“Health is an essential requirement and a common objective for everyone. The advancement of society, irrespective of its economic standing, can be evaluated based on the health status of its population, equitable distribution of healthcare across various social groups, and extent of safeguarding against adverse health outcomes. It is imperative to prioritize equal accessibility to healthcare in order to uphold this principle.”
Promoting health equity globally and within countries requires addressing the deeper social structures and conditions that shape individuals’ lives, rather than just focusing on immediate disease factors. This encompasses considering the social hierarchy and the circumstances of people’s upbringing, living situations, work environments, and aging process. Taking action to improve health is not only economically beneficial but also a matter of fairness. Professor Sir Michael Marmot emphasizes the significance of ensuring good health for all.
Despite the ideal scenario of universal good health or access to health-improving facilities worldwide, the growing global burden of diseases reveals the current state is far from perfect. South Asia, home to a quarter of the world’s population, serves as an example of this somber truth. According to the World Health Organization (WHO), health encompasses physical, mental, and emotional well-being.
Good health is more than just being disease-free and depends on a favorable environment and stable mental state. Medicine, as a social institution, has the responsibility of diagnosing, treating, and preventing illnesses. To fulfill this duty, Medicine incorporates various scientific fields such as life sciences, earth sciences, chemistry, physics, and engineering. Although science is commonly seen as the main factor in determining sickness, the sociological perspective emphasizes that social, cultural, and environmental factors also contribute to diseases. Sociology acknowledges that the well-being of its population and proper management of illness are crucial for any society.
Both communicable and non-communicable diseases are common in South Asian countries. Communicable diseases, such as respiratory infections (Tuberculosis), HIV/AIDS, infections at birth, diarrhoeal disease, malaria, and typhoid, are the leading causes of death among the population. Alongside these ongoing issues with communicable diseases, South Asians also face non-communicable diseases including heart attacks, strokes, and hypertensive heart diseases.
In terms of health conditions, urban regions have higher rates of overweight, central obesity, diabetes, high blood pressure, and other related conditions compared to rural areas. However, both urban and rural populations in South Asia show similar trends when it comes to these diseases. The occurrence of Communicable and Non-Communicable diseases in the region is influenced by social structures, cultural norms, and environmental conditions that are specific to each country. Poverty is one social factor that plays a role in the prevalence of these diseases.
Approximately half of the South Asian population resides in poverty, resulting in limited access to healthcare. This issue is particularly prevalent in rural regions, where individuals face higher susceptibility to diseases as a result of inadequate preventive and curative health facilities. Moreover, impoverished households encounter difficulties in relocating from unhealthy environments, securing adequate nourishment, and reaching accessible services. Furthermore, these marginalized communities often lack the necessary political power to advocate for improved services.
One of the main contributors to mortality in underdeveloped regions of South Asia is tuberculosis (TB), which is an infectious disease. Poverty and TB create a harmful cycle. Individuals from impoverished communities are twice as prone to contracting TB and are three times less likely to receive proper TB treatment or access care. Moreover, they are four times less likely to successfully complete TB treatment and face a five-fold increase in the likelihood of experiencing impoverishing expenses related to TB care. To cope with the disease, people may engage in actions such as reducing food consumption, selling assets, borrowing money, withdrawing their children from school, separating from their families, or delaying seeking medical attention.
The issue being discussed has multiple repercussions, including loss of income, social exclusion, and homelessness. Furthermore, there are several factors that significantly contribute to this problem such as inadequate housing conditions, overcrowding, lack of proper nutrition, and engaging in risky behaviors. Among women who can have children, tuberculosis is the leading cause of death. Particularly in South Asia, ‘food poverty’ is a major factor contributing to malnutrition and declining health. It is worth noting that China and India together have a population exceeding 350 million people who do not have access to essential nutritional needs. The World Health Organization (WHO) states that malnutrition greatly increases the likelihood of infection, infectious diseases, and child mortality.
Prostitution in South Asia takes various forms such as ‘red light areas’ and brothel-based prostitution. It is prevalent in big cities, medium-sized towns, transit business points along major commerce routes, close to major industrial centers, highways, and near military or paramilitary establishments at the borders. When examining HIV/AIDS, it is essential to take into account the social dimensions of health because this disease is firmly embedded within social structures and institutions.
Some of the largest red light areas in the region are Sonagachhi in Kolkata, GB Road in Delhi, Kamathipura in Mumbai, Budhwar Peth in Pune, Heera Mandi in Lahore, Patuakhali in Barisal, Jessore, and Khulna3. Many women choose to enter this profession due to limited economic opportunities for them. It is often the highest-paying job available to women in Southeast Asia. However, the financial benefits of sex work are overshadowed by the health risks associated with it. Sex workers are at high risk of contracting HIV – the virus that leads to AIDS.
Over 50% of sex workers in Bombay are HIV-positive. The concept of designating specific areas for sex tourism in Asia has existed for a long time, including China’s pre-Communist era brothel trains called “comfort waggons.” This practice continues today, with certain countries such as Thailand legalizing prostitution for economic benefits. However, women engaged in prostitution in these South Asian countries face a high risk of contracting HIV, contributing to the increasing rates of HIV/AIDS. Migration is widespread in South Asia due to factors like rural-urban migration caused by poverty, natural disasters like those experienced in Bangladesh, Pakistan, and West Bengal, and conflicts such as Nepal’s Maoist Rebel issue.
The poor living conditions in slums and squatter colonies where migrants live increase their risk of contracting water-borne and air-borne illnesses such as typhoid and diarrhea. The group most impacted by Rural-Urban Migration in South Asia is street children, according to UNICEF. With a staggering 25 million street children in Asia, this issue is widespread throughout the region due to the influx of migrants from rural areas and neighboring countries into cities. In Bangladesh alone, there are over 600,000 street children, with 75% of them residing in Dhaka.
In addition, Pakistan has approximately 42,500 street children, Nepal has over 5,000 street children, and India has over 11 million street children. Kolkata alone accommodates at least 100,000 of these children. These children depart from their families in pursuit of job prospects to sustain themselves and ultimately find themselves on the streets or railway platforms. Unfortunately, they not only encounter mental health difficulties as a result of escaping domestic violence or familial issues but also suffer from deteriorating physical well-being while residing in urban locations.
The street children lack necessary resources and suffer from physical, emotional, and sexual abuse as well as exploitation. These acts are perpetrated by different individuals including police officers, hawkers, vendors, and other adults who exploit these vulnerable children for prostitution and trafficking. Many children in this circumstance engage in early and unsafe sexual activities, which heightens their susceptibility to HIV/AIDS and substance abuse. Furthermore, the rise of urbanization and income disparities in South Asia has resulted in the emergence of non-communicable diseases in this area.
Urbanization has a strong connection to negative health effects, which are primarily caused by increased work hours leading to high stress levels and easy access to abundant food contributing to issues like obesity. Additionally, urbanization also exacerbates the income gap, favoring the wealthy and worsening poverty for those who are less fortunate. These economic impacts raise concerns about the well-being of rural populations.
The lack of healthcare access for the impoverished, coupled with their declining social and economic conditions, increases their vulnerability to diseases. Additionally, gender discrimination greatly influences health outcomes by creating disparities in food and medical care accessibility, favoring boys over girls in terms of nurturing and care, impeding girls’ education, exposing women to workplace sexual abuse, and subjecting them to other forms of sexual harassment that negatively affect their health.
Gender discrimination is evident in the lower enrolment rates of girls in Primary schools, with only 83% of girls being enrolled compared to 90% of boys11 in South Asia. Although the gap decreases at secondary and tertiary levels, a significant number of girls still discontinue their education after primary school. This is concerning because a sound education is crucial for good health, and the insufficient enrolment and high dropout rates at the primary level result in an overall inadequate education for females.
This leads to a higher vulnerability to health hazards, especially for women in South Asia, particularly India and Bangladesh. In these regions, women face an increased risk of various forms of violence throughout their lives, such as domestic abuse, forced pregnancies, and sexual assault during times of conflict. These acts have a significant impact on the mental and physical well-being of women. Furthermore, societies tend to stigmatize and shame women more severely than men when they contract a disease, which discourages them from seeking necessary medical assistance.
Additionally, this trend is particularly noticeable in cases of tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS).
Rates of tuberculosis (TB) are generally elevated in South-East Asia, particularly among females who experience higher mortality rates compared to other regions. The stigma associated with TB, especially for women, creates barriers to successful treatment.
Education plays a pivotal role in shaping health outcomes for individuals and communities alike. It helps alleviate poverty by offering employment prospects and equipping individuals with skills for improved well-being. Additionally, education empowers women to make informed decisions regarding their health and nutrition practices, while also increasing the pool of healthcare providers and community educators.
The World Bank recommends the implementation of participatory health education for schoolchildren in impoverished communities as an effective strategy to promote healthier lifestyles and prevent noncommunicable diseases. The table below shows data on adult literacy rates and combined gross enrollment rates in various South Asian countries:
| Country | Adult Literacy Rate | Combined Gross Enrollment Rate |
|---|---|---|
| India | 61% | 60% |
| Bangladesh | 41% | 53% |
| < |
