Socio-Economic Status of a Population - Essay Example

Various methods used for assessing socio-economic status of a population, particularly in relation to health and oral health investigations. With a critical evaluation of their validity Assessing socio-economic status of a population, in relation to health and oral health investigations Introduction People around the world are more health conscious than ever due to many practical reasons today. At the same time, the associated changes in temperature and precipitation are already adversely affecting population health. 'These changes reflect the overload of several of the Earth's biophysical and ecological systems caused by the combined impact of growing human population and economic activities. Environmental changes are now affecting the whole planet and disrupting earth's life-supporting mechanisms, but the extent to which this affects human well-being and health varies substantially in different parts of the world' (Sari Kovats, Kristie L Ebi and Bettina Menne 2003). Assessing the socio-economic status of a population based on health will require all the factors that contribute to disparities in health among humans, such as access to health care, nutritional factors, environmental exposure and social support. The health related behaviors of people in a society can be based on the individual position of its people most of the time (Kirby L. Jackson, Jennifer L. Waller, Carol Z. Garrison 1998). Even Hamm TE. Kaplan, J.R. Clarkson (1983) have summarized as top people live longer. As far as India's socio-economic scenario is concerned, four socio-economic scenarios were developed for India, in line with Intergovernmental Panel on Climate Change guidance, for use with the climate scenarios and for input to the modeling of climate impacts on different sectors (International Institute for Population Sciences & ORC Macro 2001). The socio-economic scenarios for India are consistent with national growth plans in the short and medium term. Policy direction and social values are the two dimensions on which the socio-economic framework of India is based on. In which, policy orientation can be either inward looking or globally integrated and social values focus on either economic growth or environmental consciousness. Mahal, A., J. Singh (2000) further explains it saying 'the alternative directions along the policy axis correspond to India's level of integration on global policy issues and frameworks for supporting development. Quadrants I and II reflect a more inward-looking approach to global policies and treaties, coupled with command and control-style policies for regulation at a domestic level. Quadrants III and IV reflect stronger integration with the global community, and a shift towards market-based mechanisms as a basis for regulation and economic growth. The social values axis reflects the range of possibilities from a pure focus on economic growth, to emphasis on environmental and social protection. Quadrants I and III correspond to activities that promote economic and industrial development, along with stronger participation by the private sector in traditionally public sector activities. Quadrants II and IV, by contrast, reflect social values that place a higher concern for social and environmental issues above economic growth'. However, S.C. Tiwari, Aditya Kumar and Ambrish Kumar (2004) stated that the commonly used available scales for measurement of socio-economic status (SES) with some cross regional applicability are old and have lost their relevance. There is a need for the development of a valid and reliable instrument for measurement of SES in rural and urban communities in India. On appropriate and feasible measures, the socio-economic status is assessed on the static and dynamic condition of physical infrastructure- by the numbers of paramedical, technician and medical staff employed, as well as figures for attendance and gender breakdown; by the supply, quality and range of drugs; by availability and usage of decentralized untied and maintenance funding of centers; and by actual availability of laboratory, diagnostic and service facilities- in relation to the patient satisfaction (Kaveri Gill 2009). In Indian conditions the rural health care has been put firmly on the agenda and is on the right track with the institutional changes it has wrought within the health system. Socio economic status of Indian Population in relation to oral health investigation Health is a universal human need for all cultural groups. General health can not be attained or maintained without oral health. The mouth is regarded as the mirror of the body and the gate way of good health (Navneet Grewal and Manpreeth Kaur 2007). The influences of the urbanization and the modern food habits have certainly made the Indian population at par with the world population, but still Mayer. MP, De Paiva Buishchi and Oliveira LB (2003) claimed that the oral hygienic practices of the Indian Population have not changed much with the changing times and trends. Where as, the world population is more aware of the regular visit to the dentist, mainly, because it was initiated by the parents of the children or, even by, the dentists themselves. Such an from the part of the parents is missing among the people of India, and a thought provoking action from the dental practitioners or professionals is yet to take place. Oral health status in India is traditionally evaluated using clinical indices. There is growing interest to know how subjective measures relate to outcomes of oral health (Jamil David, Anne M Astrome and Nina J Wang 2006). Several subjective oral health indicators have been developed to assess functional, social and psychological oral health outcomes ranging from single item global indicators, such as satisfaction with oral health and satisfaction with appearance of teeth, to complex inventories and scoring systems (Skaret E, Astrom AN and Haugejorden O 2004). In the social conditions of India minimum significance is given to the appearance factor in the rural conservative communities. Even then, since long time, various types of oral health maintenance materials have been used and countless numbers of dental health information programs have been conducted in schools and other settings (Kagami. N, Maki. Y and Takaesu. Y 1997). Here Kagami. et. al is talking about a world phenomena that has been increasingly found in the world population. This is where in terms of oral health habits and routines Indian mass should have taken much interest in there improving socio economic status. The importance of assessing the socio economic status was put forth by Whiteside, K. and Woolcock, M. (2004), saying, 'Socio-economic status is one of the most important variables in social science studies/researches. It plays a significant role in planning and execution of developmental programs and, therefore, there is a need for the development of a valid and reliable instrument for the measurement of SES. Socio-economic status of a family would mean the ranking of the family in the milieu to which the family belongs, in respect of defined variables viz., physical assets, economic status, education, occupation, social position, social participation, caste, muscle power, political influence, etc. Some elements of the above variables have a tendency to go together'. Socio economic inequalities in the use of oral health care services in India India is the second largest populous country in the world, with a population of more than one billion in 2001. Socioeconomic, demographic and health indicators are showing a very poor condition of the general population. It has been observed that people of lower socioeconomic status often do not avail the existing reproductive health care services, particularly oral health care service. Both socioeconomic and demographic factors, however, have been shown to have a particularly great influence on use of health care services (Bhatia J and Cleland J. 1995). Higher education levels influence the use of health services in many ways such as regular visit to the dentist and so on, among the urban population of the society. Even then just like in many southeastern cultures the (Goodburn EA, Gazi R, & Chowdhury M. 1995) the use of preventive health services even in the field of oral health service is perceived to be existing solely on curative purposes (Poula G & Stephenson R. 2001). Assessing the socio economic status in relation to oral health factors is, in fact, a search from general health to well-being. As far as the various cultures of India is concerned the oral health factor of Indian population include three major aspects Such as: A) Health System and Oral health services B) Socio-economic and cultural risk factors C) Environmental risk factors. It is important to remember the fact that Indian community has been broadly divided into tribal, rural and urban societies (Dr. Judith Macky and Dr. Michel Eriksen 1995). The tribes in India live in marked isolation. They have very distinctive culture rituals and habitual hygienic activities and health care. They are obviously considered to be socio-economically backward in many measures in the contemporary world. The rural societies are village societies which are in fact based on agricultural economy and are still very conservative to the past traditions. And the urban society is based on non-agricultural occupations such as industries, IT and so on. However the interaction between the different groups of the society to certain level is made possible through many government organizational programs (Lal S, Singh BM & Punia MS.1997). Going about with the purpose of developing a reliable and valid instrument for measuring the socio-economic status one has to begin the exercise of grouping the items/elements together with the help of available experts (Oral health workers and dentists) as well as available standard socio-economic status assessment scales. Socio-economic status of a family would mean the ranking of the family in the milieu to which the family belongs, in respect of defined variables such as physical assets, economic status, education, occupation, social position, social participation, caste, muscle power, political influence and so on. 'Some elements of the above variables have a tendency to go together' (Shirpurkar GRI. 1967). Formulation of assessment methods At initial stage, some known indicators of socio-economic status such as house, material possession, education, occupation, income, land, caste and social participation were listed. The prepared list of socio-economic status indicators would be submitted to experts to analyze and comment on the relevancy of those indicators in the present context (Srivastava GP. 1978). Then a profile should be geared up out of the elements approved by the expert, investigating along with another factors in the profile is the oral health care cervices and programs with their range of influence and acceptance by/in different communities and societies among the population. Thus, the first draft will have seven to eight profiles deciding the socio-economic status. These profiles will be house profile, material possession profile, education profile, occupation profile, economic profile, cultivated land profile, and social profile and health care service profile. The last profile can be divided into preventive and curability measures. The administration of these drafts among the people will give an accurate assessment of the socio-economic status. After the administration and re-administration the drafts needs to be send to the experts for the final analysis. Addressing the Validity of methods at large and among Indian Population The scales of assessing socio-economic status in every community are prone to change due to the dynamism of human existence. Most of the existing scales seem to have lost this ability to discern correct indices are still in use. The indication here is measuring the socio economic status according to the health and health care issues of an individual or a family. The main short coming seems to be the perception of goodness and satisfaction people have about the health and health satisfaction is changed with time and the methods need to be upgraded accordingly. It is, therefore, necessary that necessary ingenuity is brought to bear to develop appropriate scale for the measurement of socio-economic status (Depleuch, F., A. Cornu, P. Massamba, P. Trissac and B. Marie. 2002) As far as India is concerned most important resource of the country is its 1027 million population (2001 census), distributed in 28 States, 7 Union Territories, 5564, tehsils/talukas, 640,000 villages and 5161 towns and cities (Ashish Bose. 2001). Oral health care of necessity has to be delivered through primary health care infrastructure, because of limited resources and manpower of dentists. More than 70% of the population is rural and just nearly 30% lives in urban areas of which more than half lives in slums. 'Tertiary level hospitals, district hospitals, nursing homes, private practitioners and non governmental organizations provide health services. Besides these, municipal corporations also provide services; however, these services are poorly organized. Urban ICDS projects provide services on geographical basis. Health policy 2002 envisages strengthening of urban health services. RCH urban projects have been launched to increase the coverage of health services for vulnerable. Variable dental health services in urban areas are available-through public and private set up'. (Dr. Hari Parkash and Dr. Naseem Ahmed. 2001). There is an urgent need for an Oral Health Policy for the nation as an integral part of the National Health Policy. The Indian journal of community medicine 2004 has proposed an Oral Health Care Program, which envisages three pronged implementation strategies of; Oral Health Education, Preventive Program and Curative Service Program at various levels of primary, secondary and tertiary health care delivery services. Oral health has been recognized as an integral part of general health. What people do with their lives and those of their children affects their health, including oral health, far more than anything that governments do. But what they can do is determined by their income and knowledge based on their socio-economic status. Over the years evidence based "Information" on oral health has accumulated in the country but this is largely confined to dental clinics, hospitals and a few schools. The challenge is to put the available information into practice at every home/family and community. It is the information which can promote/improve the oral health of millions of young children, school children, adolescents and adults as also pregnant women and elderly people, provided it gets communicated. Therefore, the biggest challenge before us is to accept the challenge of communication of "facts for oral health" to all; in rural, urban and tribal and remote areas. 'Hygiene is embedded in Indian culture and it is the way of life. Let us promote indigenous time tested practices, of rinsing mouth with plain water after each meal, massaging gums and teeth and cleaning mouth with finger after each meal, promoting traditional diets, brushing of teeth, avoiding smoking, chewing pans and tobacco in various forms' (Bali RK, Mathur VB, Tewari A and Jayna P. 1994). Much will depend upon local efforts, as to how the teachers are trained and what responsibilities they take up on regular and sustained basis' Students follow what the teachers do and say and the teachers are considered as good role models to transmit values of life and ways of life in the school as also outside the school. Regularly one hour is devoted in each school for socially useful and productive work and that hour can be used for learning correct brushing technique and rinsing the oral cavity with safe water, as also washing of hands and cutting of nails. In our experience, whenever teachers brushed their teeth, students followed and it became a routine exercise of daily brushing of teeth in guided manner. Shaping ways of life and personality development of school children during elementary education is the key responsibility of school teachers and parents as also the community. Mid day meal program activities can be used as spring board to develop other behaviors such as washing of hands and rinsing of oral cavity after each meal, eating balanced diets, drinking clean water and eating clean food. School children can be used as ambassadors of health messages to their homes and neighborhood and can act as change agents. Child to child program in the school or out of school is yet another approach to build healthy life styles. Whatever chapters are contained in the school curriculum these need to be translated into visible actions through live demonstration. Students need to be demonstrated rinsing and mouth wash after meal, show them the content of mouth wash and let them react and participate in discussion and reach to conclusion (Gupta SC & Kapoor VK. 2002). Reference 1. Ashish Bose. 2001. Health for the millions, Population Scan, First results of census of India, 2. Bhatia. J & Cleland. J.1995. Determinant of Oral care in the region of South Asia. Health transition Review. 5:127-142 3. Bali RK, Mathur VB, Tewari A & Jayna P. 1994. National oral health policy for India formulated by Dental Council of India, 4. Depleuch, F., A. Cornu, P. Massamba, P. Trissac and B. Marie. 2002. Is body mass index sensitivity related to socio-economic status and to economic adjustment' A case study from Congo. Report of ORSTON-DGRST, Congo. Pp. 11-12 5. Goodburn EA, Gazi R, & Chowdhury M. 1995. Beliefs and practices regarding delivery and postpartum maternal morbidity in rural Bangladesh. Stud Fam Plann. 6. Gupta SC & Kapoor VK. 2002. 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European Global Oral Health Indicators Development Project Edited by: Bourgeois D and Llodra JC. Paris, Quintessence International. 24. Srivastava GP. 1978. Socio-economic Status Scale (Urban) Agra: National Psychological Corporation. 25. Whiteside, K. and Woolcock, M. 2004. Assessing Social Development Projects: Integrating the Science of Evaluation with the Art of Practice. Poverty Impact Analysis, Monitoring and Evaluation Thematic Group, World Bank, Washington DC Read More