The Impact of Poverty on Healthcare Access

Discuss about the Global Health and Sustainibility for Rohingya Crisis.

Poverty has a major impact on the social determinants of health of people around the world. There is a vicious relationship between poverty and chances of acquiring disease as the increase in one can directly affect the rate of the other. It has observed through different literatures and reteach proposals that indicated towards the linkage of poverty with that of emergence of infectious and deadly diseases that affected the morbidity and mortality related rates of the population.  This note will focus on poverty affecting social determinants of health in developing countries such as Bangladesh and the way the communities, having less or no resources struggle to achieve their right to quality healthcare.

Social determinants of health are made up of surrounding environment in which people are born, grow, work, learn, play and ages. These determinants are responsible for several aspects in life such as health, functionality, quality of lifestyle and are associated with several risks too (Penman-Aguilar et al. 2013). These social determinants dominate the physical, emotional, economic wellbeing of individual in each social setting and hence, determine the overall wellbeing of the people around. Poverty is alone the biggest social determinant of health and is the biggest hurdle for the social and economic development of countries (Castañeda et al. 2015). Poverty can be of different types such as financial poverty, health literacy related poverty, informational poverty that affect the health of people, as they are unable to access the healthcare facility around them, or to good food and drinking water that deteriorate their health status (Marmot et al. 2012). Financial poverty prevails in this case as they are unable to purchase or afford medicines or physicians that can help them improve their health condition. However, lack of social support voice for their rights, lack of information and policies also affect the healthcare needs of poor people (Benach et al. 2014). The rate of poverty is increasing in developing countries and according to the reports of World Health Organization (2018), the average poverty rate in developing countries are 65%, with 80% in Bangladesh and 70% in sub-Saharan countries. Further the data from International Monetary Fund also determined that people suffering from poverty in these countries are mostly deprived to quality healthcare. Therefore, in this assignment, the topic of “Access to healthcare in developing countries” was chosen under the theme of ‘Poverty and access to healthcare’ and Bangladesh was chosen as the country for the assessments involved in this assignment. 

The Relationship Between Poverty and Infectious Diseases

The World Health Organization, active in Bangladesh determined that the organization is still working on the equal distribution of opportunity to achieve quality healthcare in the country. The engagement is determined to help in building and formulating different health-sector interventions using different methodical studies that look into several factors that enhance the health inequities related opportunities, keeping the non-economic factors such as cultural, religious, and environmental aspects out of the health service (Marmot and Bell 2012). While discussing the level of poverty in Bangladesh, the data of The World Bank should be mentioned. In the latest research conducted by the World Bank (2018), it was mentioned that the poverty rate in Bangladesh is around 25%, whereas the extreme poor people are in 13%. The rural poverty is around 36% and the United Nation has set a target to eradicate the poverty from this country by 2030. The rate of poverty also indicated to lack of healthcare as The Asian Development Bank (2018) provided the fact that in 1000, 31 babies’ dies before their first birthday. Health inequities include the health related disadvantages that create gaps in access to health care; disturbing the poor populations, the mainly Social shield in health covers less than 2% of the country’s inhabitants (WHO 2018). Health safety have an insignificant coverage and have had little impact so far. A collection of social and cultural conditions impact upon health-care-seeking behavior in Bangladesh. There remains a strong predilection to consult quack doctors in the neighboring region, and to take on the traditional birth attendants in the home, for childbirth. Such affinities give rise to risks relating to treatment outcomes and the childbirth process. Consequently, maternal and neonatal mortality continues to remain distressingly high in Bangladesh. There is a need to systematically examine the social, cultural and economic factors that imposed on the health intervention outcomes, and influence inequities in access to affordable medicines and health care. Besides that due to Rohingya crisis, more than 671,500 Rohingyas have arrived in Bangladesh to save their life as refugees (Chowdhury et al. 2013). However, in Bangladesh, they are also facing health related crisis. They are suffering from issues related to food, water, quality healthcare and the risk of mass life loss is higher as they are in contact of several infections, especially with diarrhea and typhoid fever which is a waterborne human fecal contamination related infection affecting mostly children in the refugee community. Therefore, in this assignment, poverty and access to healthcare will be witnessed through the discussion of rohingyas, and common Bangladeshi citizens who are under the poverty line and struggling to get their healthcare related human rights (Chowdhury et al. 2013). 

Challenges Faced by Rohingya Refugees in Accessing Quality Healthcare

According to Marmot and Bell (2012), poverty and healthcare are inextricably linked to each other. It should be mentioned that the roots of poverty lies within the political, social and economic injustices that causes millions of people around the world suffer from such issues. The roots are so deep that it will take hundreds of years to make everything in favor of these million individuals and hence, it is so hard to undertake the root causes of poor health as well as the symptoms. Poverty do not make people unhealthy but it creates circumstances, within which, the chances of being severely ill becomes very high. These are:

1. Poor nutrition – Poverty is the primary reason for malnutrition and food insecurity as the people living below the poverty line are unable to access the healthy and nutritious food for themselves and their children. Hence, due to lack of good food, they become prone to severe healthcare issues, infections and mortality rate increases (Walraven 2013). This is the way poverty affects the access to nutritious food for poor people. As per UNICEF this is the primary reason for the lower birth weights (22%) and malnutrition n the children living in the Rohingya refugee campaign.
2. Overcrowding- As per the reports published by WHO, overcrowding in Bangladesh possess a major problem in health as it paved the way to several water-vector and food borne communicable diseases. Overcrowding is attributing to the outbreak of endemic diseases such as malaria and dengue fever in Bangladesh (Walraven 2013).  Overcrowding of the refugees squatting on the roadside make them exposed to the elements of the diseases and increases the chance of disease transmission via droplets.
3. Lack of clean drinking water- Lack of safe drinking water and poverty are equally reinforcing. Access to reliable sources of fresh water is vital to poverty diminution (Walraven 2013). Currently, 748 million people around the world live without the right to use safe water and 2.5 billion live without adequate sanitation. Without the access to fresh clean water, people drink water which can harm their health by making them prone to several water borne diseases such as diarrhea, tuberculosis, typhoid and so on that can spread from one community to other making everyone in the community sick and thereby affects the mortality rate. UNICEF also indicated it as one of the key reasons for the emergence of diarrhea and typhoid as 80.2% of the cases of typhoid and diarrhea is due to the lack of improved potable drinking water in the camp.

1. Social structure- Social classes and poverty are the two key elements to understand the diseases and the health inequalities. Social exclusion, high levels of unemployment and the challenges to access the labor market are the determinants of the poverty and health. The clear social stratification diminish the chances of health equalities (Interactions.eldis.org, 2018) an equilibrium in health care can be reduced by the reducing the poverty in health care.

1. Reduced work productivity- poor health is related to low socio-economic status and low socioeconomic status is again linked to reduced work force of fruitful productivity. The increasing population with the integration of the immigrants is outstripping the career opportunities or the workforce is not competent enough for increasing the productivity. Reduced job prospects cater to poverty and eventually the health.
2. Economic and political structure – Reflecting on the political and the economic context, Bangladesh is deeply embedded in poverty and hunger, growing social and the economic disparities. Frequent cases of civil unrest are found to be due to the political turmoil (Interactions.eldis.org, 2018). The association between the state and the civil society is strongly affected by the turbulent political history of the country. As per the labor force survey, 89 % of the job in the labor market falls within the category.
3. Climate change and infectious disease – Climate change and the chance of infectious diseases are interrelated. According to World health organization report (WHO), there had been an apparent increase in the infectious diseases such as diarrhea, typhoid fever, malaria and so on (Searo.who.int, 2018). This reflects the conjoint effect of the fast demographic, environmental, technological and the social changes in our ways of living. Climatic factors such as deforestation, urbanization, reforestation, agricultural intensification, elevated precipitation and many such changes can be linked to the occurrence of diseases like malaria, river blindness, dengue, cholera, rift valley fever, Venezuelan hemorrhagic fever and many more.

Resources: In case of Rohingyas, poverty takes the shape of sheer economic and psychological loss including the loss of their identity rooted in home and poverty. The children are perhaps most affected section of these people and it disintegrates their childhood and associated necessities. Amount of people fleeing Burma has accentuated the crisis and Bangladesh government has failed to provide adequate response to the crisis. The lack of resources is a product of this ever-increasing number of Rohingyas, who suffer from inadequate access to sanitation, food and standard living qualities. As per data, the rampant malnutrition level has expanded amongst the people has made 95% of its population their victim, who as a result has to drink contaminated water (Wolf 2017).. Lack of resources to keep the group nourished has claimed many children, which has also fetched the attention of UNICEF and Action Against Hunger. Health clinics have reported average weight of men to be around 32-34 kg and has treated more than 2,750 sheer malnourished children. The lack of nutrition providing agencies has perpetuated the death of children (Wolf 2017).  Lack of collaborations amongst the developed states in this juncture is apparent since more than 80,000 children have succumbed to malnutrition and around 225,000 people are in sheer need of immediate humanitarian assistance. If the situation of inadequate resources persists, more than 80,500 children will have to consult treatment or will be dying in a profuse manner. Resources form one of the major key considerations with Rohingyas since a portion of its population has been wiped out due to lack of attention from other countries. These people belonging from the ethnic minority section of Myanmar has become the “most friendless people in the world” as reported by an UN spokeswoman. More than 620,000 refugees cannot be tackled by Bangladesh alone and it needs immediate attention from neighbouring countries to battle the surmounting amount of deprivation that these people are now a part of (Hasan 2017).

Infrastructure: Rohingyas living cramped up in refugees camps, in close contamination with faeces and sewage are perhaps the worst survivors of this exodus. The women and children are consequently at the risk of severe exploitation and abuse. The lack of infrastructure in supporting these people is apparent in overflowing latrines, contaminated water and people falling frequent victim of traffickers. They do not have the luxury to afford safe water and emergency food and as a result are falling prey to diseases like cholera and diarrhoea. Nobody has assured these people any long-term plan to support their sustenance and prevent their proximity to life-threatening diseases (Beyrer and Kamarulzaman 2017).  To confront with this challenge the Bangladesh authority need to plan long-term to support the community in the deprived area. Inaccessibility to their basic life-supporting resources has made them the most discriminated community. Sexually transmitted diseases are also prevalent due to systematic rape, massacres and more inhumane physical abuse. Outbreak of diseases are naturally common and especially so in the Balukhali refugee areas where people have to live in swampy areas, resulting in bacterial infection, diphtheria and cholera. Inadequate presence of makeshift healthcare clinics has done extremely little to prevent the outbreaks as a result a majority of the population suffer from damaged heart and nervous system (Beyrer and Kamarulzaman 2017). 

The rate of diseases has also increased due to lack for vaccination, which could have avoided some of these diseases (Kennedy and McCoy 2017). It is because that the community is living in low vaccination condition, increase in number of measles, rubella and diphtheria have not been successfully avoided. Media, worldwide has reported on the appalling healthcare practices within these camps as well as lack of organizations to monitor the health of these people (Searo.who.int, 2018). However, very little has been able to achieve so far and their condition has worsened over the course of past one year. Discrimination in receiving medical attention and severe restrictions imposed on them while travelling to healthcare facilities have further aggravated the scenario.

Some of the potential ways by which the government can battle these key areas of concerns are by providing vaccinations and antibiotics to keep in check the life-threatening and transmittable diseases prevalent in the zone (Lim 2017). Healthcare check-ups have not been established which would be responsible to check into the families, make them aware of the diseases as well as control measures, provide them with financial and food security (Pocock and Mahmood 2018). Therefore, diseases have not been stopped from spreading within the camps dispersed over large areas. The community continues to suffer from poverty and health related problems due to lack of treatment, resources and government infrastructure. 

As discussed in the summary there are few key factors that are related to health and illness among the Bangladeshi population. The aspects discussed were poor nutrition, overcrowding, lack of drinking water, poor social structure, reduced work productivity, war and conflicts, economic and the political structure and climatic change and the infectious diseases (Sverdlik 2011).

A preliminary data obtained from a nutritional assessment done at the kutupalong refugee camp showed the prevalence of 7.5 of the life threatening condition due to malnutrition. As reported by UNICEFF a rate double to that has been seen among the Rohingya children. It has been found that the risk of malnutrition has exceeded the emergence thresholds (UNICEF, 2018) Milton et al. (2017) have stated that the situation has been aggravated by the long distance travelling across the borders. Overcrowding at the refugee camps in Bangladesh are posing health threats to the Rohingya Muslims mainly due to the lack of proper access to clean water. It has been reported that due to the lack of economic support the rohingya communities are lacking the basic amenities of life such as access to basic foods or clean drinking water. The refugee Rohingyas are living in tent like structures near the border of Myanmar. As reported, the drinking water wells are in close proximity to the toilets that is catering to intestinal infections. Children are playing in the playground heaped with rotten foods and feces (Milton et al.2017).

The extreme poverty stricken Rohingya people cannot access to basic health care benefits and thus are being susceptible to infectious diseases. The extreme poverty of the Rohingya people are compelling them to stay in overcrowded houses with extreme poor sanitation.

The government of Bangladesh is worried over the huge influx of the Rohingya refugees in Bangladesh as it is having financial implications on the government. The spread of infections among the Rohingyas are also affecting the native inhabitants due to the transmission of the communicable diseases. WHO has reported this condition as the level 3 emergency on the basis of the public health analysis. There had been an overburdening of the government health care facilities. The appalling condition of the finance of Bangladesh government is finding it difficult to respond to the growing population of the Rohingyas (Searo.who.int, 2018).

Conclusion

In conclusion it can be said that socioeconomic status is one of the basic determinants of health and they are intractable linked.  It is due to the extreme poverty of these community that they had to flee form Myanmar and seek shelter in Bangladesh Coxbazar. The arrival of these immigrants have had several environmental, social, economic and health care implications. As reported by UNICEF, (2018) it is affecting the current employment status, depression in the daily wages, hike in cost, increase of the non-communicable diseases. It can be said that the causes of the poor health are mainly rooted in the social and the economic injustices. Poor and vulnerable people are more likely to make harsh choices related to their health.

The ongoing challenges faced by the health care sectors of Bangladesh related to the poverty stricken Rohingya population are the severe acute malnutrition, inequitable access to the services due to new arrivals, the risks of the communicable diseases due to overcrowding, inadequate water supply, low health care facilities and low coverage of the vaccination (El Arifeen 2013). Some of the recommendations related to this critical; condition involves the demand of a proper obstetric services, geriatric services, and stringent control measures to look after the maternal and the infant health. Technological advancements can be done in order to reduce the poverty, such as the new food processing technologies, technologies for rapid screening of diseases and technological advancements in their field of health care. Technological advancements such as the provision of bio-toilets, use of proper technologies in creating out proper space for their settlement (Searo.who.int, 2018). Partnership can be set up with the government and the other NGOs to mitigate the sufferings of the people. Health sectors have to remain alert about any kind of epidemiological update to prevent the outbreak of any kind of pandemic (El Arifeen 2013). Proper toilet facilities and the disposal of the wastes generated by the Rohingya population should be made which involves the introduction of proper waste management procedures. Monsoon preparedness is another crucial factor while proposing recommendations. WHO has to collaborate with the stakeholders for developing practical guides for supporting the response activities at the time of an emergency. Planned hands on training is required for the rapid diagnosis of the diseases using the diagnostic techniques. Risk communication training is also required to be provided to the community health workers. While responding about the operational organizations in Bangladesh it is required to put a strong coordination of the response efforts with the partner’s in Bangladesh. It is to be ensured that the Rohingya community’s voices are included in a programmatic level. Focus should be given to convert the transition programming .The donors funding the crisis in Bangladesh has to commit to long term, multi -year funding in Cox bazar. Investment should be done in the local infrastructure and the development.  In addition to this, it is also necessary to address the health care sector funding and the coordination of the health sector. Although the government cannot do anything regarding the employment of the government due to the underlying international security and the political reasons, the health care issues can be taken care off. 

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