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Abstract
Objectives In recent years, Bangladesh has made remarkable advances in health outcomes; however, the benefits of these gains are unequally shared among citizens and population groups. Dalits (jaat sweepers), a marginalised traditional working community, have relatively poor access to healthcare services. This study sought to explore the sociopolitical and cultural factors associated with health inequalities among Dalits in an urban setting.
Design An exploratory qualitative study design was adopted. Fourteen in-depth interviews, five focus group discussions and seven key informant interviews were conducted. The acquired data were analysed using an iterative approach which incorporated deductive and inductive methods in identifying codes and themes.
Settings This study was conducted in two sweeper communities in Dhaka city.
Participants Participants were Dalit men and women (in-depth interviews, mean age±SD 30±10; and focus group discussions), and the community leaders and non-governmental organisation workers (key informant interviews).
Results The health status of members of these Dalit groups is determined by an array of social, economic and political factors. Dalits (untouchables) are typically considered to fall outside the caste-based social structure and existing vulnerabilities are embedded and reinforced by this identity. Dalits’ experience of precarious access to healthcare or poor healthcare is an important manifestation of these inequalities and has implications for the economic and social life of Dalit populations living together in geographically constrained spaces.
Conclusions The provision of clinical healthcare services alone is insufficient to mitigate the negative effects of discriminations and to improve the health status of Dalits. A better understanding of the precise influences of sociocultural determinants of health inequalities is needed, together with the identification of the strategies and programmes needed to address these determinants with the aim of developing more inclusive health service delivery systems.
- caste
- Dalit
- qualitative method
- sociocultural determinants
- health inequalities
- untouchability
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Footnotes
Patient consent for publication Not required.
Contributors AK, AA and BC conceptualised the study. AK, MRLM and NF performed the analysis. AK developed interview guidelines, interviewed participants, and transcribed and translated interviews. AK, AA, NF and MRLM drafted the initial manuscript with substantial support from BC. All authors substantially contributed to critically revising further version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Ethics approval Ethics review committee at Dhaka University, Bangladesh.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement As we informed the participants during the consent process that data would only be shared within the research team, then the data cannot be made available publicly. However, we shared the interview and discussion guidelines under ‘additional supporting files.’ Interested parties may contact Mr Md Shahin Chowdhury (anthro.du@yahoo.com), Senior Administrative Assistant, Department of Anthropology, Dhaka University, for further inquiries in this regard.