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Medicine is a social science, and  politics nothing but medicine on a grand scale.     -  R. Virchow,  Die  Medicinische  Reform , 1848

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One is born,
Develops ,
Works ,
Reproduces
Falls ill, and
Dies
surrounding environment, who
different modalities create diverse
modes of reaction

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This material environment is determined by  Wages,  Nutrition,  Housing,  Clothing, and  Culture … - S.  Allende

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Rapid transformation (impact of west) Joint family disintegration Strength of bond of marriage is waning Broken homes Casteism ,  Regionalism Lust for power Wide corruption  Unemployment Urbanization Confusion in the system of education

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Social epidemiology to practice social medicine To study cultural factors and social relation To study social factors of family, society, and government about health or disease To study social principles in medical organization and treatment To study social problems  To study social security

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The “study of the social distribution and social determinants of states of health”  Aim of social epidemiology is  to identify socio environmental exposures  that may be  related to physical and mental health outcomes.

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The principal concern of social epidemiology is the study of how society and social organization influence the health and standard of living of individuals and populations.

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3 billion people live on less than $2/day. 2.6 billion without access to adequate sanitation 2 billion deprived of electricity 1 billion without adequate shelter 840 million malnourished 880 million without access to medical care Human Development Report, UN Development Program

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All medicine is inescapably social medicine” - Eisenberg

Social forces as determinants of infectious disease Infectious agents as necessary but not sufficient cause of disease? Persistence of class-related inequalities in disease prevalence “Human social organization creates the conditions necessary for infectious diseases to exert selective evolutionary pressure on human biology.” Social disorganization/chaos is a “culture” medium in which IDs thrive, i.e. TB and HIV

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Many disease make a preferential option for the poor The poor have no access to vaccines, poor TB treatment, no access to HIV/AIDS medicine, shorter life expectancies Lives of the poor are not divorced from the decisions by the powerful Inequalities in society as genesis of ill health are often overlooked, or given only brief mention

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Professional  endeavour  devoted to social epidemiology, study of cultural factors and social relations in connection with illness, and the social principles in medical organization and treatment  – Charles  Mclntire  1894

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Social Medicine is concerned with a body of knowledge and methods of obtaining knowledge appropriate to a discipline.   This discipline may be said to comprise: Epidemiology The study of the medical needs of society (medical care)

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“Community is a human population living within a limited geographic area and carrying on a common inter-dependent life”    - Lundberg

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Family is a group of persons united by  the ties of marriage, blood or adoption;   constituting a single household ,  interacting and inter-communicating with each other in their respective social roles  of husband and wife, mother and father, son and daughter, brother and sister  creating a common culture  – Burgess and  locke

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Basic Unit Of The Society Biological Unit Of The Society Cultural Unit Of The Society Epidemiological Unit Of The Society

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Regulation of sexual  behaviour  and reproduction Care and training of children Economic  Recreation Protective Religious Education

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Child rearing Socialization Personality formation Care of dependents

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ROLE OF FAMILY IN                  HEALTH AND ILLNESS

Somatic symptoms increases tension among the family members Chronic illness and complicated illness is determinately to the family functioning Family prestige is affected by mentally retarded child The family will offer remedies and advice To take over the roll of the ill person when he/she is no longer capable of performing It will provide care until recovery and long term support

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GENETIC DISEASES Hemophilia,  Colour  blindness,  Diabetes  mellitis , and  Mental illness INFECTIONS MAY BE TRANSMITTED EASILY  IN FAMILIES      Tuberculosis, scabies, common cold, measles, chicken-pox, diarrhoea, dysentery, and enteric fever CONGENITAL MALFORMATION

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Economic status Education Occupation Political system Housing Employment Poverty and affluence Illiteracy and ignorance Travel Industrialization Food habits Tobacco, alcohol and drug abuse

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Per Capita Income Economic Progress Standard Of Living Urban Slum Over Crowding Environment Pollution Social Problems Eliminate Caste Distinction More Nuclear Family

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Community consciousness Role of  neighbourhood Joint family Faith in religion Simplicity

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Namelessness Homelessness Class extreme Social  heterogenesity Social distance Emotional tension and insecu rity

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Urban slums Pavement  dwellers Unemployment Anti-social activity Poverty Crime Mental illness Delinquency Begging Prostitution Population growth Political and industrial unrest Road traffic accident, Pollution

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Malnutrition under 5 year children Illiteracy Child  labour School dropout Poor transport Poor communication Inadequate water for cultivation Electricity problems Labour  problems Bonded  labourer

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It is defined as learned  behaviour  which has been socially acquired. That complex whole which includes knowledge, belief, art, morals, law, and capabilities acquired by man as a member of society

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Beliefs, assumptions and mental models Attitudes  Rules, norms, ethical codes, values   Artifacts Stories, histories, myths, legends, jokes Rituals, rites, ceremonies, celebrations Symbols and symbolic action

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Cultural rules are also very powerful levers.  If you question whether people are conforming, they will assert that they are (and likely be concerned by your questioning their loyalty).  They can also be used as safety bolt-holes where people will head for when threatened.

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Personal hygiene Nutrition Immunisation Seeking  early medical care Family planning Child rearing Disposal of excreta & refuse

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social status is the honor or prestige attached to one's position in society (one's social position).  It may also refer to a rank or position that one holds in a group, for example son or daughter, playmate, pupil, etc Status has two different types that come along with it: achieved, and ascribed

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Social stratification describes the way people are placed in society.  It is associated with the ability of individuals to live up to some set of ideals or principles regarded as important by the society or some social group within it.  The members of a social group interact mainly within their own group and to a lesser degree with those of higher or lower status.

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Groups: Wealth and Income (most common): Ties between persons with the same personal income  Gender: Ties between persons of the same sex and sexuality  Political Status: Ties between persons of the same political views/status  Religion: Ties between persons of the same religion  Ethnicity/Race: Ties between persons of the same ethnic/racial group  Social Class: Ties between persons born into the same group  Coolness: Ties between persons who have similar levels of popularity

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A set of connected  behaviours , rights and obligations as conceptualized by actors in a social situation. It is an expected or free or continuously changing  behaviour  and may have a given individual social status or social position.  The division of  labour  in society takes the form of the interaction among heterogeneous specialized positions, we call roles.

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It is defined as “ All beliefs, customs, and ethics are relative to the individual within his own social context.”  In other words, “right” and “wrong” are culture-specific; what is considered moral in one society may be considered immoral in another, and, since no universal standard of morality exists, no one has the right to judge another society’s customs .

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It should be understood that all cultures are worthy in their own right and are of equal value.  Diversity of cultures, even those with conflicting moral beliefs, is not to be considered in terms of right and wrong or good and bad.

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It is closely related to ethical relativism, which views truth as variable and not absolute.  What constitutes right and wrong is determined solely by the individual or by society.  Since truth is not objective, there can be no objective standard which applies to all cultures.

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Ethnocentrism is judging another culture solely by the values and standards of one's own culture. The ethnocentric individual will judge other groups relative to his or her own particular ethnic group or culture, especially with concern to language, behavior, customs, and religion.  These ethnic distinctions and subdivisions serve to define each ethnicity's unique cultural identity.

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The laws laid out by society that govern society’s behaviors. Although these norms are not considered to be formal laws within society, they still work to promote a great deal of social control.

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Norms in every culture create conformity ( traditional values) that allows for people to become socialized to the culture in which they live. If people do not follow these norms then they become labeled as  deviants  and this can lead to them being considered the outcast of society.

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Social security is the guarantee that the state gives to specific individuals (who may or may not be required to pay monthly by virtue of which they receive, in times of crises, free remedial and supportive measures.

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value denotes something's degree of importance, with the aim of determining what action or life is best to do or live. Types of values Ethical/moral value,  Doctrinal/ideological (religious, political) values,  social values, and  aesthetic values

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Belief is the psychological state in which an individual holds a proposition or premise to be true.

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It refers to the notion that culture takes time to catch up with technological innovations, and that social problems and conflicts are caused by this lag

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Stability of social group Community relation And shared values MEANS OF SOCIAL CONTROL Informal means Formal means

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Belief Social suggestion Ideologies Folkways Mores FORMAL MEANS Law Education Coercion ( compulsion)

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Individual responsibility Community responsibility The state responsibility International responsibility

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Social characteristics play a predominant role in determining sickness and health status Occupation related to health Social position: class, ethnicity, gender, age Disease & feelings of sickness not determined solely by underlying biology

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Medical professionals should recognize a patient as a social creature, that many aspects of their lives impact upon their health, their exposure to illness and illness-producing behaviors, and their “agency” (capacity to mobilize resources to improve well-being)

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A socially-oriented physician would take action to  improve  housing, nutrition,  educational opportunities, and  employment opportunities;  combat racism and discrimination;  eliminate poverty; and  alter the inequities and inadequacies of the medical care delivery system …     and in society at large

BASIC CONCEPTS OF MEDICAL SOCIOLOGY