The state of health in rural areas

Dhaka,  Wed,  23 August 2017
Published : 19 Jun 2017, 20:35:56 | Updated : 19 Jun 2017, 20:53:50

The state of health in rural areas

Non-communicable diseases are emerging as important sources of illness in rural areas while water-borne diseases like diarrhoea and dysentery are apparently on the decline, writes Abdul Bayes
Health or physical condition of a person essentially measures the quality of human life. The adage 'health is wealth' or Amartya Sen's seminal remark 'good health is an end in itself' possibly points to human development beyond the boundary of mere economic growth. The link between health and standard of living or long life is quite well-known: good health leads to increased productivity, wage and well-being.  It is thus no wonder that the Human Development Index (HDI), as used by the United Nations Development Programme (UNDP), puts health status at the helm of human development. 

In a broader perspective, health of population is viewed more as an essential force for promoting socio-economic progress in a society. On the flip side, poor health imposes direct burden on society/household not only by putting an extra pressure on healthcare cost but also creating a vicious circle of poverty.

Results of three rounds of surveys undertaken in 62 randomly-selected villages in 2014, 2008 and 2000 were used to examine the trends.  For evaluating health status, all the members of the sample households were taken into consideration thus drawing upon impressions of 12,380, 9,927 and 9,834 people in 2014, 2008 and 2000 respectively. The basis of morbidity statistics is individual perception collected for all members of the household.

The survey began with an enquiry into health condition in general. As can be observed, roughly half of male members of the sample households perceived themselves in relatively good health (healthy).  This compares with one-thirds feeling so in 2000. It thus seems that there has been an improvement between 2000 and 2014 as far as health condition is concerned.  

Among females, nearly 40 per cent of the respondents were perceived to be healthy compared to about 30 per cent in 2000. By and large, the proportion of people perceiving good health went up during the last one decade and a half for both sexes. Disconcertingly, however, females lagged behind males possibly for reasons like reproductive complicacies, unequal food distribution within households thus leading to less food and nutritional intake, less physical mobility, adverse working condition etc.

It becomes apparent that about half of male and two-thirds of female members of sample households were afflicted with sickness of various types and durations.  Three trends emanate from the findings. First, the overall situation regarding sickness has improved over time for both sexes; second, females lag behind males in all aspects of health problems and third, the proportion of frequently sick people remained almost constant. Finally, the most disturbing development is that the share of disabled members has gone up over time, especially of women members. For example, roughly 1 out of 10 was found disabled in 2014 compared to almost negligible proportion in 2000.

Morbidity is related to a state of being subjected to diseases of various types and durations. Field-level data reveal that almost one-fourths of the sample household members were morbid in 2014. The rate was almost the same across sex but marginally lower than that of 2000. The morbidity rate was as high as 36 per cent for children aged up to 4 years and 53 per cent for population aged 60 plus. This is not surprising given that both groups were susceptible to illness, and in general females were more morbid than males.  The higher health risk of women in the 15-59 age group needs an explanation. It coincides with the reproductive period which has remained still a hazardous part of women's life for a variety of conditions and reasons. For instance, incidence of early childbearing and pregnancy at older ages still persist in rural areas in a significant manner. Also, at the same time, the reproductive health care has remained wholly inadequate in rural areas as, reportedly, only one-thirds of the pregnant women receive some antenatal care, less than 2.0 per cent of the deliveries taking place in institutions and less than 7.0 per cent of births are attended to by trained doctors and nurses.

A list of diseases that rural people generally grapple with could be identified. Data has also been disaggregated by sex, age and time. Let us first look at the silver lining. First, between 2000 and 2014, incidence of diseases like diarrhea/cholera, dysentery, pneumonia, typhoid, malaria, pox, measles, stomach pain/gastric/ ulcer etc. were reduced drastically both for both males and females. Fever remained to be the predominant source of sickness affecting 35-45 per cent of rural household members indicating illness. Close on heels were cold and cough and pain in parts of body accounting for about one-fifths of the sufferers and that doubled between 2000 and 2014. By and large, the incidence of communicable diseases has been reduced over time. 

But the horizon of health in rural areas is cast with an emerging gloom called non-communicable diseases. Blood pressure, diabetes and heart disease have crept up over time. Also blindness/cataract and brain stroke have gone up. For example, only 3.0 per cent of males were affected by blood pressure, diabetes, heart disease and brain stroke in 2000 whereas about 8.0 per cent are affected by these diseases now. Likewise, only 5.0 per cent of women were suffering from these illnesses in 2000 but it now stands at 12 per cent. Now-a-days, 3-4 persons out of 100 suffer from diabetes in rural areas - a disease quite unknown in 2000. Blindness/cataract and sore eyes affect 3-4 per cent against hardly 1.0 per cent in 2000. Anemia affects more than 1.0 per cent although it marginally declined. 

The upshot is that non-communicable diseases are emerging as important sources of illness in rural areas while water-borne diseases like diarrhoea and dysentery are apparently on the decline owing to judicious steps taken by the government and non-governmental organisations (NGOs). Are we prepared to face the emerging diseases?

The writer is a former Professor of Economics at Jahangirnagar University.

Editor : A.H.M Moazzem Hossain
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