The community

1

Kingsuk Sarkar,MD

Assistant Professor

Department of Community Medicine

Dhanalaxmi Srinivasan Medical College

THE COMMUNITY

2

*The community-Dwells in a contiguous area

-Composed of people living together

-Based on co-operation of people to satisfy their own needs

-There are presence of common organizations: markets, schools, stores, banks, hospitals, dispensaries

-Major function unit of society,network of human relationship

3

*Societal structure is based on-caste→ sub-caste: ruled by customs & regulations on food-habit, marriage, social-contact, rituals ,following definite occupations. Indian caste system religion

-Occupation: related to social position

-Income: based on income people are classified- upper, middle, lower; upper class enjoys better amenities

4

*Urban Society:

-Consists of towns & cities

-Large, dense, permanent settlement

-Presence of occupational diversity

-Less dependence on agriculture

-Interaction between people, cultures, races

-Traditional pattern of behavior & belief not followed

-New ideas & patterns of behavior emerge

5

*Rural Society:-Majority of Indians reside in villages

-Self sufficient units for routine requirements

-Depend primarily on agriculture

-Caste, religion, marriage, kinship, ritual, economy plays important role

6

*Social Mobility:-Presence of social rigidity based on caste system

-Indian Society: ‘Closed Class

-Regressive towards personal achievement

-Attempt to make reforms are met with resistance from people

7

*CONCEPT OF SCIAL CLASS:oPeople belonging to a certain community bear distinct characteristics-Personal characteristics: age, sex, marital status, place of origin, citizenship-Economic characteristics: occupation, job profile & type-Cultural characteristics: language, religion, caste-Educational characteristics: literacy status, educational achievementoCaste hierarchy confers varying degrees of social prestige

8

*Occupation has been used as means of determining social standing

Role of occupation as deciding factor in-Economic rewards: income & wealth generation promote health & helps to achieve healthy lifestyle

-Establishment of authority: occupation may act as important determinant of authority of one individual over other people by→ influencing others life; activities related to pleasure, consumption & recreation, professional field; purchasing power

9

-Obligations: obligations demanded from individual by rest of community. Higher occupational place demands greater obligations

-Degree of status: standing of individual in the community depends greatly up on occupation irrespective of personal character, age, experience

-Life styles & Values: occupation determines personal values, goals in life, life styles, friendship & relationship, pursuit of pleasure

*High economic rewards fetch higher social prestige

10

*Social Classification based on occupation:oHistorical Perspective: Registrar General’s Occupational Classification in England & Wales-All occupations classified into five groups-Class III subdivided into two groups

I. Professional Occupation

II. Intermediate Occupation

III.(N).Non-Manual Skilled Occupation & (M).Manual Skilled Occupation

IV.Partly Skilled Occupation

V. Unskilled Occupation

11

*Limitation of occupational classification:

oHeterogeneity:

-Each social class is heterogeneous group comprising wide variety of occupation loosely related to one another

-Considerable difference exist in relation to education & family background

oOccupational Mobility:-Change in occupation may lead to discrepancy in determining & follow-up of social class over a period of time

-Change in hierarchy/status of occupation

oStatus of women:

- Male & female centered occupation, ambiguity in nomenclature

12

*Measures of social differentiation- other than occupation:

1)Education: measures inculcation of values, knowledge & achievements of individuals

2)Income:people distinguished by income or wealth generation

3)Purchasing Power:

4)Religion: has a tremendous bearing on health of the people, socio-cultural patterns of living,age-old habits, customs,, traditions affecting cleanliness, food habit, child rearing & daily life

5)Urban/Rural Life: difference exits in life style, opinions & values→ difference in health & sickness status

13

*Socio-Economic Status:

-Can be defined as “ the position that the individual or family occupies with reference to the prevailing average standard of culture and material possession, income, and participation in a group activity of the community.”

-Socio-economic standard of people is conventionally expressed in terms of various social classes in which people are distributed which are referred as social stratification.

14

*Social stratification is a horizontal division of society in to several socio-economic layers

*Each layer or social class has a comparable standard of living, status & life style

*Social class is determined on the basis of three parameters; namely education, occupation & income

*These are important determinant of health & nutritional status, morbidity, mortality & treatment seeking behavior of the family

15

*Influence of caste & religion are still very strong in rural community

*Whereas education, occupation & per capita monthly income are the important variables in urban community

*There has been many attempts to measure socio-economic status of the family

-Hollingshed in USA used three variables: education, occupation & residential address

16

Kuppuswamy in India prepared a scale based on education & occupation of the head of the family and monthly family income for measuring socio-economic status in urban areas

Kuppuswa6my’s Socio-Economic Status Scale(Urban)

Education of Head of Family

Score Occupation Score Family Income per month

Score

Professional Degree

7 Professional 10 Rs 2000 & î 12

Graduate 6 Semi-professional

6 Rs 2000-1999 10

Intermediate/Diploma

5 Clerical/shop/farmer

5 Rs 750-999 6

High School 4 Skilled worker 4 Rs 500- 749 4

Middle School 3 Semiskilled 3 Rs 300- 499 3

Primary School

2 Unskilled 2 Rs 101- 299 2

Illiterate7 1 Unemployed 1 Rs <100 1

17

*To get current income group, a conversion factor based on current All India Consumer Price Index (AICPI) is used.

*The conversion factor can be obtained by dividing AICPI by 60.04

*The income groups in Kuppuswamy scale are multiplied with conversion factor to get the appropriate income group

-AICPI of June 2008 was 650 (Approx),→

-

18

*Recalculated Family Income Groups of the Kuppuswamy’s Scale as on June 2008

Original Income Modified Income by using Coversion Factor(multiplied by 10.83)

Score

>2000 21660 12

1000-1999 10830-21659 10

750-999 8122-10829 6

500-749 5415-8121 4

300-499 3249-5414 3

101-299 1093-3248 2

<100 <1093 1

19

*Calculation of social class according to Modified Kuppuswamy’s ScaleTable: Socio-Economic Class

Total Score Class Description

26-29 I Upper Class

16-25 II Upper Middle

11-15 III Lower Middle

5-10 IV Upper Lower

Below 5 V Lower

20

*Prasad’s Scale:

-Dr B. G. Prasad’s social classification was developed in 1961 was based on per capita monthly income.

-There are five classes

-The income groups are to be recalculated by multiplying the previous income level as mentioned in Prasad’s classification with Kumar’s conversion factor i.e.,

-Example: AICPI for January 2010 was 541,

-

21

*Modified Prasad’s Scale , to be used in both urban & rural areas

-Table showing per capita monthly income

Social Class Prasad’s Classification :1961

Prasad’s Classification for 2010

I 100 & above >2700

II 50-99 1350-2699

III 30-49 810-1349

IV 15-29 405-809

V Below 15 <405

22

*Pareek’s Scale:-This socio-economic scale was developed by u. Pareek to measure socio-economic status of a rural family

- It is based on nine items:

i. Caste

ii. Occupation of Head of Family

iii. Education

iv. Level of social participation

v. Land holding

vi.Farm power(prestige animal)

vii.Housing

viii.Material possessions

ix.Family type

oEach items has got score and combined score for nine items are graded to indicate SE status

23

*Standard of living index:

-used under NFHS II

-House Type, Toilet Facility, Source of Lighting, Main Fuel for Cooking, Source of Drinking Water, Provision for separate Kitchen, Ownership of House, Ownership of Agricultural Land, Ownership of Irrigated Land, Ownership Livestock, Ownership of Durable goods: are important variable

24

*APL?BPL:

-Poverty line criteria was based on NSSO’s 61st round survey

-Per capita income

-Rs 356 per capita for rural families

-Rs 540 per capita for urban families

-GOI poverty line based on calorie intake

-Average per capita expenditure resulting in per capita calorie intake of 2400 calories for rural & 2100 calories for urban areas

25

*Wealth Index:

-Used in NFHS III as an indicator of level of wealth consistent with income and expenditure measures

-Based on 33 assets & household characteristics

-Each household asset is assigned a weight( factor score) generated through principal component analysis

-Resulting asset scores are standardized in relation to a normal distribution with a mean 0 & SD 1

-Sample is divided into quintiles, i.e., five groups with an equal no. of individuals in each

26

*Relationship between Social-Class & Health:

-Social class affects health

- Individuals belonging to the upper classes have higher life expectancy, less mortality, better health & nutritional status

- Incidence of disease varies in different social classes: NCD( CHD,HTN,DM →î incidence among Class I)

-Diarrhea, Dysentery, eye & ear infections, skin diseases→ higher incidence among lower classes

- IMR,MMR is found to lowest among highest class & highest among lowest class

-Also difference in family structure, low class→ bigger family

-utilization of health care services, low class→ low usage of prenatal, post natal, immunization services

27

*Factor found responsible in social class difference in health & disease:

Physical environment:- Quality of housing, provision of safe water, access to clean air

Differences in services provided:- Well coverage, poor coverage by GP, Specialist

Material resources:

- income, wealth, possession of tool

Genetic predisposition:

- Endogamy persist between same social class→ may influence genetic susceptibility to disease

Level of education:

Attitude towards disease:

- Attitude to health & disease vary across social classes

- Role self medication, superstition, care seeking attitude varies as well as distribution of disease among different classes

28

Thank You