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Make it as per wbuhs mbbs exam oriented answers

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I now have all the content needed. Here are the fully rewritten WBUHS MBBS exam-oriented answers for Chapter 2 - Social and Behavioural Science and Health:

CHAPTER 2: SOCIAL AND BEHAVIOURAL SCIENCE AND HEALTH

WBUHS MBBS Exam-Oriented Answers

GROUP - A: LONG ANSWER QUESTIONS

Q.1. What is medical sociology? Discuss in brief about the social determinants in health and disease. [BNMU 2013, ABKUB 2017]

Medical Sociology

Medical sociology is the study of the effects of social and cultural factors on health and medicine. It deals with:

Aspects of health and illness
Social role of health establishments and organisations
Relationship of health care delivery to other social systems
Social conduct of health personnel and consumers

Social Determinants of Health and Disease

Health is a state of not only physical but also mental and social wellbeing. The relevant social determinants are:

1. Education

Higher education improves job opportunities and socioeconomic conditions
Higher socioeconomic status improves health decision-making and health-related behaviours

2. Income

Higher income - better ability to pay for healthcare, better quality of life
Economic affluence can lead to adverse lifestyle (physical inactivity, high calorie food, alcohol) - risk for IHD, hypertension, diabetes, STDs
Poor economic status - malnutrition, low birth weight, higher maternal mortality, mental illness, substance abuse, infectious diseases

3. Gender

Men enjoy more social freedom; are paid more for similar work
Women face exploitation - rape, incest, female foeticide, dowry - all adversely affect health

4. Occupation

Government officials, professionals (doctors, engineers, lawyers, teachers) have better social status, better awareness of health facilities

5. Urbanisation and Industrialisation Problems arising from rapid industrialisation:

(a) Environmental sanitation - substandard housing, air/water pollution, improper sewage disposal
(b) Communicable disease problems - TB, malaria, waterborne diseases
(c) Social problems - alcoholism, drug addiction, prostitution, juvenile delinquency
(d) Increased accidents
(e) Food-borne infections

6. Migration

Rural people migrate to cities for employment
Migrated population has poor access to healthcare, leading to many disease problems

Q.2. Discuss in brief about the cultural factors in health and disease. [RGUHS 2010, 11, 14; SAMU 2012; TGMGRMU 2013, 16; SSUHSA 2018]

Cultural factors are deeply involved in all affairs of man including health and sickness. Important cultural factors in India:

1. Concept of Aetiology and Cure

(a) Supernatural Causes Beliefs that diseases are caused by:

Wrath of gods/goddesses (e.g., Chickenpox) - drugs considered harmful, pujas performed instead
Breach of taboo - venereal disease believed due to illicit sex or sex with a woman of low caste/during menstruation
Past sins (e.g., leprosy, tuberculosis)
Spirit or ghost intrusion (e.g., hysteria, epilepsy)

These lead to delay in scientific treatment.

(b) Physical Causes

Heat stroke in summer - remedy: application of oil and ghee on sole and palm
Impure water - associated with disease
Impure blood - boils and scabies; eating neem leaves believed to purify blood

2. Environmental Sanitation

Open field defecation - considered harmless culturally, promotes water pollution, fly breeding
Cow dung spread on earthen floors - soil contamination
Ganga water used as "holy water" - source of cholera and gastroenteritis outbreaks
Katcha, damp, ill-ventilated housing with no separate kitchen - promotes disease

3. Food Habits

Influenced by religious customs - Muslims avoid pork; Hindus avoid beef
These food habits have religious sanctions

4. Mother and Child Health (MCH) Customs

Good: Prolonged breastfeeding, oil bath, massage, sun exposure
Bad: Restriction of eggs, meat, fish, leafy vegetables during pregnancy; restricting water after delivery; delivery by untrained dais; withholding breastfeeding first 3 days (colostrum considered harmful)
Unimportant: Ear/nose piercing, turmeric paste on anterior fontanelle
Uncertain: Kajal on eyelids (partly beautification, partly "evil eye" - blamed for trachoma and eye infections)

5. Personal Hygiene

Tobacco use - culturally acceptable but causes oral cancer
Traditional barbers not sterilising instruments - skin infections
Smoking the burning end of cigar - Andhra Pradesh, associated with oral cancer
Prohibition of bathing during menstruation - skin infections
Purdah - high incidence of TB among Muslim women
Bare feet - hookworm disease transmission
Circumcision - less development of cancer of glans penis

6. Sex and Marriage

Early marriage - large families, maternal ill-health, foetal loss
Compulsion of having a male child
Universality of marriage in India - fewer problems of unmarried mothers and illegitimate births

Q.3. What is a family? Enumerate types of family. Mention the stages of family cycle. Discuss in brief the role of family in health and disease. [WBUHS 2010; SMU 2011, 12, 14; SSUHSA 2010, 13, 17]

Definition

Family is defined as "a group of individuals related either by blood or by marriage or by adoption, living together under the same roof and sharing a common kitchen." It is the basic and functional unit of a community.

Types of Family (Based on Structure)

Nuclear Family - A couple with their dependent children
Joint Family - Two or more couples, related by patrilineal blood, with ancestral property held jointly by all male members
Three Generation Family (Extended Family) - A couple with children and dependent parents

Family Cycle

No.	Phase	Beginning of Phase	End of Phase
I	Formation	Marriage	Birth of 1st child
II	Extension	Birth of 1st child	Birth of last child
III	Completion	Birth of last child	1st child leaves home
IV	Contraction	1st child leaves home	Last child leaves home
V	Completed Contraction	Last child leaves home	1st spouse dies
VI	Dissolution	1st spouse dies	Death of survivor (Extinction)

Role of Family in Health and Disease

Child rearing: Breastfeeding, eating habits, feeding habits, sleeping habits - profound influence on growing children
Socialisation: Transfer of culture, beliefs, traditional practices, codes of conduct - shapes future citizens
Personality formation: Cultural practices, family environment, parental behaviour - promote physical, mental and social health
Care of dependent adults: Sick and injured, women during pregnancy and childbirth, aged and handicapped
Stabilisation of adult personality: Family acts as a "shock absorber" to stress. Hazards of stress - peptic ulcer, hypertension, bronchial asthma (psychosomatic diseases)
Familial susceptibility to disease: Shared gene pool - haemophilia, colour blindness, diabetes, schizophrenia, psychoneuroses run through families

Q.4. Discuss functions of family in brief. How a Family Physician differs from a Clinician? Write importance of Family Adoption Program for Undergraduate Medical Students. [BNMU 2012; RGUHS 2013, 14; TRIU 2016; ABKUB 2010, 11; WBUHS 2018, 2024]

Functions of the Family

Homely life: Provides home, safety, security, social identification
Economic security: Shared income, food, shelter, education, healthcare for all members; controls inherited property; division of labour
Reproduction and child rearing: Parents provide optimum care for growth, development, and education of children
Education: Home as temple of learning, mother as first teacher - language, religion, morals, manners, cultural elements
Socialisation: Festivals, ceremonies, cultural and traditional practices - enculturation of children
Emotional support: Buffer/shock absorber at critical life events (failure, accident, illness)
Social care: Provides social status through family name/surname
Social support: Economic and social support to weaker members (old, handicapped, widows, children)
Bridging generation gap: Exchange of knowledge and culture across generations

Family Physician (Family Doctor) vs Clinician

Feature	Family Physician	Clinician
Qualification	MBBS (with/without MD), BAMS, BUMS, BHMS	MD/MS in a speciality or laboratory/research
Patient contact	First contact point, treats patients directly	Deals directly with patients in speciality or in research/theory
Scope	Basic knowledge of all specialities	Specialises in one area
Role	Gate-keeper; refers to specialist if needed	Provides speciality care and treatment
Responsibilities	Treats as far as possible at clinic level	Varies by job title - doctors, counsellors, psychiatrists

Importance of Family Adoption Program (FAP) for Undergraduate Medical Students

Useful for students of affluent background with no idea of patients' socioeconomic context
Students learn how best to help patients within their constraints
Develops spirit of service for country and community
Helps identify important health topics for the exam through field exposure
Reduces misconceptions about health among students
Better interaction at family level - family can talk about anything with the student

Q.5. What is community diagnosis? How it differs from clinical diagnosis? How will you diagnose the clinico-social factors by visiting the family of a 19-month-old female child suffering from acute episodes of acute watery diarrhoea? [WBUHS 2023]

Community Diagnosis

Community diagnosis is the pattern of disease in a community described in terms of the important factors which influence that pattern. It applies the clinical principle of diagnosis (based on signs, symptoms, and inferences) to a community as a whole.

Difference between Community Diagnosis and Clinical Diagnosis

Procedures	Clinical Diagnosis	Community Diagnosis
Assessment	Patient/family	Formal/informal community leaders and members
To detect illness	Examine patient	Observation in community, topographical features, leadership patterns
Investigations	Laboratory tests	Data collection from primary and secondary sources
Preliminary diagnosis	Doctor's initial evaluation	Data processing and analysis
Explain diagnosis	To patient	Data presentation to/with community
Start treatment	Medications, surgery, etc.	Action plan
Expected and ensured	Patient follows doctor's advice	Community cooperation and collaboration enlisted
Behaviour change	May/may not be needed	Lasting improvement in community health status
Who controls?	Doctor	Community
Follow up	Assess progress, confirm diagnosis, change treatment	Monitor, evaluate and plan new health actions

Clinico-Social Diagnosis of 19-month-old Female Child with Acute Watery Diarrhoea

Every doctor should work on the psychosocial and behavioural components along with clinical findings. Factors to be considered at different levels:

1. Factors within the Individual:

Age (19 months), sex (female child)
Level of protection - immunisation against Rotavirus or previous infection
Feeding practices
Nutritional status

2. Factors in the Family: Social factors:

Type, organisation and composition of the family
Education and occupation of parents
Socioeconomic status
Knowledge, attitude and practices toward healthy lifestyle, personal protection, disease prevention
Healthcare services available to the family
Social aberrations, if any

Physical and environmental factors:

Housing
Water supply - source, hygiene, adequacy, storage
Disposal of night soil, solid wastes, animal wastes, waste water
Food hygiene - method of cooking, storage, food hygienic practices
Nutrition

3. Factors in the Community:

General attitude toward disease prevention and healthcare
Available healthcare facilities
Availability of organised public health and social services (central water supply, purification, waste disposal, transportation, communication)
Political will of the community

Q.6. Describe the barriers to good health and health seeking behaviour in a society. [WBUHS 2023]

The households and communities are where health and health seeking behaviours are learned and supported. Common barriers are:

Poverty - Cannot afford healthcare costs (economic barrier)
Illiteracy - Lack of literacy widely prevalent in India (up to 90%); universal health literacy needed for universal health coverage
Cultural barriers - Poor acceptability due to wrong beliefs, attitudes and practices
Lack of access to healthcare services - Distance, lack of transport and roads, inaccessible health services
Poor quality of health services
Unsuitable timings of services
Gender biases and discrimination in service use
Stigma associated with diseases like leprosy, TB, mental illness
Lack of cooperation and poor communication skill of service providers
Lack of faith and trust in the health system

Q.7. Define social security. Why it is essential? Enumerate different types of social security. [WBUHS 2014]

Definition

Social security is the security or guarantee that the society (State) furnishes through appropriate organisations to its members during the time of crises (risks) such as loss of working or earning capacity due to sickness, invalidity, maternity, old age and death.

Why Essential?

Those not secured may cause social harm by fulfilling their own needs through anti-social means
Number of insecure individuals leads to increasing social pathology
Total development of society lags behind
Social security is the basis of social welfare

Types of Social Security

A. Social Security for Industrial Workers:

Workmen's Compensation Act, 1923
Central Maternity Benefit Act, 1961
Employees State Insurance (ESI) Act, 1948
The Family Pension Scheme, 1971

B. Social Security for Civil Servants:

Pension, gratuity, provident fund, and family pension scheme by Central and State governments

C. Social Security for General Public:

Risks of death, accident, fire covered by Insurance schemes
LIC has many schemes for general public
Public Provident Fund (PPF) schemes

Q.8. Write the differences between social assistance and social insurance. [WBUHS 2023]

Characteristics	Social Insurance	Social Assistance
1. Contribution	By employees, employers AND organisation	Non-contributory
2. Benefit	In the form of cash; by right, not sympathy	In the form of cash or kind
3. Inferiority complex	Members do NOT develop inferiority complex	May develop
4. Involvement	Members actively involved in economic planning	Not actively involved
5. Suitability	Suitable for workers who CAN contribute	Suitable for workers who CANNOT contribute
6. Dependency	Members may NOT become permanently dependent	May become permanently dependent
7. Legislation	There are many legislations	Hardly any legislation
8. Beneficiaries	Industrial workers, Central and State government employees, others who can contribute	Unemployed, widows, orphans, handicapped, old age people
9. Examples	ESI Scheme, PPF Scheme, LIC, Group Insurance Scheme, Medicaid	Unemployment allowance, Sanjay Gandhi Niradhar Yojana, SavithriBai Dattakpalak Yojana, Kannyashree Prakalpa, Workmen's Compensation Act 1923

GROUP - B: SHORT NOTES

Q.1. Socialisation [RGUHS; SMU; SSUHSA]

Socialisation is the process by which an individual acquires culture (knowledge) and becomes a member of a social group.

Begins directly after birth
The newborn has reflexes, instincts, urges, capabilities - develops these based on genetic makeup

Factors Influencing Socialisation:

(i) Suggestions (ii) Imitations (iii) Identification (iv) Language

Two Sources of Socialisation:

Those who have authority over the child - parents, teachers
Those equal in authority - friends, playmates, fellow school members

Chief Agencies of Socialisation:

(i) Family - parents, brothers, sisters, other family members (ii) School - education moulds child's ideas and attitudes (iii) Playmates and friends - based on cooperation and mutual understanding (iv) Temple - in early society, religion provided a bond of unity (v) The State - authoritarian agency; makes laws about morals (vi) Environmental stimuli - often determine growth of human personality

Q.2. Acculturation [RGUHS 2012; SAMU 2012, 15; TDMGRMU 2010, 12, 13]

Acculturation means "culture contact" - when two persons or groups with different types of culture come in contact, there is diffusion (exchange) of culture both ways. It is always reciprocal, hence called culture diffusion.

Factors Influencing Acculturation:

(i) Trade and commerce (ii) Conquest of one community by another (iii) Migration (iv) Industrialisation (v) Need for new elements to meet a crisis (vi) Education (vii) Propagation of religion

Barriers to Acculturation:

(i) Resistance to cultural changes:

Mores and taboos
Sense of superiority
General culture inertia

(ii) Adaptability of recipients to new culture (iii) Physical isolation (due to poor transport facilities)

Types of Culture Diffusion:

Direct diffusion - persons and groups in actual physical contact
Indirect diffusion - spread of culture traits without personal contact (through TV, cinema, radio)

Effects:

Has both good and bad effects
Good: Introduction of scientific medicine
Bad: Changes in food habits, smoking, drinking, drug abuse

Q.3. Family Diagnosis

Family is the functional unit of a community - defined as "number of individuals related biologically (by blood) or by marriage or by adoption, sharing a common kitchen and living under the same roof."

Family diagnosis is medical diagnosis for all members of the family as well as other determinants existing in the family which influence the ill-health of its members. Also termed medico-social diagnosis.

Determinants Considered in Family Diagnosis:

(i) Demographic distribution of family members (ii) Environmental status - housing, water supply, refuse and mode of sewage disposal (iii) Socioeconomic status of the family (iv) Socio-cultural background (v) Nutritional factors (vi) Individual health status (vii) Knowledge regarding common diseases in the community and practice in situations of ill-health (viii) Health care seeking behaviour

Exam Tip for WBUHS: Questions from this chapter that appear repeatedly include: Q.1 (Social determinants), Q.3 (Family - types, cycle, role), Q.4 (Family functions + FAP), Q.5 (Community vs Clinical diagnosis with case scenario), Q.6 (Barriers to health), Q.8 (Social insurance vs Social assistance). The 2023 paper specifically asked Q.5 and Q.6, so these are high-priority topics.

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