Seminar-Tiviean-Social Determinants of Health and Social Problems in Malaysia

Social Determinants of Health
1
and Social Problems in Malaysia.
By : Tiviean Appadurai
2 What is social determinants of health ?
 Social determinants of health are the non medical factors that influence health outcomes.
 They are the conditions in which people are born, grow, work, live and the wider set of
forces and systems shaping the conditions of daily life.
 Social gradient : the lower the socioeconomic position ,the worse the health
3 Social determinants of health.
 Education
=the ignorant and illiterate are likely to to have much difficulty in pursuing good health
 Social Class
=individual in upper social classes have longer life expectancy
 Rural and Urban

=they differ in lifestyle, opinions and values
 Physical Environment
=mortality and morbidity differs because of differences in physical environment such as
housing, safe water, access to clean water and etc
4
 Differences in Service Provided
=differences in services provided some areas are less developed as compared to others. Eg :
rural area, mountain areas
 Material Resources
=income ,wealth, and possessions help achieve better health .it can also intervene in the
occurrence of disease or in the maintenance of health status
 Genetic Endowment
(set of attributes transmitted by genes (inherited) which creates the predisposition for certain
behaviors and affect health status)
=people in same social class tends to marry in the same social class
=the differences in genetic endowment may cause certain disease
5
 Attitude to Disease
=there are people who diagnose illness themselves and there are others who seek early medical
aid
=some might think disease is punishment
=some might think it may be due to natural causes
6 Social problems
 In a community, there are both individual and 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.
 But all individual problems are not social problems. Poverty, crime and disease are the
common social problems.
7 Social problems
 Social problems as housing, divorce, population growth, increased number of old people
have public health implications calling for a combined sociological and public health
action.
 Social problems are solved by social and political action:
- Social welfare programs
- Social assistance
- Social legislation in the community
8 Prostitution
 Prostitution is an age-old social evil. It is a social problem in most urban areas, and to a lesser
extent in rural areas.
 Sociologists who have studied prostitution have mentioned the following underlying causes of
prostitution:
i. Changes in environment
ii. Breakdown of family relations
iii. Parenteral quarrels
iv. Want of affection
v. Illegitimate love
vi. Easy money
vii. Low moral standards
viii. Poverty, etc.
9 Prostitution
 In Malaysia:
• Section 372A. Persons living on or trading in prostitution – Whoever knowingly lives wholly
or in part on the earnings of the prostitution of another person shall be punished with
imprisonment for a term which may extend to fifteen years and with whipping, and shall also
be liable to fine.
 Shariah law –
• Section 25. An act preparatory to prostitute
• Section 26. An act preparatory to prostitute wife and child under his care
• Section 27. Prostituting wife or child
• Liable to a fine not exceeding five thousand ringgit or to imprisonment for a term not
exceeding three years or to whipping not exceeding six strokes or to any combination thereof
10 Delinquency
 Someone who shows deviation from normal behaviour. For example, he is one who has
committed an offence, e.g., theft, sexual offence, murder, burglary, etc.
 Delinquency is a social problem in many communities.
 Causes responsible for delinquency are:
i. Social maladjustment
ii. Poverty
iii. Disturbed home conditions
iv. Alcoholism
v. Drug addiction
11 Delinquency
 The programme for the prevention and control of juvenile delinquency centre round the
implementation of Juvenile Courts Act 1947, Act 90 in Malaysia.
 Provides a specialized approach towards the care, protection, maintenance, training and
rehabilitation of delinquent children.
 The institutional infrastructure consists of Juvenile/Children's Courts, child welfare boards,

remand homes, certified schools, children homes and after-care facilities.
12 Drug Addiction
 Drug addiction is defined as a state of periodic or chronic intoxication detrimental to the
individual and society produced by the repeated intake of habit-forming drugs.
 "Drug culture" is fast making inroads into the lives of young people from all walks of life.
The reasons given for drug dependence include the following:
i. Curiosity and natural tendency to experiment with drugs
ii. Disturbed home environment : children from broken homes, indifferent parents, lack of
communication between parents and children.
iii. An escape phenomenon from tensions and frustrations in life, e.g., unemployment, failure
in examinations.
iv. Impact of disco culture, mobile, TV, internet etc.
v. Ignorance regarding the habit-forming nature of the drugs.
13 Drug Addiction
 To call a person a drug addict, the following criteria must be satisfied :
1) Psychological dependance : there is an overpowering desire (compulsion) to take the drug

and obtain it by any means.
2) Physical dependance : when the drug is withdrawn, the patient shows "withdrawal
symptoms" such as irrational and violent behaviour, nausea, diarrhoea, watering of eyes
and nose, etc.
3) Development of tolerance : there is a tendency to increase the dose.

14 Drug Addiction
 Management if drug addiction :
i. Identification of drug addicts and their motivation for drug detoxification
ii. Detoxification (requires hospitalization)
iii. Post-detoxification counselling and follow-up
iv. Rehabilitation and psychotheraphy
 With medical treatment, changes in environment (home, school, college, social circle) are
important. The patient must effect a complete break with his group, otherwise the chances
of relapse are 100%
 Preventive measures include education of target groups and the general public through TV,
radio, leaflets, and posters to create awareness of the problem
15 Alcohol Abuse
 Alcoholism is world-wide social and medical problem.
 Over the past 30 to 40 years, alcohol consumption has increased in quantity and frequency.
 The population groups at great risk are those undergoing rapid socioeconomic and cultural
changes; they view alcohol as a symbol of prestige and social status.
 Drinking by adults serves as a role model for the young.
 As drinking patterns vary considerably, the prevention of alcoholism is not easy.

Widespread public education and discussion, and investigation of public attitudes may
improve.
16 Alcohol Abuse
 The consequences of alcohol abuse:
i. Crime
ii. Murder
iii. Prostitution
iv. Neglection of families
v. Malnutrition
vi. Disease (e.g., cirrhosis of liver, alcohol-dependant syndrome, alcoholic psychosis)
vii. Unemployment
viii. Indebtedness
ix. Child delinquency
x. Road accidents
17 Handicapped
 Categories of handicap
(i) The blind
(ii) The hearing disability
(iii) The orthopedically handicapped
(iv) Multiple disabilities
(v) The mentally retarded
(vi) The mental illness
(vii)The speech disability
(viii) Others
18 Handicapped
Source : Social Welfare Department, Malaysia
19 Handicapped
 Types of Rehabilitation Therapy and Services available for the handicapped:
-Cognitive Rehabilitation
-Pharmaco-rehabilitation
-Physical Therapy
-Recreational Therapy
-Speech and Language Therapy
-Occupational Therapy (job placement and sheltered workshops)
-Vocational Rehabilitation
-Pensions, scholarships and allowances for the education and training of the handicapped
20 References
 Park, K. (2019). Health Planning & Management. In Park's Textbook of Preventive and
Social Medicine (25th ed).
 https://
www.researchgate.net/figure/This-graph-shows-the-number-of-registered-persons-with-dis
abilities-in-Malaysia-from_fig2_341778084
 https://
www.tenethealth.com/healthy-living/corporate-content/7-types-of-rehabilitation-therapy
21

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Social Determinants of Health

 Rural and Urban

 In a community, there are both individual and social problems.

 The institutional infrastructure consists of Juvenile/Children's Courts, child welfare boards,

1) Psychological dependance : there is an overpowering desire (compulsion) to take the drug

3) Development of tolerance : there is a tendency to increase the dose.

 Drinking by adults serves as a role model for the young.

 As drinking patterns vary considerably, the prevention of alcoholism is not easy.

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