To understand social and

psychological factors
(bio psycho social
Medical environment )
in health and disease
sociology
Dr. SaGAR.M.V. professor
,department of community
medicine
 Application of principles of Medical
sociology
 (Application of principles of sociology in health and
disease )

 For understanding social factors as

 determinants in disease , health ,
 ,and in providing health care services ,
 and
 utilization of health care services by client
 Behaviour of health care provider towards patient .etc.
Dr.sagar m v., professor ,department of community medicine
 l Social
i c a
d g y anthropology ps So
e lo yc ci
M io ho al
o c log
s
y
• Application of principles of
sociology in health and
disease
Medical sociology

Social psychology

and social
anthropology

in health ,disease
and health care.

Dr.sagar m v., professor ,department of community medicine

medical sociology
is the science application of principles of sociology
in health care
understanding the social and cultural determinants
of disease ,
role of family , community ,society and government
in health and sickness ,
behaviour of the health care institutions,
patient doctor /relationships
attitude of health care professionals toward patient
care
AND SICK ROLE OF PERSON
 Why health care professionals expected to be well aware
of the basic concepts of social sciences in relation to
health care

Various social ,factors are

extremely important in the
genesis, ,prevention, and cure
of human diseases.
 Why health care professionals expected to be well aware
of the basic concepts of social sciences in relation to
health care

The way people live ,their habits ,beliefs

,values ,and customs are significant
determinants of individual ,family,and health
at community level .
• It is therefore of great relevance for all those
health care professionals concerned with
health care individuals and communities
Social sciences
• Study of organization and behaviour of
groups of human beings
• Evolution of organization and
behaviour of human beings
Major disciplines included under social sciences

Sociology
Psychology
Anthropology
Human history ,law , economics
 • Discipline that deals with
the study of human society
Sociology • Kinds of variation in society

Concerned with • Structure of social variation

organization • Processes of social structure
and structure of maintenance
social groups
 acculturation

Transfer of values and customs from one

culture to another

Military or political conquest

Positive and negative impact on health

Migrated individuals ,changes in lifestyle

 Society
• Defined as a group of individuals
who have organised themselves
and follow a given way of life
which members of society follow .
 Behaviour customs and beliefs Follow
religious and formal legal codes
• Indian society ,modern society and western
society , traditional society
• Modern society follow a given pattern of
life and behaviour which distinguishes
them from persons who belong to the
traditional society
Community
• Defined as a group of people who have some common
characteristics and are bonded by the “ WE “ FEELING

BONDING
• SHARED TOGETHERNESS ON THE BASIS OF SOME
PARTICULAR PRINCIPLE OF LIFE
MAY BE DUE TO A PLACE WHERE THEY
ALL STAY or due to some other common
intrest
 Accordingly the communities can be either “structural” or
“functional”

functional communitiesare non geographical aggregates

,which are bound together by some common factor other
than the geographical place or residence or work ,for
example ,religion , occupation ,special intrest ,or need
 structural communities are organised by geographical or
political boundaries .ex in patients in a hospital or larger
mohalla , village ,slum ,city ,district ,state or even a nation

The sense of group identity causes the growth of motivation .

For this reason th community is ideal as for as focal point of a

programme
 Essential difference between society and community lies in the
presence or absence of “we” feeling

Which gives a small bonding and not only affects the way in
which people from group would think .

But also respond to a situation .

Thus “ we” bond is present istrongly in a community.

 Culture
 It is
 Defined as
 “ learned behaviour ”
 Which has been socially acquired
 CULTURE IS A WAY OF LIFE THAT TAKE VERY LONG ,EVEN
CENTURIES ,TO DOVELOP AND HANDED OVER FROM ONE
GENERATION TO ANOTHER
 Cultural factors
 CULTURAL factors are deeply involved in all human
affairs including health and sickness .
 The cultural factors include
 Customs, beliefs , moral values
 And religious taboos
 Cultural which create an environment that helps in
the spread or control of certain diseases and affects
the health of the community .
 Health seeking behaviour
Is defined as any action undertaken by individuals who
perceive themselves to have a health problem or to be ill
for the purpose of finding an appropriate remedy

Many of the community members may not utilise health

services even at low cost or free health services

May prefer to use unqualified traditional healers

 Health seeking behaviour
Is preceded by a decission making process that is
governed by an individual’ s behaviour ,family
behaviour ,community attitude ,as well as provider
( hospital ,or doctor or nurse ) related services

For example community members may not utilise the

services
If the rude behaviour of the doctors
Or the cost of the treatment is too high
or the health care facility is located too far away
Health seeking behaviour utilization of health fecilities can
be influenced by the cost of services

Cost of the services

Distance of the health fecility
Cultural beliefs
Level of education
In adequqte health fecility such as non availability of drugs
 Health seeking behaviour is influenced by two major factors which are as follows

1) The degree to which the disease

( negative outcome) is perceived by the person as
threatening
( perceived outcome or consequences of the disease
)
 Health seeking behaviour is influenced by two major factors
which are as follows

2) The degree to which the health behaviour is believed to be

effective in reducing the risk of a negative outcome .i e ., the
perceived effectiveness of the health seeking behaviour .
This will take into account not only whether the person thinks
the behaviour is useful , but how costly ( in terms of money
,time ,and efforts ) it is to carry out the health seeking behaviour
Common Barriers to positive health –
seeking behaviour and methods to
overcome them
• 1 low education
• 2 poverty an inability to pay health care costs
• 3 negative attitude of the individuals ,families
,and communities
• 4 negative instances in the past
• 5 Rude or impersonal behaviour of the staff .
• Lack of essential fecilities
 T o change negative behaviour • 1 Health education and communication
to positive health seeking
behaviour should be worked out .
Education of the community
and due participation of the
community are most important

• Health messages should demonstrate That there

is a real threat to their health
2 keeping in view of the health •
And convince them that a particular behaviour
seeking behaviour patterns of the
can reduce their risk.
individuals
Moreover ,any health programme or
health care facility should ensure
participation of community members .

2 this will give a feeling of “ ownership”

among the community members
 Social psychology
Combines psychology Study behaviour of
and sociology . the individuals as
Play significant role in influenced by the
understanding human groups which they
behaviour in groups and belong to .( family
community who are the community ,work
clients of the health care place )
services
Social psychology
Main objective of social psychology
is to find out as to how people’s
thoughts feelings , and behaviour are influenced
by other persons or the family
behaviours are influenced by or the family or the
community .
Social psychology has a significant role in
understanding human social behaviour
 Community behaviour • Focusses on health related attitude and
behaviours

Social environment of the • Use of health care practices

community which affects the • Adopting self care practices
health of the community

Evidence based practices and • Motivate the community to participate

to encourage people to make actively in the planning and planning and
healthy choices implementation of health programme
Community relationship
“community engagement ”
• Maintence of good relationship

Between the health care providers

and the community members
• In volving community in Identifying
health problems and addressing solutions
for the health problem
Evaluating and sharing the results with
the community

Importence of engaging the

community comes from the
fundamental principle
• PUBLIC HAS RIGHT TO PARTICIPATE
FAMILY IN HEALTH
AND DISEASE
 family is defined as a group of persons either
related by blood
or by sexual relationship
living at a common place
genarally at a common roof
eating out of a common kitchen
,sharing common resources ,
and having a relationship precise and enduring ,to provide for the
procreation and upbringing of children
 family is the primary unit of all societies

Towards which all our health care actions are

directed ,

Reflects the culture of the overall society of

which it forms a part and determine the
behaviour and attitude of its members
family is the primary unit
of all societies

Family is an
epidemiological unit

For providing
comprehensive health care
Types
of Nuclear
family

Joint

Extended
 Nuclear family

Nuclear families gives Gift of the modern

the advantage of industrialised society
freedom of action and due to migration consist
decissions regarding of husband wife and
their life to the couple children
 Comprises
Traditional However now
blood gradually it is
feature of
related giving way for
Indian to the nuclear
persons and
society family
their wives

Joint families
Nuclear families gives However ,it reduces the
the advantage of substantial amount of
social ,emotional
freedom of action and economic support ,wich
decissions regarding is available in a joint
their life to the coup family

Joint families
 Extended
family is an In which the couple with
their and dependent
extension of parents live together
nuclear family

Extended families
 Stages of evolution of family

Point of formation• By marriage of a man and woman

Phase of proliferation • Children are born

and grown up

• Children after education

Phase of retraction
and turning in to adults
leave the family
Original spouses dies and family
terminates
 Stages of evolution of family
Point of formation
• By marriage of a man and woman

Phase of proliferation
• Children are born and grown up

Phase of retraction

Original spouses dies and family terminates

• Children after education and turning in to adults leave the
 Functions of Family
and its role in health and disease
 Functions of Family
and its role in health and disease
Unit of health care
action is the family
Inculcate cultural characteristics, customs ,and beliefs

Growth of new family is the reproductive nucleus of the society

born to adult Nourishment, protection, care, education ,

Instils various
social values
 Functions of Family
and its role in health and disease
Unit of health care
action is the family

Growth of new
born to adult

Instils various
social values
 Inculcate cultural characteristics, customs ,and
beliefs

Nourishment, protection, care, education ,

family is the reproductive nucleus of the

society a fundamental and social institution
Primary task of the family is to socialise the child
and nurture him ;’/her to be placed in life as a
mature and independent member of the society .

His physical and mental dovelopment is

determined his /her initial experience with the
family

Every society has its institution of marriage .and a

stable family life
Through the family system ,human beings
maintain physical continuity through
reproduction .

and social and cultural continuity through

training and education .

Share pool of genes

Common environment as well as common
modes of thoughts
Familial beliefs Share family
and attitudes go a materials and
long way in social
shaping the environment
perception about
the causes of
health and belief
Familial beliefs Share family
and attitudes go a
long way in materials and
shaping the social
perception about environment
the causes of
health and belief
 Functions of family and its role in health and
disease

1) Attitudes , 11
beliefs, and
practices in
relation to
health ;
 Functions of family and its role in health and
disease

1) Attitudes , 11
beliefs, and
practices in
relation to
health ;
Acculturation
Dovelopment of
personality and
life style
Care
during
illness
 Social support
system during ill-
health and period of
crisis
Mother and
child health
Health care of children
And adolescents
Reduction of mental stress
Susceptibility to diseases
Thank

You
 Social stratification , socio economic
classification and poverty
 Expressed in terms various social classes in which
people are distributed .
 this is refered to as social stratification .
 Social stratification is a horizontal division of the
society in to several socio economic layers ;
 Social stratification , socio economic
classification and poverty
 Each social class has a comparable standard of living
,status ,and life style .

 Social class is determined on the basis of three

parameters of development ;
 Social stratification , socio economic
classification and poverty
 1) education
 2) occupation
 3) income
 On the basis of these parameters populations are divided upper
,middle and lower class .
 The social class gradations helped to provide deeper understanding
of various health related phenomena .
 Social stratification , socio economic classification and
“ poverty
Social stratification is a horizontal division of the
society in to several socio economic layers ;

”
 , socio economic status and social class

 Two most ommonly used socio economic

classifications
 1) kuppuswamys scale of social classification
 2) prasad ‘ s scale of social classification
Kuppuswamy scale
Prasad clssificaion
poverty
 poverty
 Kuppuswamy’ s scale and prasad are
commonly used to classify the population
into different socioeconomic strata
 However they do not strictly measure
“poverty ”
Percentage of population living below poverty line (B P L FAMILY)

 Commonly used index of the overall standard of living and economic status of the
country
 Also used to identify those who need to be supported by the various social security
schemes
 Poverty line actually means inability to buy adequate food which can provide 2400
calories per day per person .
 According to recent world bank report 21% of india population is below poverty
line
 World bank has kept the threshold for poveety as 1.90 U.S.$ dollars
 ( 1.90 $ per day per person means 3900 rupees
Percentage of population living below poverty line (B P L FAMILY)

 Commonly used index of the overall standard of living and economic status of the
country
 Also used to identify those who need to be supported by the various social security
schemes
 Poverty line actually means inability to buy adequate food which can provide 2400
calories per day per person .
 According to recent world bank report 21% of india population is below poverty
line
 World bank has kept the threshold for poveety as 1.90 U.S.$ dollars
 ( 1.90 $ per day per person means 3900 rupees
 Human poverty index (H P I )

used as an indication of the standard of living in a country

• doveloped by U N with human dovelopment index ( h p I )

H P I concentrate on deprivation in three essential

elements ty 2) knowledge

1) longevity 2) knowledge 3) decent standard of living

• HPI derived saparately for doveloped countries and doveloping countries
 GLOBAL HUNGER INDEX ( G H I )
 Global hunger index composed of three
components
1) The percentage of undernourished population as a
percentage of total population

The %age of under weight children under the age of 5

years as a percentage of population of children under 5
years of age

The mortality rate of children under 5 years as

percentage
 GLOBAL HUNGER INDEX ( G H I )

Percentage of these three are

added and divided by three to
get HUMAN HUNGER
INDEX parameters
• SCORE OF ZERO ARE BEST AND
SCORE OF 10 IS WORST
SITATION
 Rank for india as per GLOBAL HUNGER INDEX ( G
H I ) ( very poor )
Grades < 10 ; =low hunger
are

10 to less than 20 = moderate • India was ranked 100 out

hunger of 119 countries
20 to less than 35 = serious
hunger
35 to less than 50 = alarming In 2017 G H I for
india was 31.4 “
50 and above extreemlly
alarming hunger
serious situation of
hunger ”
 Medical social worker ( MSW)
 Auxiliary medical worker who has been trained in principles of
social sciences and in medical case work .
 Visit the community
 Develop and complete family health folders of the community
being served by community medicine department .
 He works at rural health centre and urban health centre .
 Medical social worker ( MSW)

Theu also prepare “ case work diary” in the community of the

persons suffering from chronic diseases ,
or
Are in need of rehabilitation / social support
In hospital they visit patients and after discharge in their home and
community environment .
 Medical social worker ( MSW)
They communicate to the doctor about patients
socio economic and environmental conditions

the medico social worker thus forms a very useful interface

between the medical professionals and the community .
An example of Importence of bio psycho
social factors in health and disease
A child admitted with diarrhoea and treated with ORS / I V FLUIDS
/AND SUPPORTVE THERAY and discharge him or her . As cured

Work on environmental sanitation ,water supply , at the child house ,

Details of knowledge ,attitude of the mother toward disease ,health

related practices ( hand washing ,food preservation ,
Feeding practices , weaning foods , using feeding bottle ,
about

About hazards of using artificial weaning foods , low cost

supplementary weaning foods ,

Small scale disinfection of water

Vaccination

Identifying signs of dehydration ,fast breathing

,and seeking health care

Spacing of births ,using ontraceptive methods ,

choice of contraceptivs ,
The Root causes

Treat not only clinical diseases ,but also the social causes

Female literacy ,food supplementation,

fertility control .
 Social pathology
 Study of causes of human disease due to social
conditions
Social pathology Study of causes of human disease due to social
conditions

Living below
poverty line

Most of the adults

work as asual
Lack of basic
labourers ,or part
sanitory feilities
time domestic
servants ,alcoholism

Poor educational
Non availability of
status / poor health
drinking
illiteracy

Poor educational
fecilities