The community

Kingsuk Sarkar,MD
Assistant Professor
Department of Community Medicine
Dhanalaxmi Srinivasan Medical College
1

*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, dispensar
ies
-Major function unit of society,network of human
relationship
2

*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
3

*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
4

*Rural Society:
-Majority of Indians reside in villages
-Self sufficient units for routine requirements
-Depend primarily on agriculture
-Caste, religion, marriage, kinship, ritual, econ
omy plays important role
5

*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
6

*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 achievement
oCaste hierarchy confers varying degrees of social
prestige
7

*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
8

-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
9

*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
10

*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
11

*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
12

*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.
13

*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
14

*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
15

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/D
iploma
5 Clerical/shop/fa
rmer
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
16

*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
18

*Calculation of social class according to
Modified Kuppuswamy‟s Scale
Table: 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
19

*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
21

*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 items22

*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
23

*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
24

*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
25

*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
26

*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
27

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