Sociology

Sociology: Health, Disease and Community



Dr. Niraj Pandit http://drpamhrdconsulting.blogspost.com



Changing concept of Health

 Health has evolved over centuries from



individual concept of disease free to healthy society. The whole evolution is as follow



Biomedical concept

 For centuries, traditionally people say health



means ‘absence of disease’. This biomedical concept was popular till 20th century.  The ‘Germ theory of disease’ was the base for this concept. People looked human body as machine.  The criticism of this concept is that many disease like malnutrition, mental diseases do not have any relation with germ.



Ecological concept

 It is the dynamic equilibrium between man



and his environment.  The disease is the out come of maladjustment between man and environment. The improvement in socioenvironment conditions can lead to longer life and better quality of life.  This model can not explain the behaviour problems like smoking, HIV/AIDS, accidents etc.



Psycho-social concept

 There are many psycho-social factors



which affect the individual and community health. They are social life, mental condition of individual, cultural factors, economical factors and political factors.



Spiritual or Holistic concept

 In medical sciences there are many



questions which are unanswered. They can not be explained by above all concept. The healing power of body and many unanswered questions in medical science that is spiritual health.  The holistic approach means the use of all dimension of health, physical, mental, social and spiritual dimension in improvement of community health.



Definition of health

 Webster: Health is the condition of being



sound in body, mind or spirit especially freedom from physical disease or pain.  Oxford dictionary: Health is sound ness of body or mind, that condition in which its functions are duly and efficiently discharge.  Dubos defined health as the relative absence of pain and discomfort and continuous adaptation and adjustment to the environment to ensure optimal function.



 Perkins: Health is a state of relative



equilibrium of body from and function which results from its successful dynamic adjustment to forces tending to disturb it. It is also passive interplay between body substance and forces impinging upon it but an active response of body forces working towards readjustment.

 WHO definition: World Health



Organization has given definition of health in the preamble of its constitution, which is, ‘Health is a state of physical, mental and social wellbeing and not merely an absence of disease or infirmity’.



Critics of definition of health

 Health is not the static condition. It is



continuous changing state. For example, it is not like chair or any object which is static for whole life. Ageing process starts as person born. So it is better to use word dynamic condition.  Second is the addition in dimensions of health, need to add one more dimension that is spiritual health. Very limited literature about spiritual health is available but there is need to explore.



 Third one is also addition in last part of



definition that ‘which leads to person economical and socially productive life.  The refined definition is that ‘Health is the dynamic condition of physical, social, mental and economical wellbeing, not merely an absence of disease or infirmity which leads to individual socially and economic productive life’.



Sociology

 Sociology is derived from the Latin word



“societus’ meaning society and Greek word ‘logos’ meaning ‘study or science’.  Thus, sociology means the ‘science of society’ or ‘scientific study of society’, the scientific or systematic study of society, including patterns of social relationships, social interaction, and culture.



Broad view of Sociology

  



  



Sociology is the science of society. It is the science of social relationships. It is the study of social actions. It is study of forms of social relationships. It is study of social life. It is study of social groups and social system. It is study of social behaviour.



Health sociology

 The subject deals with the study of health,



health-related problems, health-related events, health-related behaviours and health institutions.  Medical sociology: the study of cultural factors and social relations in connection with illness and social principles in medical organization and treatment’.



 A new broad concept that is emerging in



this field is that of the sociology of health. Health is a broader term than medical alone. Medical science is a subset of health.  Health sociology has many subsubjects, like social anatomy, social physiology, social pathology, social psychology, social behaviour, social therapy and many more are coming up.



Social anatomy

 It deals with principle form of social structure



like anatomy deals with human body structure. The basic structure of human body is cell; in the same way, basic structure of social body is the family. Just as there are various body structures like heart, kidney and system in human body, there are many social structures like primary group, secondary group, school, colleges, political institutions, etc.



Social physiology

 Physiology deals with the functions of



human body. Social physiology deals with social functions and relationship within all social structures.



Social pathology

 In medical science, pathology deals with



abnormality in function and structure of human body. Social pathology deals with abnormality within social structure and functions. For example, crime, poverty, unemployment, rape, prostitution, etc., are all parts of social pathology.



Social therapy

 In medical science, there is a treatment



of each disease; in the same manner, the remedies of social problems constitute social therapy.



Social control

 In health, there is the concept of



prevention of diseases, as a part of control of the diseases in community. There is a similar role of social controls system, which prevents the development of social pathology.





Signs of individual Good Health

 Physical health: A person who enjoys good



physical health is one who is energetic, has good posture, weighs normal for age and height, has all body organs functioning normally, has a clear and clean skin, has bright eyes, has good textured and shining hair, has a clean breath, has a good appetite, gets sound sleep and others. All body organs are normal size and function optimally.



 Mental health: A person is mentally healthy



that means control on emotions, sensitive to the needs of others, confidence in one’s own abilities and freedom from unnecessary tensions, anxieties and worries, free from internal conflicts, well adjusted with surrounding and balanced self control.  Social health: A person with good social health - gets along well with people around, has pleasant manners, helps others and fulfills responsibility towards others. The social health is defined as the quantity and quality of an individual’s interpersonal ties and the extent of involvement with the community.  But these all components are inter-related to



 But these all



components are inter-related to each other.



Determinants of health

 These are the factors, which affects the



individual health they are known as health determinants.  There are two groups of factors which determines the individual health

 intrinsic



or inherent factors  extrinsic or outside factors



Intrinsic factors

 Age: The mortality and morbidity are not



similar in all age group.  Sex: There are many diseases, which affects predominantly male or female like cancer breast and cervix are in female, hernia is more common in male etc. The life expectancy at birth in India is higher for female (64 years) than male (62 years) in 2001  Genetic makeup: The physical and mental make up of every human being are some extent determined by his/her genes.



Extrinsic factors

 Environment: Hippocrate first related



diseases to environment. Next Pettenkofer in Germany gave the concept of disease and environment association.  There are two types of environments, internal and external.  Internal environment means each and every part, component, tissue, organ and system of body should work harmonious with each other at optimum level  The external environment is all those out side human body. They are two types: Microenvironment and Macro-environment.



 Socio-economic conditions: It is now



known that the health status is determined by socio-economic condition of individual. Socio-economic condition is determined by income, education and occupation of individual and family.  Nutrition: Nutrition means the science of food. Whatever we are eating in our day to day life has impact on our health. Our diet determines the health of individual. Both under-nutrition and over-nutrition are unhealthy for human.



 Habits and life style: Our personal habits do



also play important role for our health. Getting up early in morning, taking daily bath, wash hand after toilet use, washing hand before food, brushing teeth, taking balance diet, doing regular exercise, taking adequate sleep and many more are the good personal habits. But poor habits like smoking, chewing tobacco etc may cause many health hazards.  Health services: The availability of health services and utilization of such health services are also determining the health of individual and community.



Responsibility for Health

 Individual responsibility: As we discussed



above health is a basic human right, but it is essentially an individual responsibility. It is not the item that someone purchase from market. It has to be develop and maintained by individual himself which is known as self care.  Self-care means all those health generating activities that are under taken by the person themselves



 Family responsibility: After self-care, next



important responsibility is of family. Family is the very good medium for socialization. People learn all self-care activities from family. Mother or wife in family, she is key for many healthy practices.  Community responsibility: Healthy community is the aim of any society. Thus without community efforts and involvement, health can never be protected by health services. Community can provide resources like manpower, materials and fund (money) for health care of own. Second way is to actively involve in planning, implementation, management and evaluation of services. And thirdly, by utilizing health services.



 State and National responsibility: The



responsibility for health dose not end with individual, family and community level. Indian constitution, part IV says that Health is a state responsibility. Thus all health related issues should be addressed by state. State has to implement, manage and evaluate all national health programme as per national guideline. The state is the responsible to achieve all health related goals and objective. The national or central government is making the guideline and providing funds to the state for national programme. The implementation of guideline and utilization of funds are the responsibility of state government.



 International responsibility: Health and



diseases do not have national boundaries. Large number of diseases can spread and cross international borders in few days like SARS, Avian flue, anthrax etc. Not only disease but health status of one country not same to other. So to improve the health status of all mankind on earth we need the cooperation and support from all nations and people. This cooperation includes exchange of experts, knowledge, drugs and materials. The large number of associations are made to achieve such cooperation like WHO, UNDP, UNICEF, ASEAN, SAARC etc.



Concept of disease



 It is very difficult to define disease because











 



disease is the subjective phenomenon. The WHO did not define disease. The dictionary meaning of disease is as described by, Webster defined disease as a condition in which body health impaired, a departure from state of health. The oxford defined a condition of body or some part of body organ in which functions are disrupted or deranged. The ecologist said that it is the maladjustment of man and its environment. But the sociologist says that disease is the social phenomenon and it occurs due to particular cultural and social factors which prevalent in society.



 Disease



is a physiological / psychological dysfunction.  Illness is a subjective state in which person feel not well.  Sickness is a state of social dysfunction.



Disease causation theory

 The ancient theory of disease causation



is known as ‘supernatural theory of disease’.  Germ theory of disease causation

 Germ







Man  Disease



 Epidemiological triad  Multifactoral causation theory  Web of causation theory



Understanding of Agent

 The agent is defined as ‘a substance



living or non-living or a force tangible or in tangible, the excessive presence or relative lack of which may initiate or perpetuate a disease process’.



Classification of Agent

 1.  2.



 3.  4.

 5.



 6.



Biological agents Nutritional agents Physical agents Chemical agents Mechanical factors Social agent



Host

 The host means the human being. The



epidemiological point of view the host is the soil and agent is the seed for disease. The intrinsic host factors play very important role for disease development. The characteristics like age, sex, occupation, education, living standard, life style, genetic factors etc are the important host factors for disease causation.



Environment

 The environments are three types



physical, biological and psychosocial environment.



Iceberg phenomenon of disease



Concept of Disease control

 The disease control means  the reduction of incidence of disease,  reduction in duration of disease so the risk of transmission and  reduction in outcome of infection in term of physical and psychological complications.



The control of disease is achieved by the prevention. There are four types of preventions.



 The prevention activities in community



are so strong that it will reduce the level of agent such a low level that the disease dose not becomes the public health problem.  This will achieve the state of equilibrium between disease agent, host and environment.  It dose not mean the elimination and eradication.



Disease elimination

 It means the interruption of transmission



of disease in large geographical area.  The examples are polio, measles, leprosy etc.  This is the precursor of eradication



Disease eradication

 It means to tear out by roots.



 it implies termination of all transmission of



infection by extermination of the infectious agent.  Thus the agent is removed from world. It is all or none phenomenon and absolute process.  Till date small pox is the only disease that has been eradicated.  There are some diseases which might eradicated in near future, they are polio, measles and guinea worm.



Concept of disease prevention

 The goals of medicine are to promote



health, to preserve the health, to restore health when it impaired and to minimize the suffering and distress.  The all goals are embodied in the word ‘Prevention’



Four level of prevention

-



-



Primordial prevention Primary prevention Secondary prevention Tertiary prevention



Primordial prevention

 New concept of disease prevention  It is the purest type of prevention.  It means the prevention of emergence of risk



factors in community.  action taken before the risk factors develop in community.  more importance in non-communicable disease prevention.  main interventions in primordial prevention are mass media and individual education.



Primary prevention

 means the action taken before the onset of



disease, which minimize the possibility of disease.  intervention, which takes place in prepathogenesis stage of disease.  goal of primary prevention is to promote the health and maintain the health.  The intervention strategies are population strategy and high risk strategy.



Secondary prevention

 It means the actions, which halts the progress



of disease at its incipient stage and prevents the complication.  The main strategy is the early diagnosis and prompt treatment. Thus the secondary prevention attempts to arrest the disease progress, restore health by diagnosis of disease and treatment. It is largely the clinical medicine and curative aspect.  It is less effective tool for disease prevention at community level.



Tertiary prevention

 When disease process has advanced



beyond its early stage and it is still possible to do something, which improve health of individual.  the type of prevention, which include disability limitation and rehabilitation.



Rehabilitation

 It has been defined as’ the combined



and coordinated use of medical, educational, social and vocational measures for training and retraining the individual to the highest possible level of functional ability’.  goal of rehabilitation is to achieve social integration of disabled.



The areas of rehabilitation:

 1.



Medical rehabilitation: Aim to restore the functions  2. Vocational rehabilitation: Aim to restore the capacity to earn a livelihood  3. Psychological rehabilitation: Aim to restore personal dignity and confidence.  4. Social rehabilitation: Aim to restore family and social relationship.



Relation of Community Medicine, Clinical Medicine and Epidemiology

 Clinical medicine: The primary objective of



clinical medicine is the removal of pain of disease from patient not from mass. It involves techniques like diagnosis and treatment to individual.  This field deals with the individual patients. The physician sits in clinic and patients comes for their pain.  specialization will improve the quality of service, but it raises the cost of service.



Community medicine or Preventive Medicine

 The goal of community medicine is to prevent



the disease from community and to promote the health of community.  It is defined as ‘the speciality deals with population, and comprises those doctors who try to measures the need the population, both sick and well, who plan and administrate the services to meet those need and those who are engaged in research and teaching in the field’.



 The important component of subject is



the social medicine.  It defines as the study of man as a social being in his total environment with focus on health of community.



Thank you Dr. Niraj Pandit