CM2.1-5 | Social and Behavioural Determinants of Health — Graded Quiz

Correct. The Modified Kuppuswamy scale scores education (0–7), occupation (1–10), and per-capita monthly income (1–12), giving a minimum of 3 and a maximum of 29.

Kuppuswamy total range: 3–29. Class cut-offs: ≥26 = Upper (I), 16–25 = Upper middle (II), 11–15 = Middle (III), 5–10 = Lower middle (IV), 3–4 = Lower (V).

Incorrect. The three domains score: education (0–7) + occupation (1–10) + income (1–12) = range 3–29. A total score of 26–29 = Class I (Upper), 16–25 = II, 11–15 = III, 5–10 = IV, 3–4 = V (Lower).

Correct. Only the income component requires annual CPI-IW-based updating to reflect current rupee values. Education and occupation classification systems remain stable over time.

A critical examination point: only the income cut-offs in the Kuppuswamy scale require annual CPI-IW updating. Using outdated rupee thresholds (e.g., from a 5-year-old textbook) causes systematic SES misclassification.

Incorrect. Education and occupation scores are stable. Only the per-capita monthly income thresholds are anchored to the 1982 CPI-IW base and must be recalculated annually.

Correct. The Andersen Behavioural Model (1968, updated 1995) categorises determinants of health service utilisation into predisposing factors (beliefs, socio-demographics), enabling factors (income, transport, access), and need factors (perceived and evaluated illness severity).

The Andersen model has three categories: (1) Predisposing — who you are and what you believe before illness; (2) Enabling — resources and access that make care possible; (3) Need — perceived severity of illness driving the decision to seek care.

Incorrect. The three categories are predisposing, enabling, and need. 'Reinforcing factors' are from Green's PRECEDE-PROCEED model. Individual/community/structural and economic/cultural/geographic are not the Andersen model's categorisation.

Correct. PM-JAY provides Rs 5 lakh per family per year for secondary and tertiary hospitalisation, targeting the bottom 40% of India's population. This replaced and subsumed RSBY (Rs 30,000 cover).

PM-JAY = Rs 5 lakh per family per year. RSBY (predecessor) = Rs 30,000 per family per year. ESIS benefits are wage-linked, not a fixed annual limit. These figures are standard for community medicine examinations.

Incorrect. PM-JAY (Ayushman Bharat) offers Rs 5 lakh per year per family. Rs 30,000 was the RSBY (its precursor) limit. Rs 1 lakh and Rs 10 lakh are not PM-JAY figures.

Correct. A reference group is a group whose norms and values an individual uses as a standard for self-evaluation and behaviour, even if they are not currently a member (aspirational reference group). The student is conforming to his aspirational reference group's descriptive norms despite family disapproval.

Reference groups can be membership groups (groups you belong to) or aspirational groups (groups you want to join). Social psychology in community health uses reference group theory to explain why health behaviours — including healthcare use, dietary habits, and preventive practices — often mirror peer group norms more than family norms.

Incorrect. A reference group is a group we compare ourselves to or aspire to join. The student is adopting his peers' descriptive norms (what peers typically do) even though his family (membership group) disapproves. This is aspirational reference group conformity.

Correct. The five-step clinico-social assessment framework proceeds: (1) identify chief complaint and clinical features → (2) take a comprehensive clinico-social history → (3) assess SES (Kuppuswamy/Pareek) → (4) assess environmental and housing conditions → (5) identify community-level factors. This integrates clinical and social data systematically.

The clinico-social assessment is not a linear demographic form — it is an integrated clinical-social interview. Starting with the chief complaint establishes clinical context before exploring socio-cultural and SES factors that influence the illness presentation and management options.

Incorrect. The standard five-step framework integrates clinical data first, then progressively expands to social, SES, environmental, and community-level factors. Starting with SES scoring (Option D) or demographics (Option C) skips the presenting complaint context.

Correct. The Tendulkar Committee (2009) methodology is the most widely cited official BPL definition for national schemes and is referenced in Park's. The Rangarajan Committee (2014) proposed a revision using higher thresholds, but the Tendulkar methodology remains the primary policy reference.

BPL definitions in India: Lakdawala (1993) → Tendulkar (2009) → Rangarajan (2014). For scheme eligibility and current Park's-cited definition, Tendulkar (2009) is the standard. Know that Rangarajan proposed higher cut-offs that would have enlarged the BPL population significantly.

Incorrect. The Lakdawala Committee (1993) was superseded by Tendulkar (2009). The Rangarajan Committee (2014) proposed higher poverty thresholds but has not been formally adopted for scheme eligibility. Park's primarily references Tendulkar for current BPL definitions.

Correct. The CSDH framework identifies (1) structural determinants — governance, macroeconomic policies, education systems, social norms that generate social hierarchies; and (2) intermediary determinants — the downstream living conditions (housing, income, occupational exposure, healthcare access) through which structural factors translate into differential health outcomes.

Structural determinants shape who is exposed to what conditions; intermediary determinants are the conditions themselves (material circumstances, psychosocial, behavioural, biological pathways). Understanding this hierarchy explains why interventions targeting only individual behaviour often fail without addressing structural conditions.

Incorrect. The CSDH framework uses structural (upstream social forces) and intermediary (downstream living conditions) as its two primary levels. Proximal/distal and modifiable/non-modifiable are useful clinical distinctions but not the CSDH's framework terminology.

Correct. MGNREGA guarantees 100 days of wage employment per rural household per year. This income supplement addresses enabling factors in the Andersen model — it increases household income, reduces financial barriers to healthcare access, and decreases catastrophic health expenditure risk.

Mapping social security schemes to Andersen model categories: MGNREGA → enabling (income); PM-JAY → enabling (insurance/economic access); ICDS → intermediary (nutrition, child development); health education campaigns → predisposing (beliefs, awareness). This cross-mapping is examinable.

Incorrect. MGNREGA is a wage employment scheme; it improves income and economic enabling factors for healthcare access. It does not directly change health beliefs (predisposing), perceived illness severity (need), or governance frameworks (structural).

Correct. The WHO standard threshold for catastrophic health expenditure is out-of-pocket spending exceeding 10% of total household consumption, or equivalently 25% of non-food (subsistence) expenditure. This threshold is the benchmark used in NFHS and national health account analyses.

Catastrophic health expenditure (CHE) definition: >10% of total household consumption OR >25% of non-food expenditure (WHO). India's National Sample Survey data show that hospitalisation is the leading cause of CHE. PM-JAY specifically targets reduction of CHE for BPL families. Know both thresholds for examinations.

Incorrect. The standard WHO/NSSO threshold for catastrophic health expenditure is 10% of total household consumption (or 25% of non-food subsistence expenditure). 5% and 20% of income are not the standard WHO thresholds; 30% of savings is not a recognised standard.