social

INTRODUCTION
	Health cannot be isolated from its social context.
	The last few decades have shown that social and economic factors have as much influence on health as medical interventions.
	All these factors have a direct bearing on the incidence course, and outcome of a wide variety of communicable and non-communicable disease as well as on many other health problems besetting the world today.
	They also have an important effect on the provision of health care to all strata of society
	PREDISPOSING FACTORS TO ILL HEALTH Poverty Malnutrition Poor sanitation Lack of education Inadequate housing Unemployment Poor working conditions Cultural and behavioural factors
	Today more than ever before, there has been an increasing recognition that successful application of medicine to individuals and groups involves more than mere scientific or biological knowledge.
	It involves an understanding of the behaviour of individuals and groups who live together and also share certain values of life.
	Man is a social animal.
	The patient is no longer considered as one who is under strict laboratory control, but an indidividual with personal idiosyncrasies, erratic habits, customs and beliefs reacting on his body and mind.
	Thus, there has been a shift from the earlier concept of visualizing disease in terms of a specific germ to the involvement of "multiple factors" in the casuation of the disease.
	Good doctors are being identified as those who treat people, and bad ones as those who treat cases.
	As a result of this new outlook, concept of sociology are increasingly being used in the study of disease in human societies.
	In order to fully appreciate the impact of social environment on man, it is essential to have a proper understanding of social sciences in general and of sociology in particular.
	The five social sciences include ; Sociology Structural aspects of society social institutions community associations Functional aspects of society social norms customs and habits etiquettes and conventions social values Social or cultural anthropology Social psychology Economics, and Political science
	The first three are together called " Behavioral Sciences".
1. SOCIOLOGY
	Sociology is the study of individuals as well as groups in a society
	Society is a group of individuals who have organised themselves and follow a given way of life.
	Sociology can be viewed from two angles
1.	First, it can be seen as the study of relationship between human beings and how these relationships change or vary in different parts of the world and at different times.
	The unit of study can be a small group ( e.g., family ) consisting of parents and children, or the study can extend beyond the family or small groups into the complex society where a greater number of people interact and interdepend in terms of economics political power general organisation and ways of living.
2.	The other part of sociology is concerned with the study of human behaviour.
	Human behaviour is determined not merely by biological and physical environmental factors but also by social factors.
	Sociologists are interested in the study of social determinants of human behaviour.
	In the final analysis it may be stated that the aim of sociology is to search for the pattern of relationships between people in order to pave the way for the betterment of individuals in relation to society.
Structural aspects of society social institutions community associations
SOCIAL INSTITUTION
	A social institution is an organised complex pattern of behaviour in which a number of persons participate in order to further group interest.
	The family the school the church the club the hospital political parties associations and the panchayats are all social institutions.
	Within each institution, the rights and duties of the members are defined.
COMMUNITY
	The definition accepted by WHO Expert Committee is " A community is a social group determined by geographical boundaries and / or common values and interest"
	Its members have the same pattern of life
	They know and interact with each other
	The community functions within a particular social structure and exhibits and creates certain norms, values, and social institutions.
	The individual belongs to the broader society through his family and community.
ASSOCIATIONS
	They are 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 Dental association.
Functional aspects of society social norms customs and habits etiquettes and conventions social values
SOCIAL NORMS
	Every living organism has some basic requirements and tries its best to satisfy them.
	In man, biological forces trigger the desire but, contrary to animals, there are social standards which guide man.
	The resultant of these two forces is the actual bahavior which we perform in society.
	The specified rules of conduct to be followed by the members of a society are technically known as social norms. They are Folkways Mores Laws
FOLKWAYS
	They refer to customary ways of behavior.
	People confirm to these ways not out of fear of being penalized, but because it is obligatory in the proper situation, e.g., ways of eating, dressing.etc.
	They are necessary for the group solidarity. Vitality of a group is indicated by the extent to which people follow or abide by folkways.
MORES
	They are socially accepted ways of behaviour that involve moral standards.
	Each 'more' is believed to be essential for social welfare.
	There is a greater feeling of horror about violating mores and grater unwillingness to see them violated.
	Folkways are the protoplasm of the cell, the bulky part, while the 'mores' form the nucleus, the essential part.
	Taboos are specific types of mores expressed in negative. e.g., Abstinence from beef in Hindus Abstinence from pork in Muslims Abstinence from smoking in Sikhs.
LAWS
	Some important 'mores' are converted into laws in order to ensure implementation.
CUSTOMS AND HABITS
	Customs The mere existance of a society , the mere plurality of individuals give rise to customs from which no single member of the community can escape.
	These customs are quite numerous and quite as powerful.
	Customs are technically divided into "folkways" and 'mores'
	HABITS :- habit is an accustomed way of doing things.
	Habits are said to have 3 characreristics they are acquired through repetition. They are automatic, and They can be performed only under similar circumstances.
	Habits accumulated through generations emerge as customs, and customs in turn create habits.
	Habits once formed persist and influence human behaviour.
ETIQUETTES AND CONVENTIONS
	The customary behaviour of members towards each other is called etiquette.
	etiquettes are concerned with choice of the proper form for doing something in relation to other people.
	convention is merely an agreed upon procedure.
	It is a geneal agreement on social behaviour etc. by implicit consent of the majority.
SOCIAL VALUES
	They constitute an important part of the selective behavior of man.
	Values refer to those standards of judgement by which things and actions are evaluated as good or bad.
	Thus, values are directive principles of human action and serve as criteria of selection.
	Norms are said to be the enactment of social values. e.g., It is a norm that no man should be differentiated in terms of sex, caste, color or creed while practicing the art of medicine.
	The value behind it is that " all men are born free and equal ".
2. CULTURAL ANTHROPOLOGY
	Anthropology is the study of man and its works. It has two main divisions Physical anhropology Cultural anthropology
	Physical anthropology is the study of man as a biological organism.
	Cultural anthropology is the branch dealing withman's behaviour and products. Its main theme is culture.
CULTURE
	The word "culture" is widely used in sociology. It is the central concept round which cultural anthropology has grown.
	Culture is defined as "learned behaviour which has been socially acquired
	Culture is the product of human societies, and man is largely a product of his cultural environment.
	Culture is transmitted from one generation to another through learning processes, formal and informal.
	Culture plays an important part in human societies.
	It lays down norms of behaviour and provides mechanisms which secure for an individual his personal and survival.
	In general, it is widely held, that culture stands for the customs, beliefs, laws, religion and moral precepts. arts and other capabilities and skills acquired by man as a member of society.
	Cultural factors in health and disease have engaged the attention of medical scientists and sociologists.
	Every culture has its own customs, some of which have a profound influence on the incidence of disease.
	In developed countries, for example, cancer of the lung from smoking and cirrhosis of liver from drinking are the result of the abuse of widely proclaimed social habits.
	In India chewing pan is associated with oral cancer.
	It is now fairly established that cultural factors are deeply involved in matters of personal hygiene nutrition immunisation seeking early medical care family planning child rearing disposal of refuse and excreta outlook on health and disease --- in short the whole way of life.
	Culture is a dynamic force of the society. It is the cumulative experience of mankind's history from the origin to the present.
	Culture has three parts. It is an experience which is " learned, shared and transmitted".
3. SOCIAL PSYCHOLOGY
	Social psychology is an important branch of psychology.
	It is defined as the science of behaviour of the individual in group, crowd, mob, audience and other social situations.
	It also studies the attitudes of the individuals towards cultural and social values.
4. ECONOMICS
	The field of economics has a very close relationship with sociology.
	It is the parent discipline from which sociology has emerged.
	Economics deals with human relationships in the specific 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.
5. POLITICAL SCIENCE
	Historically economics and political science tended to be a single discipline.
	As a separate discipline, political science is concerned with the study of the system of laws and institutions which constitute government of whole societies.
HEALTH BEHAVIOUR AND LIFE STYLE
	Human behaviour relates to health in both direct and indirect ways.
	The direct ways that behaviour influences health involves preventive behaviour and self-care behaviour, including diet and physical fitness actions.
	The indirect influence of behaviour on health is through social norms, culture, organization and environment.
	The four kinds of behaviour or health related habits that can be harmful are Alcohol use Smoking Nutrition Drug use
ALCOHOL USE
	Alcoholism is world-wide social and medical problem.
	Over past 30-40 years, alcohol consumption has increased in quantity and frequency.
	The age at which pepple start drinking has also declined.
	The population groups at great risk are those undergoing rapid socioeconomic and cultural changes; they view Alcohol as a symbol of prestige and social status.
	Drinking by adults serves as a role model for the young.
	The identification of risk factors is essential for prevention.
	Alcohol has a marked effect on the central nervous system.
	It is not a "stimulant" as long believed, but a primary and continuous depressent.
	Alcohol produces psychic dependence of varying degrees from mild to strong.
	Physical dependence develops slowly.
	According to current concepts, alcoholism is considered a disease and alcohol as "disease agent" which causes acute and chronic intoxication cirrhosis of liver toxic psychosis gastritis pancreatitis cardiomyopathy, and peripheral neuropathy
	Also, evidence is mounting that it is related to cancer of the mouth phaynx larynx, and oesophagus
	Further alcohol is an important aetilogic factor in suicide, automobile and other accidents, and injuries and deaths due to violence
	The health problems for which alcohol is responsible are only part of the social damage which includes family disorganization, crime and loss of productivity.
	As drinking patterns varies considerably, the prevention of alcoholism is not easy.
	A widespread public education and discussion, and investigation of public attitudes may result in measurable improvement.
	This should be combined with social welfare and health services.
SMOKING
	It is pernicious scourage of the world today.
	In most communities, it is the greatest single health hazard.
	Smokers suffer the highest relative risk with respect to cancer.
	Those who are highly exposed to "passive smoking" are also at increased risk of developing lung cancer
	It has been calculated that in countries where smoking has been a widespread habit, it is responsible for 90% of lung cancer deaths.
	Methods of controlling, the smoking epidemic has been described by the WHO expert committee in their reports. Broadly these methods include public information and education Legislative and restrictive measure Smoking cessation activities National and International coordination
NUTRITION
	Nutrition and food consumption involve complex interactions of social cultural economic behavioural, and psychological factors
	Adequate intake of sorces of energy and of essential nutrients are necessary for satisfactory rate of growth and development and maintenance of health.
	Deficiencies can lead to specific diseases and increased susceptibility to others
	Excessive or inappropriate consumption may contribute to adverse conditions such as obesity.
	Frequent consumption of highly cariogenic foods, especially in between meals can cause dental caries.
DRUG USE
	Drug addiction is defined as a state of periodic or chronic intoxication detrimental to the individual and society produced by the repeated intake of habit-forming grugs.
	Drug abuse has reached an alarming proportion in recent years.
	"Drug Culture" is fast making inroads into the lives of young people from all walks of life.
	The solution for this must come through education of target-groups and social change.
SOCIAL SCIENCE IN DENTAL PUBLIC HEALTH
	One of the important developments in public health during the last decade is that the social scientists have been called in to aid in adapting new health programs to existing cultural patterns.
	When applied to a practicle problem such as dental planning, social science in effect adds a new dimension to the process of surveying and evaluation.
	The social scientist becomes necessary when we want to know why effort and effect do not match other.
	He helps us in the assessment of the process our program is using or plans to use in finding out how well this process fits the sociocultural group with which we are working.
	Studies by behavioural scientists on a group of 126men, women and children living in a typical Mid Western Community resulted in the description of certain social classes and the reaction of each to dental care. They are :- The Upper Middle Class The Lower Middle Class The Upper Lower Class The Lower Class
	Trithart in 1968 has summarized the attitudes of the underprivileged people toward health care, in the following listing Castration Complex Contradiction Of Common Sense Comming In Crowds The Last Ditch Effort If It Hurts, You Are A Quack Unclean Or Dirty Feeling The Clinic Was Built There, Not Here Cold Professional Attitudes Difference In Pain Threshold Complication Of The Unknown The Pills Don't Work Appointments Are Not Important Teeth Lost anyhow Traditions