Medical sociology - strictly from the park textbook spm
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Medical Sociology
Park's Textbook of Preventive and Social Medicine
Definition and Scope
Medical sociology is a specialization within the field of sociology. Its main interest is in the study of health, health behaviour and medical institutions. As a specialized field, it was first proposed by Charles McIntire in 1894.
It is defined as:
"Professional endeavour devoted to social epidemiology, the study of cultural factors and social relations in connection with illness, and the social principles in medical organization and treatment."
Broadly, medical sociology includes studies of:
- The medical profession
- The relationship of medicine to the public
- The social factors in the aetiology, prevalence, incidence and interpretation of disease
Background: Sociology
Sociology is derived from Latin socio (society) and Greek logos (science). The word "society" comes from socius (individual) and societa (group).
Sociology can be viewed from two angles:
- (a) Study of relationships between human beings - how these change/vary across the world and time. The unit of study can be a small group (e.g., family) or complex society with wider economic, political and organizational interactions.
- (b) Study of human behaviour - behaviour determined not merely by biological but also by social forces.
Specialization Within Sociology
The following sub-disciplines feed into medical sociology:
| Discipline | Focus |
|---|---|
| Political Science | Study of systems of laws and institutions constituting government of societies |
| Sociology | Study of human relationships and behaviour for understanding patterns of human life |
| Social Psychology | Psychology of individuals in society/groups; understanding perception, attitudes, motivation, learning |
| Anthropology | Study of physical, social and cultural history of man; "Medical Anthropology" deals with the cultural component in the ecology of health and disease |
Concepts in Sociology
The following terms form the necessary equipment by which sociologists organize their thinking, do research and communicate results. Many have entered medical terminology and are increasingly used in epidemiological studies.
1. SOCIETY
Society may be defined simply as an organization of member agents. A group of people must be organized and settled - a crowd watching a hockey match is NOT a society.
Key features:
- The outstanding feature is a system of social relationships between individuals
- Society controls and regulates behaviour both by law and customs; it exerts pressure on individuals to conform to its norms
- Society is a "vast network of relationships and compulsions that propel, direct and constrain man's individual efforts"
- The character of society is dynamic - it changes over time and place
Relation to public health: Public health is an integral part of the social system. It is influenced by society, and society by public health. Social organization has made it possible to translate scientific concepts into practice, bringing mortality rates to low levels.
Types of Society:
- (1) Primary group - members know each other and have face-to-face relations (e.g., family, neighbourhood)
- (2) Secondary group - large, impersonal organizations (e.g., a political party, a trade union)
2. COMMUNITY
A community is a group of people living in one locality under the same general culture and government, having some common interest. A community has:
- A territorial base
- A common life with some common characteristic interests
- An awareness of its unity
Communities may be classified as:
- Rural community - people living in villages, dependent mainly on agriculture
- Urban community - people living in towns and cities, dependent on industry, trade and services
- Semi-urban or peri-urban - intermediate between the two
The community has a direct bearing on health. Community life shapes the individual's habits, customs, attitudes and behaviour.
3. SOCIAL STRUCTURE
Social structure refers to the network of social relationships in a society. It includes:
- The organization of positions and roles
- The norms governing interactions
- It is the organized set of social relationships in which members of the society are variously implicated
Social structure includes: family, caste, class, and occupation as important sub-structures.
4. SOCIAL INSTITUTIONS
Social institutions are the organized systems of practices and roles developed around the basic needs of society. They are the structural component of society. Examples include:
- Family
- Marriage
- Religion
- Education
- Government
- Economy
Social institutions regulate human behaviour. Every institution has its own rules of behaviour and norms which must be observed by its members.
5. ROLE
Role refers to the behaviour expected of an individual who occupies a given social position or status. Every person in society occupies several positions simultaneously - as father, doctor, citizen - each position having a corresponding role. The concept of "sick role" (Parsons) is important in medical sociology.
6. SOCIALISM
Socialism is a social and economic system characterized by social ownership and democratic control of the means of production.
7. SOCIALIZATION
Socialization is the process by which an individual learns to conform to the norms of a group. Through socialization, the individual internalizes the cultural values of the society. It is the process of social learning by which the individual acquires the customs, values, norms and beliefs of the society.
8. SOCIAL CONTROL MECHANISMS
Social control refers to the mechanisms by which a society maintains order and ensures conformity to norms and values. Mechanisms include:
- Law
- Custom
- Religion
- Public opinion
- Education
- Socialization
9. CUSTOMS
Customs are the traditional modes of behaviour established by social usage. They are a form of social control. Customs include:
- (a) Folkways - ways of acting that are common to a group or society; lack strong moral overtones; e.g., customs of dress, eating habits
- (b) Mores - customs of great importance to the welfare of society with strong moral overtones; e.g., prohibition on incest, the requirement to care for children
- (c) Taboos - prohibitions imposed by social custom. A "taboo" is a thing forbidden or untouchable by social custom. Examples include food taboos: in India, the cow is sacred; among Muslims, pork is prohibited.
Customs can have both beneficial and harmful effects on health. Many disease patterns are shaped by customs.
10. CULTURE
Culture is defined as "learned behaviour which has been socially acquired." Culture is the product of human societies, and man is largely a product of his cultural environment. In general, culture stands for the customs, beliefs, laws, religion and moral precepts, arts and other capabilities acquired by man as a member of society.
Culture is transmitted from one generation to another through learning processes, formal and informal. It lays down norms of behaviour and provides mechanisms for individual personal and social survival.
Cultural factors in health and disease:
- Every culture has customs that profoundly influence the incidence of disease
- In developed countries: lung cancer from smoking, cirrhosis from drinking
- In India: chewing pan is associated with oral cancer
- Cultural factors are deeply involved in matters of personal hygiene, nutrition, immunization, seeking medical care, family planning, child rearing, disposal of excreta, and overall outlook on health and disease
11. ACCULTURATION
Acculturation means "culture contact." When two peoples with different cultures come into contact, there is diffusion of culture both ways.
Ways by which culture contact takes place:
- Trade and commerce
- Industrialization
- Propagation of religion
- Education
- Conquest
Examples: The British brought their culture into India through conquest; the introduction of scientific medicine is through culture contact; changes in food habits; widespread use of tobacco worldwide.
12. STANDARD OF LIVING
"Standard of living" refers to the usual scale of expenditure, goods consumed and services enjoyed - food, dress, house, amusements - in short the mode of living.
Depends on:
- Level of national income
- Total goods and services a country can produce
- Size of the population
- Level of education
- General price level
- Distribution of national income
13. DYNAMICS OF SOCIAL CHANGE
Society is not static - it is dynamic. Social change refers to changes in social structure and functions of society over time. Factors contributing to social change include:
- Technology - industrialization, mechanization
- Migration - rural to urban drift
- Education - raises awareness, changes attitudes
- Mass media - radio, television, cinema
- Legislation - laws change social behaviour
Social change has important health consequences. Rapid urbanization, industrialization, and migration create new patterns of disease and disrupt traditional support systems.
14. SOCIAL STRESS
Social stress refers to stress arising from social situations and social conditions. Stress is the body's response to any demand placed upon it. Social stress can be acute (e.g., bereavement, job loss) or chronic (e.g., poverty, social isolation).
Sources of social stress:
- Life events (Holmes & Rahe Social Readjustment Rating Scale)
- Role conflict and role ambiguity
- Poverty and unemployment
- Social isolation
- Overcrowding
Effects on health: Social stress is a major contributor to psychosomatic illness, hypertension, peptic ulcer, coronary heart disease, mental illness and accidents.
The Social Readjustment Rating Scale developed by Holmes and Rahe lists life events weighted by their stressfulness, with death of a spouse scoring highest.
15. SOCIAL PROBLEMS
Individual problems become social problems when they affect a large number of people amounting to a threat to the welfare or safety of the whole group.
Common social problems:
- Poverty
- Crime
- Disease
Many public health problems are social problems and vice versa. Alcoholism, sexually transmitted diseases, mental illness and narcotic addiction are both public health and social problems.
Social problems with public health implications: housing, divorce, population growth, increased numbers of old people - all call for combined sociological and public health action.
16. SOCIAL PATHOLOGY
Social pathology has a restricted interpretation linking it to poverty, crime, delinquency and vagrancy. In the modern context, the term is also used to describe the relation between disease and social conditions.
The social pathology of accidents, diabetes, cardiovascular disease, cancer, and chronic bronchitis have all been subjects of recent investigation in medical literature. Social pathology is uncovered by "social surveys."
17. SOCIAL SURVEYS
Social surveys disclose social pathology. They have played an important role in the development of public health. Chadwick's survey led to the foundation of the General Board of Health in 1848 in Great Britain.
There is a strong kinship between epidemiological survey and social survey. When the objective is to study the role of social factors in the aetiology of disease, the two merge into what is known as "social epidemiology." Large-scale social epidemiological studies have investigated the relationship of social factors to heart disease, cancer and arthritis.
18. CASE STUDY
A case study is a method of exploring and analyzing the life of a social unit - a person, family, institution, culture group, or entire community. Its aim is to determine the factors that account for complex behaviour patterns and the unit's relationships to its surrounding milieu.
- Case study: collects large amount of information from a small number of units
- Survey: collects small amount of information from a large number of units
A combination of survey and case study provides more information than either alone. Limitation: a single instance may not be representative of a larger population.
19. FIELD STUDY
Whereas surveys are concerned with the breadth of knowledge (systematic data collection from populations/samples), field studies are concerned with the depth of knowledge - intensive study of a limited number of units in their natural settings.
20. COMMUNICATION
Communication is the process of conveying information, ideas, feelings or emotions from one person to another. It is a two-way process. Types of communication:
- Verbal (spoken or written)
- Non-verbal (gestures, postures, facial expressions)
Effective communication is essential in health education and in the doctor-patient relationship.
21. SOCIAL DEFENCE
Social defence involves measures taken to protect society from crime, delinquency and anti-social behaviour. It includes crime prevention, rehabilitation of offenders and treatment of those with antisocial personality. The sociological approach emphasizes addressing root causes - poverty, ignorance, social inequality.
Psychology
Psychology is defined as the science of mind and behaviour. It is concerned with the study of behaviour in response to environmental stimuli.
Scope of psychology includes:
- Normal and abnormal psychology
- Social psychology
- Industrial/occupational psychology
- Educational psychology
- Developmental psychology
- Clinical psychology
Dynamics of Behaviour
Human behaviour is the response of an individual to stimuli. Behaviour has three components:
- Health behaviour - actions people take to maintain or improve health (e.g., brushing teeth, eating nutritious food, exercising)
- Illness behaviour - actions taken when a person perceives he may be ill (e.g., seeking medical advice, taking medicines)
- Treatment behaviour - actions taken to comply with a prescribed treatment regimen
Causes/Determinants of Behaviour:
| Determinant | Description |
|---|---|
| i) Environmental stimuli | Physical/social environment shapes behaviour |
| ii) Emotions and feelings | Positive/negative emotions drive actions |
| iii) Needs | Maslow's hierarchy: physiological, safety, love/belonging, esteem, self-actualization |
| iv) Motivation | An inner force driving an individual to a certain action; without motivation, behavioural changes cannot take place |
| v) Intellectual perception | A person's thinking and reasoning can influence behaviour; each individual behaves in ways that make sense to him |
Types of behavioural responses:
- Making adjustments - behaviour as adjustment to meet needs of a situation (e.g., reacting to failure by complaining, isolating, making excuses, or accepting with good grace)
- Unconscious behaviour - forces like perceptions, prejudices and notions colour behaviour over which the individual has no control
Emotions
An emotion is a strong feeling of the whole organism. Emotions motivate human behaviour. Emotional experiences have:
- External changes - facial expression, changes in posture (apparent to others)
- Internal changes - rapid pulse, rapid respiration, increased blood pressure, tension and pain (psychological)
Major Emotions:
| Fear | Jealousy | Sympathy |
| Anger | Moodiness | Pity |
| Love | Joy |
Specific emotions:
- Fear - most common emotion of man; may produce excitement or depression; flight or fight. When exaggerated/unnecessary = phobia; common in mental disorders
- Anger - basic emotion; reaction of the offensive type; a destructive force; if uncontrolled may lead to violence
- Anxiety - manifests as rapid pulse/breathing, flushing, tremors, sweating, dry mouth, nausea, diarrhoea, raised blood pressure; anxiety leads to tension, and tension to pain; a kind word from the doctor gives considerable relief
- Love - feeling of attachment to some person; a basic emotion of man
Source: Park's Textbook of Preventive and Social Medicine, Chapter on Medical Sociology (block 9)
U mean... everything should be written? For this medical sociology question?
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Got it - exam short note covering everything. Here's a clean, to-the-point version you can write in 5-10 marks:
Medical Sociology - Short Note
(Park's Textbook of Preventive and Social Medicine)
Definition
Medical sociology is a specialization within sociology. First proposed by Charles McIntire in 1894.
Defined as: "Professional endeavour devoted to social epidemiology, the study of cultural factors and social relations in connection with illness, and the social principles in medical organization and treatment."
Broadly includes:
- Study of the medical profession
- Relationship of medicine to the public
- Social factors in the aetiology, prevalence, incidence and interpretation of disease
Key Concepts in Sociology
| Concept | Definition |
|---|---|
| Society | Organization of member agents; a system of social relationships; dynamic in character |
| Community | Group of people in one locality under same culture/government with common interests |
| Social Structure | Network of social relationships in a society (family, caste, class, occupation) |
| Social Institutions | Organized systems of practices regulating behaviour (family, religion, education, government) |
| Role | Behaviour expected of an individual occupying a given social position |
| Socialization | Process by which individual learns to conform to norms of a group |
| Social Control | Mechanisms maintaining order and ensuring conformity - law, custom, religion, education |
| Customs | Traditional modes of behaviour; include folkways, mores, and taboos |
| Culture | "Learned behaviour which has been socially acquired"; shapes health, hygiene, disease patterns |
| Acculturation | Culture contact - diffusion of culture between two groups (trade, education, conquest) |
| Social Problems | Individual problems affecting large numbers threatening group welfare - poverty, crime, disease |
| Social Pathology | Relation between disease and social conditions; uncovered by social surveys |
| Social Surveys | Disclose social pathology; Chadwick's survey led to General Board of Health (1848, UK) |
Social Stress
- Stress from social situations - acute (bereavement) or chronic (poverty, isolation)
- Holmes & Rahe Social Readjustment Rating Scale - life events ranked by stressfulness; death of spouse scores highest
- Contributes to: hypertension, peptic ulcer, coronary heart disease, mental illness
Behaviour (Psychology Component)
Three types:
- Health behaviour - actions to maintain/improve health
- Illness behaviour - actions when a person perceives illness
- Treatment behaviour - compliance with treatment
Determinants of behaviour: environment, emotions, needs (Maslow's hierarchy), motivation, intellectual perception
That's everything an examiner expects for a 5-10 mark short note - definition, concepts in a table, social stress, and behaviour. Clean and complete.
Social security
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I have all the key content. Here's the clean exam short note:
Social Security
(Park's Textbook of Preventive and Social Medicine)
Definition
Social security is defined as:
"Security that society furnishes, through appropriate organization, against certain risks to which its members are exposed."
Risks covered in most countries: sickness, invalidity, maternity, old age and death.
Social security includes social insurance and social assistance.
Social Security in India
Organized under three categories:
1. Social Security for Industrial Workers
Covered by the following legislations:
| Act | Year |
|---|---|
| Workmen's Compensation Act | 1923 |
| Central Maternity Benefit Act | 1961 |
| Employees' State Insurance (ESI) Act | 1948 |
| Family Pension Scheme | 1971 |
2. Social Security for Civil Servants
- Pension, gratuity, provident fund and family pension schemes for Central and State Govt. employees
- Central Government Health Scheme (CGHS) - provides comprehensive medical care to all Central Govt. employees; extended to multiple cities
3. Social Security for General Public
- Risks of death, accident, fire covered by insurance schemes
- Life Insurance Corporation (LIC) of India - multiple schemes
- Public Provident Fund (PPF)
- ESI schemes
ESI Act, 1948 - Key Details
(Most important Act for exam purposes)
- Passed in 1948; amended in 1975, 1984, 1989, 2010 and 2019
- Provides cash and medical benefits to industrial employees in case of sickness, maternity and employment injury
- Salary limit: up to Rs. 21,000/month (revised 2016)
Finance:
- Employer contributes: 3.25% of total wage bill
- Employee contributes: 0.75% of wages
- Employees earning below Rs. 176/day are exempted
- State Govt. bears 1/8 of medical care cost; ESI Corporation bears 7/8
Benefits to Insured Persons (7):
| Benefit | Details |
|---|---|
| 1. Medical | Full medical care - OPD, drugs, specialist, investigations, hospitalization, domiciliary, ANC, immunization, family planning, emergency, ambulance |
| 2. Sickness | Cash ~50% of wages for up to 91 days/year; Extended sickness benefit for 34 specified long-term diseases (up to 2 years); Enhanced benefit for sterilization |
| 3. Maternity | 26 weeks for confinement; 6 weeks for miscarriage; 30 days for sickness arising from confinement; Confinement expenses Rs. 7,500 |
| 4. Disablement | Temporary: ~90% wages; Permanent total: life pension; Permanent partial: proportionate pension |
| 5. Dependant's | On death from employment injury - pension at 90% of wages shared among dependants |
| 6. Funeral expenses | Lump sum payment |
| 7. Rehabilitation allowance | For undergoing vocational rehabilitation |
That covers everything Park's asks on Social Security for a 5-10 mark exam answer.
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