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Write a social history for community medicine
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WHO social determinants of health housing sanitation income health factsheet
Social History
The family is a nuclear Muslim family belonging to the OBC category, residing at the same address for approximately 20 years. The family consists of five members, including four males and one female. The head of the family is engaged in running a vegetable shop. The family has an estimated monthly income of about ₹15,000 from the vegetable shop and the earnings of a son. They belong to the lower-middle socioeconomic class.
The house is a pucca house with approximately three rooms, a separate kitchen, and a store room. The family owns the house. There is adequate natural lighting and ventilation, though windows are generally kept closed. Cooking is done using LPG, and the cooking area and food-storage practices are reported to be clean.
Water is obtained from a borewell and is available in adequate quantity. No household water-purification method is used. Water is stored in buckets. A latrine is present inside the house with water available for use. Solid waste is disposed of regularly, but waste-water disposal is through an open drainage arrangement.
There are no known addictions among family members. The female member works in the shop. There is no history of domestic violence or quarrels with neighbours. The family is not currently practising family planning, but they have awareness regarding contraception, maternal health, and child health services.
The family’s major monthly expenditure is on food, followed by clothing, education, electricity, fuel, health care, and other household needs. The family possesses its own house as a major asset.
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History presentation of community medicine focus on hypertension
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Community Medicine Family Case Presentation: Hypertension-Focused
Identification data
This is a nuclear Muslim family belonging to the OBC category and residing in the same locality for approximately 20 years. The family has five members, comprising four males and one female. They belong to the lower-middle socioeconomic class, with a reported monthly family income of approximately ₹8,000-15,000.
The index patient is Mr. [Name to be confirmed], aged 50 years, who is engaged in shop-related work. He is being assessed with special reference to hypertension and associated cardiovascular risk factors.
Note: The uploaded records do not document an actual blood-pressure value, duration of hypertension, treatment, or complications. These must be measured/asked before presenting the person as a confirmed case of hypertension.
Presenting complaints
The patient was screened during a family health survey / community visit.
Ask and record:
- Raised blood pressure detected since ______
- Headache, particularly occipital or early morning: Yes/No
- Giddiness, blurring of vision, palpitations, chest pain, breathlessness: Yes/No
- Pedal edema, reduced urine output, weakness, or neurological deficits: Yes/No
Hypertension is frequently asymptomatic; therefore, absence of symptoms does not exclude it.
History of present illness
The patient was found to have blood pressure of _____ / _____ mmHg on screening. Blood pressure should be measured properly after at least 5 minutes of rest, using an appropriately sized cuff, with repeat readings on separate occasions.
If already diagnosed with hypertension, ask:
- Duration since diagnosis: ______ years
- Highest recorded BP: ______ mmHg
- Current antihypertensive drugs, dose and timing: ______
- Regularity of treatment and missed doses: ______
- Whether BP is monitored at home or at a health facility: ______
- Previous hospital admission for hypertensive emergency, stroke, myocardial infarction, heart failure, or kidney disease: ______
Hypertension-related lifestyle measures include weight reduction when indicated, a DASH-type diet, physical activity, sodium restriction, and avoidance of excess alcohol. These measures are useful both for prevention and treatment.
Past history
Enquire for:
- Diabetes mellitus
- Dyslipidemia
- Coronary artery disease, angina, myocardial infarction
- Stroke or transient ischemic attack
- Chronic kidney disease
- Thyroid disease
- Obstructive sleep apnea
- Long-term use of NSAIDs, steroids, oral contraceptives, decongestants, or traditional/herbal medicines
- Previous tuberculosis or other chronic illness
Also ask about evidence of target-organ damage:
| System | Symptoms to ask |
|---|---|
| Brain | Headache, transient weakness, speech difficulty, seizures, stroke |
| Eye | Blurring of vision, visual loss |
| Heart | Chest pain, palpitations, dyspnea, orthopnea |
| Kidney | Nocturia, oliguria, frothy urine, edema |
| Peripheral circulation | Claudication, cold extremities |
Family history
The family consists of five members. Family history should specifically include:
- Hypertension in parents or siblings
- Diabetes mellitus
- Stroke at a young age
- Ischemic heart disease or sudden cardiac death
- Chronic kidney disease
- Obesity
A positive family history increases cardiovascular risk and supports screening of all adult household members.
Personal and dietary history
The family consumes rice, pulses, milk, vegetables, roots/tubers, sugar, and oil/ghee. The diet survey indicates relatively high household use of oil/ghee and calorie-dense food items.
Hypertension-relevant dietary observations
- Intake of salt, pickles, papad, chutneys, namkeen, packaged snacks, bakery items, and restaurant food should be specifically assessed.
- Quantity of oil/ghee used at household level appears high and should be reduced.
- Fruit intake was not clearly documented and should be encouraged.
- Green leafy vegetables and pulses are present in the diet and should be continued.
- The patient should avoid adding table salt to prepared food.
Personal habits
- Addiction: Recorded as none.
- Tobacco use, including smoking, bidi, chewing tobacco, gutkha, or khaini, should be reconfirmed.
- Alcohol intake should be specifically asked, including type, frequency, and quantity.
- Tea/coffee intake, sleep, physical activity, and stress should be assessed.
Socio-environmental history
The family lives in a pucca house with approximately three rooms, a separate kitchen, and a store room. Natural lighting and ventilation are stated to be adequate, though windows are usually kept closed.
- Cooking fuel: LPG
- Water source: Borewell
- Water storage: Buckets
- Water purification: Not practised
- Latrine: Present inside the house
- Solid waste disposal: Regular disposal
- Waste-water disposal: Open drainage
The home setting is generally satisfactory; however, improved ventilation, safe covered water storage, and appropriate waste-water drainage should be advised.
Socioeconomic history
The main income is from a vegetable shop and contribution from a working son. Monthly income is approximately ₹8,000-15,000. The family owns its house.
Economic constraints can affect regular BP monitoring, medicine purchase, diet quality, and follow-up. Social and living conditions such as income, housing, education, diet, and work conditions influence cardiovascular health, as described by the WHO social determinants overview.
Hypertension risk assessment
Non-modifiable risk factors
- Age: 50 years
- Male sex
- Family history: To be elicited
Modifiable risk factors
- Possible high dietary salt intake: To be assessed
- High oil/ghee consumption
- Possible overweight/central obesity: Measure BMI and waist circumference
- Physical inactivity: To be assessed
- Stress related to work/economic circumstances: To be assessed
- Tobacco and alcohol use: To be reconfirmed
- Diabetes and dyslipidemia: Screen
Examination to be presented
General examination
- Height: _____ cm
- Weight: _____ kg
- BMI: _____ kg/m²
- Waist circumference: _____ cm
- Pulse: _____/min, regular/irregular
- Blood pressure: / mmHg
- Repeat BP: / mmHg
- Pallor, pedal edema, cyanosis, clubbing: Present/Absent
Systemic examination
- Cardiovascular system: Apex beat, heart sounds, murmurs, signs of heart failure
- Respiratory system: Basal crepitations, if heart failure suspected
- CNS: Motor and sensory deficits, if prior stroke suspected
- Fundus examination: Hypertensive retinopathy, if available
- Abdomen: Renal bruit, enlarged kidneys, abdominal aortic pulsation
Investigations advised
- Repeat and properly document blood pressure on separate visits.
- Urine routine examination and urine albumin/protein.
- Fasting blood glucose or HbA1c.
- Serum creatinine, estimated GFR, serum sodium and potassium.
- Lipid profile.
- ECG.
- Fundus examination.
- BMI and waist circumference.
Assessment
Provisional assessment:
A 50-year-old male from a lower-middle socioeconomic nuclear family, being evaluated for hypertension. The household has potential modifiable cardiovascular risk factors, particularly possible excess dietary salt and oil intake, possible insufficient physical activity, and the need for screening for obesity, diabetes, dyslipidemia, and target-organ damage.
A 50-year-old male from a lower-middle socioeconomic nuclear family, being evaluated for hypertension. The household has potential modifiable cardiovascular risk factors, particularly possible excess dietary salt and oil intake, possible insufficient physical activity, and the need for screening for obesity, diabetes, dyslipidemia, and target-organ damage.
Final diagnosis should only be made after documented repeated BP readings and clinical evaluation.
Family-centered management plan
For the index patient
- Confirm diagnosis through repeat BP measurement.
- Ensure regular treatment if hypertension is diagnosed.
- Advise reduction of salt intake. Avoid extra table salt, pickles, papad, processed snacks, and salted foods.
- Reduce oil/ghee intake and avoid frequent fried foods.
- Increase vegetables, fruits, pulses, and whole grains.
- Encourage regular aerobic physical activity, such as brisk walking, subject to clinical fitness.
- Measure and manage body weight and waist circumference.
- Avoid tobacco and alcohol.
- Screen for diabetes, dyslipidemia, renal disease, and hypertensive complications.
- Maintain a BP record and attend regular follow-up at the nearest PHC/UPHC.
For the family
- Screen all adults for blood pressure, diabetes, BMI, and tobacco use.
- Adopt low-salt cooking for the whole family.
- Use less oil in cooking and avoid repeated heating of oil.
- Encourage daily physical activity among all family members.
- Improve water storage hygiene and ventilation.
- Provide health education regarding warning signs such as severe headache, chest pain, breathlessness, weakness of one side of the body, or sudden visual disturbance. These require urgent referral.
Closing statement
This family requires regular BP screening, confirmation of hypertension where applicable, risk-factor modification, treatment adherence, and family-level health education to reduce the risk of stroke, heart disease, kidney disease, and other hypertension-related complications.
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Make a made of socioeconomic history of this family on bg prasad scale
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B G Prasad socioeconomic scale January 2026 per capita monthly income classification India CPI IW
Socioeconomic History
The family is a nuclear family consisting of five members. The head of the family, aged 50 years, has completed secondary education and runs a shop. His wife, aged 40 years, is also educated up to secondary level and assists with shop work. Their three sons, aged 25, 23, and 19 years, have completed secondary education and work as labourers.
The family has two reported sources of income:
| Source | Monthly income |
|---|---|
| Vegetable/shop business | ₹8,000 |
| Son’s income | ₹7,000 |
| Total monthly family income | ₹15,000 |
Per-capita monthly income
= Total monthly family income ÷ Number of family members
= ₹15,000 ÷ 5
= ₹3,000 per month
= Total monthly family income ÷ Number of family members
= ₹15,000 ÷ 5
= ₹3,000 per month
According to the Modified B. G. Prasad socioeconomic scale, 2026, a per-capita monthly income of ₹3,000 falls under:
- Class I, Upper: ≥ ₹9,769
- Class II, Upper-middle: ₹4,885-9,768
- Class III, Middle: ₹2,931-4,884
- Class IV, Lower-middle: ₹1,465-2,930
- Class V, Lower: < ₹1,465
Conclusion
The family belongs to Class III (Middle socioeconomic class) according to the Modified B. G. Prasad scale, 2026. The family owns its house and has a regular, though limited, monthly income. Economic constraints may affect expenditure on nutritious food, regular health check-ups, investigations, and long-term treatment adherence for hypertension. The 2026 income cut-offs are based on the CPI-IW-linked updated B. G. Prasad classification.
Doetry cofficet of the family
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dietary coefficient consumption unit family community medicine India adult male female moderate heavy work
Dietary Coefficient / Consumption Units of the Family
For dietary assessment, one consumption unit (CU) is equivalent to the calorie requirement of an adult male doing sedentary work. The coefficient varies by age, sex, and physical activity.
| Family member | Age/Sex | Occupation/activity | Dietary coefficient (CU) |
|---|---|---|---|
| Mehar | 50/M | Shopkeeper, sedentary work | 1.0 |
| Vakmin | 40/F | Shop work, moderate activity | 0.9 |
| Firoz | 25/M | Labourer, heavy work | 1.6 |
| Faruk | 23/M | Labourer, heavy work | 1.6 |
| Sarukh | 19/M | Labourer, heavy work | 1.6 |
| Total family consumption units | 6.7 CU |
Calculation
[
1.0 + 0.9 + 1.6 + 1.6 + 1.6 = \mathbf{6.7\ CU}
]
Interpretation
The dietary coefficient of the family is 6.7 consumption units.
For a hypertension-focused dietary assessment, calculate the intake per CU as:
[
\text{Calories per CU} = \frac{\text{Total family calorie intake}}{6.7}
]
[
\text{Protein per CU} = \frac{\text{Total family protein intake}}{6.7}
]
Note: This calculation assumes that the three sons are doing heavy manual labour. If their labour is only moderate, their coefficient should be taken as 1.2 each, and the total family coefficient would be 5.5 CU.
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Create a syrvey 24 hour recall like thia for the family above with high salt intake and pickles
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24-Hour Dietary Recall Survey - Family Diet
Family members: 5
Total consumption units: 6.7 CU
Dietary pattern: Mixed diet
Special finding: High salt intake due to excess salt in cooking, regular pickle intake, papad, and added table salt.
Total consumption units: 6.7 CU
Dietary pattern: Mixed diet
Special finding: High salt intake due to excess salt in cooking, regular pickle intake, papad, and added table salt.
Meal-wise recall
| Meal | Foods consumed by the family | Approximate quantity |
|---|---|---|
| Early morning | Tea with sugar | 5 cups |
| Breakfast | Wheat chapati | 15 chapatis |
| Potato curry with added salt | 750 g | |
| Mango/lemon pickle | 100 g | |
| Tea | 5 cups | |
| Mid-morning | Salted biscuits / namkeen | 200 g |
| Lunch | Cooked rice | 1,200 g |
| Dal | 450 g | |
| Green leafy vegetable curry | 500 g | |
| Potato curry | 500 g | |
| Curd | 500 ml | |
| Pickle | 150 g | |
| Papad | 5 pieces | |
| Evening | Tea with sugar | 5 cups |
| Fried snacks / samosa | 10 pieces | |
| Dinner | Wheat chapati | 20 chapatis |
| Dal | 450 g | |
| Mixed vegetable curry | 600 g | |
| Egg curry | 5 eggs | |
| Pickle | 150 g | |
| After dinner | Milk | 1,000 ml |
One-Day Diet Survey by Raw-Food Weighment Method
| Food item | Raw quantity consumed by family/day | Approximate calories | Approximate protein |
|---|---|---|---|
| Cereals: rice and wheat flour | 2,000 g | 6,800 kcal | 190 g |
| Pulses/dal | 450 g | 1,530 kcal | 100 g |
| Milk | 1,000 ml | 670 kcal | 32 g |
| Eggs | 5 eggs | 330 kcal | 30 g |
| Green leafy vegetables | 500 g | 150 kcal | 10 g |
| Other vegetables and potato | 1,850 g | 1,100 kcal | 35 g |
| Oil/ghee used in cooking and frying | 200 g | 1,800 kcal | - |
| Sugar | 150 g | 600 kcal | - |
| Pickle | 400 g | 500 kcal | 8 g |
| Papad and salted snacks | 300 g | 1,200 kcal | 25 g |
| Estimated total | 14,680 kcal | 430 g |
Per consumption unit calculation
[
\text{Calories per CU} = \frac{14,680}{6.7} = 2,191\text{ kcal/CU/day}
]
[
\text{Protein per CU} = \frac{430}{6.7} = 64.2\text{ g/CU/day}
]
Salt Intake Assessment
| Source of salt | Approximate family intake/day |
|---|---|
| Salt used during cooking | 40 g |
| Added table salt | 5 g |
| Pickle | 400 g/day |
| Papad, namkeen, salted biscuits | Regular consumption |
| Conclusion | High dietary salt intake |
Dietary interpretation
The family consumes a cereal-based diet with adequate calories and protein. However, the diet contains excess salt, primarily from salt added during cooking, regular consumption of pickle, papad, namkeen, and added table salt. Oil/ghee consumption and fried snacks are also high.
For hypertension prevention and control, the family should:
- Reduce total salt intake to less than 5 g per person per day.
- Avoid adding table salt to cooked food.
- Restrict pickle to occasional use and reduce its quantity.
- Limit papad, namkeen, salted biscuits, packaged snacks, and fried foods.
- Increase fresh vegetables, fruits, pulses, and low-fat preparations.
- Use less oil during cooking and avoid frequent fried snacks.
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