLAVERY
2. CASTE
3. CLASS
4. ESTATES
22

•Slavery especially flourished in ancient Greece and Rome,
which used thousands of slaves for their trade economies.
•But once Europeans began exploring the Western
Hemisphere in the 1500s, slavery regained its popularity.
•The United States, of course, is all too familiar with slavery, which remains perhaps the most
deplorable experience in American history.
•Slavery is thought to have begun 10,000 years ago, after agricultural
societies developed, as people in these societies made prisoners of war
work on their farms.
23

Slavery in Ancient and Medieval India
How Devadasis went from
having high social status to
being sex slaves and child
prostitutes???https://yourstory.com/2017/04/devadasis-india
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•Estate systems are characterized by control of land and were common in Europe and Asia
during the Middle Ages and into the 1800s.
•Landed gentry and the peasantry
•Estate systems thrived in Europe until the French Revolution in 1789 violently overturned the
existing order.
•Much of Asia, especially China and Japan, also had estate systems.
Estate systems
26

•In a caste system, people are born into unequal groups based on their parents’
status and remain in these groups for the rest of their lives.
•For many years, the best-known caste system was in India, where, supported by Hindu
beliefs emphasizing the acceptance of one’s fate in life.
•Many observers believe a caste system also existed in the South in the United States
JIM CROW
CASTE
SYSTEMS
27

28
Caste system in the Indian
scenario
https://www.bbc.com/news/world-asia-india-35650616
https://economictimes.indiatimes.com/news/elections/lok-sabha/india/view-
fundamental-shifts-in-indias-electoral-politics-witnessed-in-the-2019-poll-
battle/articleshow/69417681.cms?from=mdr

•Many societies, including all industrial ones, have class systems.
•A system of stratification containing unequal groups but with a relatively high degree of
social mobility.
•In this system of stratification, a person is born into a social ranking but can move
up or down from it much more easily than in caste systems or slave societies.
Weber’s dimensions
of class stratification
WEALTH POWER PRESTIGE
CLASS SYSTEMS
29

•Some jobs are more important than other jobs.
•Some jobs require more skills and knowledge than other jobs.
•Relatively few people have the ability to acquire the skills and knowledge that are
needed to do these important, highly skilled jobs.
•To induce the people with the skills and knowledge to do the important, highly
skilled jobs, society must promise them higher incomes or other rewards.
Davis & Moore(1945). Some principles of stratification. American Sociological Review; 10: 242–249.
30

•Gender is a socially constructed definition of women and men.
•Gender determines what is expected, allowed and valued in a woman or a man in a given
context.
•In most societies there are differences and inequalities between women and men in
responsibilities assigned, activities undertaken, access to and control over resources, as
well as decision-making opportunities.
Gender and stratification
31

•The gender approach highlights:
1. Differences between women’s and men’s interest
2. Conventions and hierarchies which determines their positions
3. Differences among men and women based on various aspects
4. Change in gender roles and relations
32

33
Race, Ethnicity and social
stratification
•Ethnicity is often assumed to be the cultural identity
of a group from a nation state
... Race is assumed to be
biological and/or cultural essentialization of a group
hierarchy of superiority/inferiority related to their
biological constitution.
•Before Weber, race and ethnicity were often seen as
two aspects of the same thing.
•Races were constructed and incorporated during the
period of European mercantile expansion, and ethnic
groups during the period of capitalist expansion.

34
•Ethnic and racial groups may perform the same functions in a particular society.
•Race can be regarded as one of broader class of social phenomena that we might term
as essentialist identifications.
•The relation of caste to race is not simply a question of whether the groups are in fact
racially different, but rather that there seems to be some disposition to attribute racial
difference to even the most marginal cues in caste and caste-like situation???
•Caste has been resilient, adaptive and discrete system

It has been defined as 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.
Socioeconomic status
• Identification and classification of socioeconomic variables.
• Each classification and scale has its own strength and inadequacy.
• Occupation, income, and education are the key variables.
35

40
1. Introduction to Medical sociology
2. The Social hierarchy of health
3. Indices
4. Social class and health status
5. Tackling the inequalities of health
6. Summary
7. Conclusion
8. References
CONTENTS

41
MEDICAL SOCIOLOGY
• It is defined as the “science of the social phenomena of the physicians
themselves as a class apart and separate, and which investigates the laws
regulating the relations between the medical profession and human society as a
whole”
-Charles Mentite(1894)
Sociology IN Medicine
Sociology OF Medicine

43
CONTENT AREAS
• Social etiology and etiology of disease
• Sociological study of treatment and recovery and social
support for illness.
• Study of the institutional organization of health, its
components and their relationships.
• Sociology of medical education.

44
The social hierarchy of
health
• Social class affects one’s life chances across a broad spectrum of social phenomena.
•Inequality in Health
• Inequality and Equity???
• WHO commission on Social Determinants of Health To propose evidence
based policy recommendations.

45
 WEALTH INDEX
 STANDARD OF LIVING INDEX
 GROSS NATIONAL HAPPINESS INDEX
 HUMAN DEVELOPMENT INDEX
 GLOBAL HUNGER INDEX

46
Wealth Index
• It is a composite Index composed of key asset ownership variables; it is used as a
proxy indicator of household level wealth.
• It was used in NHFS-3 as an index of economic status of households.
• used information on 33 household assets and housing characteristics.
• The household population is divided into five equal groups:
Lowest/Poorest- 1
Second-2
Middle-3
Fourth-4
Highest/Wealthiest-5

48
28
3
20
26
6
20
23
14
20
16
29
20
7
48
20
Rural
Urban
National
Lowest Second Middle Fourth Highest

49
Standard of living
Index
• It was created by the NHFS as a summary household measure(IIPS
2000).
• It is composed of 27 items.
• Used to measure the SES of both urban and rural areas.

50
Standard of living Scores
Low 0-14
Medium 15-24
High 25-67
• For the purpose of comparison the index was grouped into quintiles based on
a reference population consisting of the 1999 All India NHFS-2 data set.

51
Gross National Happiness Index
Happiness Index
Economy
Environment
Education
Society
Physical health
Mental health
Politics
Methodology:
1. Informal interviews
2. Focus group discussions
3. Secondary source of data
4. The happiness survey

54
•Across 101 countries, 1.3 billion people—23.1 percent—are multidimensionally poor.
•Two-thirds of multidimensionally poor people live in middle-income countries.
•India and Cambodia reduced their MPI values the fastest—and they did not leave the
poorest groups behind.
2019 Global Multidimensional Poverty Index (MPI). Human Development Report. United Nations Development Programme.

55
Global Hunger Index
• Comprehensively measure and tackle hunger
globally.
• Highlights successes and failures in hunger
reduction.
• International Food Policy Research Institute

56
https://www.globalhungerindex.org/

57
Human development
Index
• The Human Development Index is a statistic composite index of life expectancy,
education, and per capita income indicators, which are used to rank countries into
four tiers of human development: Very High, High, Medium and Low human
development.
Indicators
Life
expectancy
Education
Income per
capita
•A country scores higher HDI when the life expectancy at birth is longer, the
education period is longer, and the income per capita is higher.
Human Development Report-2018; United Nations Development Programme

58
World map representing Human Development Index categories (based on 2017 data, published in 2018).
• The index was first published in 1990 along with the Human Development Report.
•The latest index — covering 189 countries — was launched on 14 September 2018.

59
Social class and Health Status
Upper social classes have a longer life expectancy, less mortality and a better
health and nutritional status than those in lower classes.
 Poor state of physical environment
 Infant mortality rate – Wealth Index
 Family Structure
 Utilization of healthcare services
• K.Park. Textbook of Preventive and Social Medicine. 23rd edition. Medicine and social sciences. 668.

60
Factors involved in social class differences in health
and disease
• Physical environment
• Differences in services provided
• Material resources
• Genetic endowment
• Educational status
• Attitude to disease
• K.Park. Textbook of Preventive and Social Medicine. 23rd edition. Medicine and social sciences. 668.

62
Social class and coronary heart disease
• The Whitehall Study
• High incidence amongst the males in the lower social class.
• Exposed to more of physical or emotional stimuli at work.
• Differences in smoking behaviour.
• Affluent urban living does not necessarily carry a high risk of death from coronary
heart disease.

64
Social class and obesity
•According to the U.S Centres for Disease Control and Prevention, over
one third of the U.S adults are obese.
• CDC defines obesity as a body mass index greater than or equal to 30.
• Leading cause of death…
• Recent research highlights the complexity and variation in how SES and
obesity are related.
How Obesity relates to Socioeconomic status; Population reference Bureau.2019

65
• The Copenhagen Male Study
Cross sectional study of 3290 men aged 53-75 years(mean-63) carried out in
1985-1986 using in addition, data from a previous baseline established in 1970-
1971.
291 men(8.8%) were obese. The lower the social class, the higher the proportion
of obese men.
I and II- 4.5%
V- 11.6%
Suadicani P et.al. Lifestyle, social class and obesity- The Copenhagen male study. Eur J Cardiovasc Prev Rehabil. 2005; 12(3): 236-242

66
Socioeconomic status and the prevalence of skin and
atopic diseases
Robert F Ofenloch et.al. Socioeconomic status and the prevalence of skin and atopic diseases in five European Countries.. Acta Derm Venereol
2019; 99: 309-314.

67
Mind over Matter
• Depression is a significant public health issue which transcends communities and
countries.
• The role of SES in depression is an important theme and there is a large body of
literature which illustrates the negative association between SES and depression.
• Subjective social status and Depression
• Poverty and income inequality as ‘fundamental causes’.
• Health is thus an aggregate process of contextual influences people undergo in
their lives.
Katie A McLaughlin et.al. Socioeconomic status and adolescent mental disorders. American Journal Of Public Health 2012; 102(9): 1742-50.

68Aislinne Freeman et.al. The role of socio-economic status in depression: results from the COURAGE(aging survey in Europe). BMC Public
Health.2016; 16: 1-8

69
Social class and oral health
• Association between socioeconomic status and oral health behaviour
1. Lower income and fewer years of education are reported to increase the risk
for oral diseases.
2. Individuals with low education levels, defined as less than a high school
degree, had a higher prevalence of tooth loss.
3. Patients with a low SES should be investigated further in relation to oral
health.
Jun-Beom Park et.al. Association between socioeconomic status and oral health behaviours: The 2008-2010 Korea National
health and nutrition examination survey. Exp and Therap Medicine. 2016; 12(4) 2657-2664.

70
Socioeconomic status, oral health and dental disease in
Australia, Canada, New Zealand and the United States.
• Individuals from lower income and education groups consistently experienced higher
burdens of untreated dental decay and poorer self oral health.
• Differences in outcome estimates within countries also indicate conceptual differences
between health and disease.
• Need for further understanding socio-cultural and contextual determinants of oral health.
Gloria C Mejia et.al. BMC oral health. 2018; 18: 176

71
Association between socio economic status and dental
caries in elderly people in Sichuan province, China: A
cross sectional study
1. SES is associated with dental caries, and older people with low SES have poor oral
health.
2. The associations were explained partly by diet, behaviour and awareness.
3. Pertinence measures, economic assistance and medical insurance funds should be
provided to older people of low SES.
Wang L et.al. BMJ Open 2017; 7(9): 1-10

72
• Make inequality a political campaign issue
• Give a voice to oppressed groups
• Eliminate caste discrimination
• Make development inclusive of those with disabilities
• Stop the blame game
https://www.theguardian.com/global-development-professionals-network/2014/apr/22/india-elections-tackling-inequality-advice

74
Conclusion
• Social stratification is universal but variable.
• With limited resources we should first target the ones with inadequate access to
health care.
• The greater the income inequality is in a community, the worse are the health
indices.
• There is far more to poverty than not simply having money.
• To implement, suggest and participate in policies to reduce health inqualities.

75
References
• K.Park. Textbook of Preventive and Social Medicine. 23rd edition. Medicine
and social sciences. 668.
• Piyush Ghai. Textbook of Community medicine. Social and Behavioural
sciences in health. 623-629.
• Eero Lahelma. Health and Social stratification.
• K L Sharma. Handbook of social stratification for the BRIC countries.

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