Social Determinants of Health in Understanding the Socio-Economic Impacts of Covid-19 Pandemic in Bangladesh ()
1. Introduction
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the main cause of the Covid-19 virus all over the world [1]. Coronavirus has played a dangerous role in every nook and corner of our day-to-day life from accommodation to economic, political, and also religious views in Bangladesh. Bangladesh is an overpopulated country of almost 170 million people1. Covid-19 has badly affected people’s social, political, economic, and psychological health. Both the urban and rural populations have experienced the impact of the Covid-19 pandemic. Social determinants of health (SDOH) are important to understand the socio-economic impacts and implications of this pandemic in Bangladesh. The perspective of ‘Social Determinants of Health’ is adopted by epidemiologists and others who are engaged in the field of social medicine. There are different socio-economic factors such as income, wealth, and education as the fundamental causes of a wide range of health outcomes in a society that are considered as SDH [2]. Social determinants of health are income, education, social class, gender, race, environment, health status, etc. The non-medical elements that influence health outcomes are known as social determinants of health (SDH). They are the circumstances in which people are born, grow, work, live, and age, as well as the larger set of factors and institutions that influence daily life conditions. Economic systems and practices, development objectives, social norms, social policies, and democratic structures are examples of these forces and systems. The aim of this study is to understand the socio-economic conditions of Bangladesh during Covid-19 pandemic in the context of the social determinants of health in Bangladesh. In fact, there are several social and economic breakdowns have occurred during the pandemic and the study will focus exploring the causes of these breakdown on the basis of social determinants of health such as education, employment and access to healthcare etc. In this study, secondary data have been used to explore the socio-economic condition of the people of Bangladesh during Covid-19 pandemic. The secondary data were gathered from a variety of sources including books, articles, and websites including Google Scholar, JSTOR etc. The websites have been explored with the main keywords. This is mainly a review article where secondary data have been used and analyzed according to the theme such as educational breakdown, challenges in livelihood, challenges in the healthcare system etc. The non-medical elements that influence health outcomes are known as social determinants of health (SDH). The impact and implications of Covid-19 are prominent in people of all ages and all classes. In Bangladesh, the elderly population has been increasing over the past few decades. They have suffered a lot due to poor socio-economic conditions, and inadequate access to healthcare services is another reason for their suffering [3].
2. Literature Review
The impact and implications of Covid-19 remain everywhere in society. In Bangladesh, the social and economic impacts of this pandemic are extreme due to being a developing country. Using secondary data, a study assessed the impact of Covid-19 on the social and economic realms in Bangladesh at the very first stage of this outbreak. The study focuses on social impacts like social interaction, religious overviews about coronavirus, violence against women, etc. They have recommended that the Government should take necessary steps to increase productivity and should invest more in the health care and education sector [4]. Another study explored the challenges faced by Bangladesh in the healthcare, social and economic sectors due to the Covid-19 pandemic. A mixed-method approach had been used for this study. The study disclosed the inadequate facilities in the hospitals, economic breakdown due to lockdown, and as a result, the living standard slowed down among the people of Bangladesh. The study also pointed out that a large number of people who are physically disabled and people with low immunity are affected by the coronavirus [5]. The social and economic impacts of Covid-19 and the emerging challenges faced by the South-Asian countries have been focused on in several types of research. The study disclosed that migration and remittances are affected by the long-term lockdown and restrictions on mobility during this pandemic. The study also explained the cultural and psychological impact of coronavirus in South-Asian countries and suggested taking some short-term strategies which will ensure long-term benefits to combat the social and economic challenges [6]. Study used a cross-sectional online survey to conduct this study and the main objective was to describe the effect of Covid-19 on different realms of people’s life in Bangladesh. Regression analysis was conducted in this research to show the awareness level about Covid-19 and they found awareness level is only 25% although Covid-19 is very well-known to around 90% of the people in Bangladesh. The study claimed that the education system has seriously been broken due to the long shutdown [7]. Research using both quantitative and qualitative data. The aim of this study was to understand the impact of Covid-19 on the psychology and livelihood of people who are dependent on their daily income for their survival. The study found that 94.1% of respondents are affected by coronavirus [8]. A study has revealed the economic impacts of Covid-19 on the South-Asian countries (Bangladesh, India, Pakistan, Nepal, and Srilanka) and explored how Covid-19 affects the GDP growth of these countries and also suggested some policies that should be implemented by the governments of these countries in some important economic sectors such as agriculture, service, and manufacturing [9].
3. SDOH and the Socio-Economic Impacts and Implications of Covid-19 in Bangladesh
Social determinants of health are associated with the socio-economic impacts in Bangladesh including economic, healthcare, education, and livelihood impact. Income, social class, status, wealth, access to health care, and living environment are the most important social determinants of health that have direct effects on the social and economic sectors in Bangladesh during Covid-19 pandemic in Bangladesh. For example, people from lower and lower-middle-class families suffer from poor income during this pandemic. As a result, their living conditions, access to education, and healthcare have been hampered badly.
3.1. Healthcare Challenges Faced by Doctors and Patients
Access to healthcare services is considered the most important social determinant of health as, without it, people of all ages suffer a lot. For people who are not wealthy and have no access to healthcare, their hardship has become very acute during this pandemic. As Covid-19 is a transmitted virus, people of all ages have been affected by this virus. This is not only dangerous for the general people but also has created a big challenge among doctors and other healthcare staff. We can find that every country has faced challenges in providing healthcare facilities among the general population which also creates a big question about the safety of the doctors and other healthcare staff estimates that in Bangladesh there are 3.05 physicians per 10,000 population and 1.07 nurses per 10,000 population2. Another important fact is that, although around 70% of people live in villages, most physicians are available in urban areas in Bangladesh. During this pandemic, doctors have considered the front fighters as they have served the people all day long. Besides this, at the first stage of this pandemic, it was noticed that many doctors were unwilling to serve Covid-19 patients, the crisis started at that time. The doctors got scared to contact the patients as there was a greater chance to become infected from the transmission of this virus. The general people also felt helpless and become anxious as they are sometimes avoided by many hospitals and doctors as well. It also disrupts the relationship between the doctor and patient or the doctor-patient relationship in the healthcare system. There are some factors that affect much of the healthcare system during this pandemic including poor administration, increased rate of corruption, and fragmented public health communication [10]. Although doctors feel at high risk for themselves and their families and there is a lack of medical facilities in the hospitals, they are trying to serve the people as much as they can [11]. If we want to be precise about the effects of this virus on a patient, then we must say that it affects both the public and private self of a patient.
3.2. Challenges in Economic Sector
The Covid-19 pandemic has affected the economic sectors of the life of people in Bangladesh. During this pandemic, many people have lost their jobs, especially those who worked in the informal sectors. Bangladesh Institute of Development Studies has reported that during this pandemic 13% of people have lost their job and as a result, 16% of new people are now living under the poverty line3. Because they are not able to pay them. As a result, the total production system has decreased at an alarming rate that affects the whole economic body of the country. Moreover, 42.9% of people strongly agreed that there will be a reduced supply of basic products. For daily use and 50.8% of respondents strongly agreed that there will be increased prices for basic products [12]. As there is a reduction in supply of the daily products in the market, the price of the products has also increased in Bangladesh. It creates a great challenge for the middle class and the lower-class people in the country. Most of the farmers are not adapted to mechanized technology, which causes shortages in agricultural production and they face risk in terms of harvesting [13]. The village people in Bangladesh also face the same problem because they are not getting proper profit from agricultural products. People from urban areas are unable to produce due to the lockdowns and therefore, are impacted economically. Many families have broken down because of the Covid-19 pandemic and social classes are also transforming every day.
3.3. Educational Breakdown
Apart from the healthcare and economic sectors, Covid-19 has also exerted an influence on the educational sectors in Bangladesh. Students from primary to the graduate level are going through great trouble because of the discontinuation of the study. All the educational institutions have been closed since March 2020. Income and social class are the two determinants of health that are also related to the educational impact in Bangladesh. Lower and lower-middle-class families face discrimination in both the healthcare and education system. Students from lower-class families feel much mental pressure during the lockdown as they spend minimal time on social sites compared to higher-class students [14]. In July 2020 the government of Bangladesh and the education minister decided to start a program called “distance learning”. In this program, many students cannot take part, especially those who live in the rural and hill areas of Bangladesh due to electricity and network problems. Students living in rural areas (45%) reported not getting any direction from their schools about how to continue their education at home4. The primary level students are affected much during this pandemic, especially in rural areas. Their economic condition has created a barrier to accessing education through using electronic devices. It has been found that many students claimed that online education is not helpful due to poor lectures, shortages of class materials, and most importantly many students are not skilled enough to run electronic gadgets [15]. Students living in rural areas have also suffered from a lack of food and other services as their family has fallen down the poverty line due to the lockdown and shutdown. On the other hand, students from public and private universities have also gone through session delays and many of them become mentally ill due to depression and anxiety. A study has predicted that people from lower-income deciles cannot bear educational expenditures due to a fall in income in a widespread way in Bangladesh [16].
3.4. Challenges in Livelihood
The main prerequisite of protecting our body from coronavirus is keeping ourselves clean and leading a healthy life. Agriculture in the South-Asian region is labor-intensive, employing more than half of the workforce in each country. Agriculture-based rural industries and livelihoods are affected by COVID-19 and the subsequent quarantine because of its large labour intensity [17]. Many people cannot manage their daily necessities like food, and clothing and suffer from a lack of nutrition. These categories of people are not able to maintain healthy food and proper safety. Income is the social determinant of health that is the main causative factor behind poor livelihood during the covid-19 pandemic. During the Covid-19 pandemic, many people who worked in the informal sectors had to leave their workplaces. It has been reported that, because of the lockdown and shutdown, a large number of people have moved to their hometowns. We know that a large portion of the people living in rural areas is engaged in many informal jobs in urban areas such as Dhaka, Chittagong, Rajshahi. These people are becoming helpless when they are losing their jobs and as a result, they decide to leave their working place. 60.5% people strongly agreed that “most of the poor people living in urban areas have to leave the city due to not having any options for income [12]. They have faced extreme living challenges because of the transformation process during this worldwide pandemic. It is assumed that among these types of people a large number of people will not return to the city and not permanently engage with the agricultural sector in their village. It also indicates the economic breakdown of Bangladesh. It is inevitable that subsequently many people who belonged to the middle class are coming down to the lower class. That means the social status of the people is also changing as they have to change their living place and their occupation as well.
4. Conclusions
Bangladesh is experiencing several social and economic impacts of Covid-19 from its emergence. Coronavirus is a disease that mainly affects public health and, in this case, social determinants of health are the main factors to understand the impacts of coronavirus on a human’s socio-economic life. There are some social determinants of health by which we understand the health status of the people living in a country. Social determinants of health indicate peoples’ access to healthy and nutritional food and also the chances of getting medical services. Through social determinants of health, we can understand the impacts and implications of the Covid-19 pandemic in Bangladesh. The social determinants of health include income, education, accommodation, access to healthy and nutritional food, access to health care, environment, and language skill. Poor living conditions, lack of nutrition, lower access to health care services, a decrease in income, environmental pollution are responsible for the socio-economic hardship faced by the people of Bangladesh. Government should take some initiatives to improve people’s health and their socio-economic status in any further pandemic. We propose the following steps:
1) Government should ensure minimum wages and salaries for the informal or temporary workers so that they can maintain their living standard in case of any pandemic situation.
2) Living conditions should be improved for the lower and lower-middle-class people especially those who live in the slum areas. Because people who live in an unhealthy environment have a greater chance to be affected by coronavirus.
3) As this pandemic affects people’s income in both higher and lower class, the government should provide financial help to the students who belong to the lower-class family. All primary, secondary, and tertiary level students should be introduced to technical devices for online classes by arranging virtual workshops or seminars.
4) Free access to healthcare should be declared by the Ministry of Health for the poor and needy people during this pandemic. Authorities should provide incentives for doctors and other health professionals for the safety of their families.
Limitations and Future Directions
The authors have faced some problems for conducting this study. Among them lack of funding is one of the most important issues. The authors have conducted this study by their own, there was no support of funding in this research. Another one is the overall pandemic situation. Due to lockdown and shutdown, it was quite impossible for the authors to collect field data for better understanding of the topic. So, the study has been conducted by collecting secondary data from different journals, newspapers and other authorized sources. Although our review does not fill up the gaps that we mentioned above, collecting field data, quantitative and qualitative analysis and more review of the literature may contribute more for exploring the socio-economic condition in the context of social determinants of health in Bangladesh.
NOTES
1Census of Bangladesh, 2022.
2World Health Organization, 2012.
3“Covid-19 and The Economy: Where on The Path to Recovery Are We?” The Daily Star, November, 2020.
4BRAC (2020) A Rapid Assessment Impact of Covid-19 on Education in Bangladesh.