Community medicine ug teaching

1. SOCIAL AND BEHAVIORAL
FACTORS RELATED TO HEALTH
AND DISEASE II
DR THULASI M
MBBS, MD COMMUNITY MEDICINE

2. Family life cycle

3. TYPES OF FAMILIES
1.Nuclear family
2.Extended family
3.Three generation family
4.Joint family

4. • Broken family
• Problem family

5. Functions of family
• Residence
• Division of labour
• Reproduction and bringing up of children
• Socialization
• Economic function
• Social care

6. Social care
• (a) Giving status in a society to its members, i.e., Use of family names
• (b) Protecting its members from insult, defamation
• (C) Regulating marital activities of its members
• (d) Regulating political, religious and general social activities
• (e) Regulating sex relations through incest-taboos

7. Family in health and diseases
• Child rearing: Feeding, nutrition, hygiene, sleep, discipline etc.
• Socialization: Make them fit for membership in the wider society
• Personality formation: Capacity to withstand stress and strain
• Acts as a “placenta”
• Stabilization of adult personality: “shock absorber”
• Injury, illness, births, deaths, tension, emotional upsets, anxiety,
economic insecurity
• Peptic ulcer, high blood pressure, rheumatism, skin diseases are
accepted as “stress diseases”

8. • Familial susceptibility to disease: haemophilia, colour blindness,
diabetes and mental illness
• 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

9. Cultural factors relating to health and disease
• Concept of etiology and cure
• Environmental sanitation
• Food habits
• Mother and child health
• Personal hygiene
• Sex and marriage

10. Concept of etiology and cure..
• Cause of disease as understood by majority of rural people fall into
two groups,
a) supernatural
b) physical

11. Supernatural causes..
• Wrath of gods and goddesses
• Breach of taboo
• Past sins
• Evil eye
• Spirit or ghost intrusion

12. Physical causes..
Effect of
 Weather
 Water
 Impure blood

13. Environmental sanitation..
• Disposal of human excreta
• Disposal of wastes
• Water supply
• Housing

14. Food habits..
 Associated with love affection warmth self image and social prestige.
 Vegetarianism is given a place of honor in Hindu society.
 Concept of cold and hot food is prevalent in the country: jaggery,
sugar, groundnuts, eggs and meat.
 Drinks and drugs
 Ganja, bhang consumed by Sadhus.
 Alcoholic drinks are tabooed by Muslims
 Fasting
 Eating from common utensils
 Men eat first

15. Mother and child health..
• Marriage is universal in Indian
society.
• Family is incomplete with out the
birth of male child.

16. Mother and child health..
• Various customs in the field of MCH have been classified as..
a) good
b) bad
c) unimportant
d) uncertain

17. Mother and child health..
Good:
 Prolonged breast feeding.
 Oil bath
 Massage
 Exposure to sun

18. Mother and child health..
Bad:
 Varies from society to society
 Delivery by untrained dai
 Branding of skin
 Administration of opium
 Drastic purgatives

19. Mother and child health..
Unimportant:
• Punching ear and nose
• Application of oil on anterior frontanelle
• Application of paste of turmeric on anterior frontanelle

20. Personal hygiene..
1. Oral hygiene: use twigs of neem as toothbrush, some use ashes
some charcoal
2. Bathing: bathing naked is a taboo. Practice of oil bath is an Indian
custom.
3. Sleep: Many villagers sleep on ground for the reasons of poverty
and they are exposed to insect bites
4. Wearing shoes: Many villagers in South India do not wear shoes.
5. Circumcision: Prevalent custom among Muslims

21. Personal hygiene..
Smoking:
1. Mothers smoking during pregnancy may retard the growth of fetus.
2. Smoking Hubble bubble is a social custom in some parts of country.
3. Smoking with the burning end of cigar in the mouth is a common
custom among the villagers in Andhra Pradesh.

22. Sex and marriage..
• Sexual customs vary among different social religious and ethnic
groups.
• For certain religious groups menstruation is a time of uncleanness
when women are forbidden to pray or have intercourse.
• Orthodox Jews are forbidden to have intercourse for seven days after
menstruation ceases.

23. Sex and marriage..
• Marriage is a sacred institution.
• Usual social custom in India to perform marriages early at about the
ages of puberty.
• The mean age at marriage in India is 24 years in case of male and 19
years in case of female.
• Monogamy is the most universal form of marriage.
• Polygamy prevails in certain communities.

24. • Community
• Social class
• Hospital sociology
• Psychology
• Economics
• Health indices

25. Socio-economic classification
• Modified KuppuswamY Scale
• B G prasad Classification

26. MODIFIED KUPPUSWAMY SCALE

27. MODIFIED B G PRASAD CLASSIFICATION

28. Social Class & Health
“Health is a state of complete physical, mental, and social well-
being and not merely the absence of disease or infirmity.”
World Health Organisation
Social Class & its effect on health

29. • Social Class & Health
•Those in the upper class live longer and are healthier while doing so.
• Those in lower classes die at a younger age and are considerably less
healthy over their entire life course (Evans, 1994).
• Numerous studies have found that a "gradient" exists along the social class
continuum - with increasingly higher class position, health improves, and with
descending class position health deteriorates (Marmot et al, 1978, Lynch &
Kaplan, 2000).
• There is an emerging consensus that social class is a "fundamental
determinant" of population health. (Link & Phalen, 1995)
Social Class & its effect on health

30. Widening gap in Life expectancy:
• People in lower social classes are
biologically older than those in higher
classes, according to research.
• Seven year difference - of life
expectancy in Upper SES and Lower
SES.
• Not only does social class effect health
and age-related disease, but seems to
have an impact on the ageing process
itself.
• Probable explanation : Telomere length
corresponded to their social class. Stress
may have a biological impact on the body,
making cells divide more quickly and
reducing the telomere length.
• Telomere length is used by some
scientists as an indicator of biological
ageing.
Social Class & its effect on health

31. Mortality rates:
•Aggregate level: Areas with more lower SES- higher mortality rates.
•Individual level: SES inversely proportional to all- cause mortality
Social Class & its effect on health

32. Widening gap in Infant mortality
•In 1997-99, the infant mortality rate among the ‘routine and
manual’ occupational group was 13% higher than for the
total population. In 2001-03, it was 19% higher.
Social Class & its effect on health

33. Narrowing gap in Lifestyle disorders
• Coronary heart diseases.
• Hypertension.
•Diabetes mellitus
•Breast cancer
High incidence in Social Class 1
•Diseases in skin, eye, ears, diarrhea, dysentery
High incidence in lower social classes
Social Class & its effect on health

34. Factors involved in social in
social class differences in
health and disease
Social Class & its effect on health

35. Factors involved at work place
• It is not so much social class per se that influences health, but
characteristics associated with class.
• There are several factors through which class or socioeconomic position
may influence health:
•Health hazards:
Exposure to hazardous substances or processes in the workplace.
Hazardous work exposures and heavy physical job demands often
present in lower level service and manual groups while being almost
non-existent in managerial/professional class groups (Johnson & Hall,
1992).
Social Class & its effect on health

36. The managerial/professional class tends to have:
•High psychological job demands
•High levels of work control
•Very low levels of physical demands
•Low levels of hazardous exposure.
•They work longer work hours
•Their jobs require considerable flexibility (Johnson & Hall, 1992).
Social Class & its effect on health

37. Working class jobs by contrast have:
• Much less control
• Are more routine.
•Fewer psychological job demands and
•Considerable monotony.
•Have much higher physical demands and more hazardous
exposures (Johnson & Hall, 1992).
•High demands for effort coupled with low rewards
(Seigrist & Marmot, 2004).
Social Class & its effect on health

38. Other factors :
Physical environment: Housing, water, clean air, over- crowding due to larger
family size.
Consumption patterns: unhealthy foods, cigarettes, alcohol and illicit drug usage
(Cockerham, 2000)usage.
Access to medical care and services when needed.
Education also facilitates access to information that can benefit health. More
educated people are better able to communicate with their physicians and interact
with the health care system, and make informed choices among treatment options.
Attitude: Higher social status is associated with attitudes, such as positive self-
esteem or a sense of being in control of one's life. Such feelings are difficult to
maintain when a person is unemployed.
Economic deprivation: Low income.
Social Class & its effect on health