Q1. Acculturation (6 Marks)

1. Trade and commerce
2. Industrialization
3. Propagation of religion
4. Education
5. Conquest

• Introduction of scientific medicine into a society (e.g., modern allopathic medicine spread through culture contact)
• Improvement in hygiene, sanitation, and health practices
• Spread of education and literacy
• Adoption of better nutritional habits

• Changes in food habits - e.g., many orthodox groups now eating meat
• Widespread tobacco use across the world (due to culture contact)
• Disruption of traditional values and social fabric
• The radio, television, cinema and now the internet have shaped cultural-behaviour patterns of people, not always positively

Q2. Types and Functions of Family (10 Marks)

Definition

Types of Family

1. Nuclear family (Conjugal family): Consists of husband, wife and their unmarried children. It is the most common unit in urban areas. Also called "elementary" or "primary" family.
2. Joint family (Extended family): Consists of several generations living under one roof - grandparents, parents, children, uncles, aunts, cousins. Common in rural India.
3. Single-parent family: One parent (mother or father) with children, arising from death, divorce, or separation.
4. Reconstituted/Step family: Formed after remarriage.

1. Patriarchal family: Authority rests with the eldest male (father). Common in India.
2. Matriarchal family: Authority rests with the mother (e.g., Nair community in Kerala).
3. Egalitarian family: Equal authority for husband and wife.

1. Patrilocal: Wife goes to live at husband's home.
2. Matrilocal: Husband goes to live at wife's home.
3. Neolocal: Couple sets up an independent home.

1. Monogamy: One husband, one wife.
2. Polygamy: One husband, many wives.
3. Polyandry: One wife, many husbands (e.g., Toda tribe of Nilgiris).

Functions of Family

1. Biological/Reproductive function: Procreation and perpetuation of the species; fulfillment of sexual needs within socially accepted norms.
2. Economic function: Family is the unit of economic activity. Members pool resources, share food, shelter and meet basic needs.
3. Socialisation function: Family is the primary agent of socialization. Children learn language, values, norms, customs and behavior within the family.
4. Psychological function: Provides emotional security, love, affection, mental stability, and a sense of belonging. First source of emotional support for the individual.
5. Educational function: Primary education and moral values are imparted through the family. The child learns from parents before going to school.
6. Protective function: Protects members - especially the young, old, sick - from exploitation. Provides physical and social protection.
7. Religious function: Family transmits religious beliefs, rituals, ceremonies, values, and moral codes to the next generation.
8. Status giving function: The family confers social status, caste identity, and class membership on its members.
9. Health and welfare function: Family provides care during illness, ensures nutrition, and maintains hygiene. It is the first point of healthcare.
10. Recreational function: Provides leisure activities, festivals, celebrations, and opportunities for rest and relaxation.

Q3. Role of Family in Health and Disease (10 Marks)

Role of Family in Health Promotion

1. Health education: Family transmits health beliefs, attitudes, and practices - including hygiene, nutrition, immunization, and seeking healthcare. Healthy habits taught at home form the foundation of lifelong health.
2. Nutrition: Family controls the preparation and distribution of food. Dietary habits, including breast-feeding, weaning, food taboos and balanced diets, are determined by the family.
3. Sanitation and hygiene: Personal hygiene habits - hand-washing, safe water use, disposal of refuse - are learned and practiced at the family level.
4. Immunization: Acceptance or rejection of vaccines is a family decision. The family's health beliefs determine immunization coverage.
5. Family planning: Decisions about contraception, family size, and child spacing are made within the family unit.
6. Mental health: A stable family provides emotional security, reducing stress-related disorders. Love, acceptance, and support are protective against mental illness.
7. Antenatal and postnatal care: The family encourages or discourages the pregnant mother from seeking antenatal care, safe delivery, and postnatal services.
8. Child rearing: The family determines infant feeding practices, growth monitoring, and care of sick children.

Role of Family in Disease

1. Genetic diseases: Many hereditary conditions (sickle cell disease, thalassemia, hemophilia, congenital disorders) run in families. Family history is a major risk factor.
2. Infectious disease spread: Communicable diseases like tuberculosis, typhoid, hepatitis, and diarrheal diseases spread rapidly within households due to shared living space, food, water, and utensils.
3. Social and behavioral determinants: Addiction (alcohol, tobacco, drugs), dietary excesses, and sedentary habits may be family-linked behaviors that lead to non-communicable diseases like hypertension, diabetes, and cancer.
4. Psychological illness: Family dysfunction - conflict, divorce, abuse, neglect - contributes to depression, anxiety, conduct disorders, and substance abuse.
5. Rehabilitation: The family is central to rehabilitation of the chronically ill, disabled, or mentally ill. Patient compliance, follow-up, and recovery are all family-dependent.
6. Economic burden: Disease creates financial strain on the family; conversely, poverty within the family is a root cause of malnutrition and vulnerability to disease.
7. Illness behavior: How a family perceives symptoms, when they seek care, which practitioner they consult (modern vs. traditional healer), and compliance with treatment all depend on family beliefs.
8. Care of the elderly: The aged family member with chronic disease depends entirely on the family for daily care, medication, and emotional support.

Q4. Social and Cultural Factors in Health and Diseases (10 Marks)

Social Factors

• Poverty leads to malnutrition, overcrowding, poor sanitation, illiteracy, and limited access to healthcare.
• Lower social class has higher mortality and morbidity from infectious diseases, malnutrition, and perinatal conditions.

• Education improves health literacy and the ability to adopt preventive measures.
• Educated mothers have lower infant mortality rates; they are more likely to use immunization, family planning, and antenatal services.

• Certain occupations carry specific health risks (e.g., silicosis in miners, lead poisoning in battery workers, occupational asthma).
• Occupational status also determines income, housing, and lifestyle.

• Overcrowded, poorly ventilated housing promotes the spread of tuberculosis, respiratory infections, and skin diseases.
• Lack of safe water and sanitation leads to diarrheal diseases, typhoid, cholera.

• Nuclear vs. joint family has implications for childcare, support of the elderly, mental health, and response to illness.
• Single-parent families are at higher risk of social problems and childhood ill-health.

• Strong social ties are protective against mental illness and improve recovery from physical illness.
• Isolation and loneliness are risk factors for depression and cardiovascular disease.

Cultural Factors

• Religious beliefs influence diet (vegetarianism, fasting, food taboos), healthcare-seeking behavior, and acceptance of procedures like blood transfusion, contraception, or vaccination.
• Example: Jehovah's Witnesses refuse blood transfusions; religious fasting may affect management of diabetes.

• Cultural food taboos may cause specific nutritional deficiencies (e.g., avoidance of animal protein causing protein-energy malnutrition).
• Cultural preference for polished rice contributes to thiamine deficiency (beriberi).

• Female genital mutilation, child marriages, preference for male child, and early widowhood are cultural practices with serious health consequences.
• Traditional birth practices may compromise maternal and neonatal safety.

• In some cultures, illness is seen as a punishment, or as fate/karma, leading to delay in seeking care or rejection of medical treatment.
• Mental illness, tuberculosis, and HIV/AIDS carry social stigma in many cultures, preventing patients from seeking help.

• Contact between cultures leads to changes in diet, tobacco and alcohol use, and health behavior - with both beneficial and harmful effects.

• Gender roles affect health: women may have less autonomy to seek healthcare, may be malnourished due to eating last, and face higher risk of domestic violence.

• Language barriers reduce access to health services and limit health education.

Q5. Operational Research (6 Marks)

• Pure research: e.g., a mathematician working on atomic structure.
• Applied research: e.g., an engineer designing a new industrial plant.
• Operational research: concerned with the activities of a group of people with the purpose of inducing beneficial changes - it is therefore a sociological science with an immense social content.

Phases in Operational Research

1. Formulation of the problem - define the issue clearly
2. Collection of relevant data - if necessary, by a suitable sample
3. Analysis of data and formulation of hypothesis - interpret findings
4. Deriving solutions from the hypothesis or "model" - theoretical solutions
5. Choosing the optimal solution and forecasting results - best-fit approach
6. Testing of solution - e.g., pilot projects
7. Implementing the solution in the whole system - scale up

Operational Research Team

Operational Research in Health Services

• Optimal size of area/population covered by a midwife or health unit
• Ideal vehicle for local health workers
• Architectural design of hospitals and health centers
• Queuing problems in outpatient departments
• Study of bed load and nursing services in hospitals
• Effectiveness of malaria eradication and family planning programmes
• Quality of medical care services
• Investigation of disease outbreaks

Q6. Social Problems (6/10 Marks)

Definition and Nature

Major Social Problems

• A public health problem and a social problem. Leads to family breakdown, domestic violence, accidents, liver disease, poverty, and crime.
• Management: medical detoxification, counseling, Alcoholics Anonymous, social rehabilitation.

• Defined as a state of periodic or chronic intoxication detrimental to the individual and society produced by repeated intake of habit-forming drugs.
• Criteria: psychological dependence (compulsion to take drug), physical dependence (withdrawal symptoms on stopping), development of tolerance (need to increase dose).
• Causes: curiosity, disturbed home environment, escape from tensions, unemployment, ignorance.
• Management: medical detoxification, psychological counseling, rehabilitation, legislative control (Narcotic Drugs and Psychotropic Substances Act, 1985).

• Causes: social maladjustment, poverty, disturbed home, alcoholism, drug addiction, modern ways of living.
• Management: The Children Act, 1960 - Juvenile/Children's Courts, child welfare boards, remand homes, certified schools, children's homes.

• Causes: changes in environment, breakdown of family, poverty, low moral standards, easy money.
• Legislation: Immoral Traffic (Prevention) Act, 1986 - covers all persons exploited sexually for commercial purposes.

• Has grown from a cultural custom into a social evil with bride burning and suicides.
• Dowry Prohibition (Amendment) Act, 1986: minimum punishment of 5 years imprisonment and Rs. 15,000 fine.

• Sexually transmitted diseases (STDs)
• Mental illness
• Housing and homelessness
• Divorce and family breakdown
• Population growth
• Problems of the elderly

Q7. Social Security (6 Marks)

• Social insurance - contributory schemes
• Social assistance - non-contributory, state-funded support for the destitute

Social Security in India

For Industrial Workers:

1. Workmen's Compensation Act, 1923 - compensation for workers injured at work or who contract occupational disease.
2. Employees State Insurance (ESI) Act, 1948 - provides medical care, sickness benefits, maternity benefits, disablement benefits, and death benefits to industrial workers and their dependents.
3. Central Maternity Benefit Act, 1961 - maternity leave and financial benefits for working women.
4. The Family Pension Scheme, 1971 - pension for family members after worker's death.

For Civil Servants:

• Pension, gratuity, provident fund, and family pension schemes.
• Central Government Health Scheme (CGHS) - provides comprehensive medical care to all categories of central government employees; extended to several cities.

For the General Public:

• Risks of death, accident, and fire covered by insurance schemes.
• Life Insurance Corporation (LIC) of India has many schemes.
• Public Provident Fund (PPF) scheme.
• Pradhan Mantri Jan Dhan Yojana, Atal Pension Yojana (more recent schemes).

Q8. Social Stigma (6 Marks)

Types of Stigma

1. Public stigma - negative attitudes held by the general public toward a stigmatized group (e.g., people with mental illness are seen as "dangerous" or "incompetent").
2. Self-stigma (Internalized stigma) - the person accepts and internalizes the negative beliefs about themselves, leading to low self-esteem, shame, and reduced help-seeking.
3. Structural stigma - institutional policies and practices that disadvantage stigmatized groups (e.g., restricted employment opportunities for people with HIV).
4. Courtesy stigma (Associative stigma) - stigma extended to family members and caregivers of stigmatized individuals.

Conditions Associated with Stigma in Health

• Mental illness (most prominently)
• HIV/AIDS
• Tuberculosis
• Leprosy
• Epilepsy
• Substance abuse / addiction
• Sexually transmitted infections
• Obesity
• Cancer (historically)

Effects of Stigma on Health

1. Delayed treatment seeking - fear of being labeled leads to avoidance of healthcare.
2. Non-disclosure - patients conceal symptoms, reducing effectiveness of contact tracing (e.g., TB, HIV).
3. Poor treatment adherence - stigma-driven shame causes patients to default on treatment.
4. Worsening mental health - stigma causes depression, social isolation, and loss of self-worth.
5. Social exclusion - loss of employment, relationships, housing, and community membership.
6. Increased mortality - stigmatized individuals avoid care until disease is advanced.

Stigma as a Barrier to Public Health Programmes

Reducing Stigma

1. Public education and awareness campaigns.
2. Contact-based interventions (direct interaction between the public and stigmatized individuals).
3. Anti-discrimination legislation.
4. Normalizing mental health discussions in schools, workplaces, and media.
5. Training healthcare workers to provide non-judgmental care.
6. Community-based rehabilitation and support groups.