Poverty, Social Exclusion and Health: A Case-Study on the Koutruk Community of Manipur

Abstract

Social exclusion is the process through which individuals or groups are wholly or partially excluded from the society in which they live. Social exclusion is the driving force of health inequalities. It may directly influence health by affecting the health system and indirectly by affecting economic and other social inequalities that influence health. This qualitative study explored the experiences of social exclusion among members of a remote and marginalised community of Manipur, India (Koutruk). Furthermore, this study aimed at understanding various factors responsible for social exclusion, especially in the health-care service sector and how these factors adversely affect their health. Seven key community members and two medical officers from adjacent primary health-care centres were selected purposively and were asked to participate in the semi-structured interview. Data generated from the interviews were qualitatively analysed using a thematic approach. This study clearly demonstrated that the Koutruk community has been experiencing social exclusion in various dimensions such as education, employment and health-care services. Furthermore, the prevalence of high poverty in the community can be considered the cause as well as product of social exclusion. The health status of the community was found to be very poor. High infant and maternal mortality rates, as well as various diseases were found in the community. Multiple factors were found to be responsible for exclusion of this community in the health sector. Major factors include physical isolation due to poor transportation and communication as well as cultural differences, high poverty and unemployment, traditional beliefs and attitudes about health and wellness, lack of awareness due to illiteracy and lack of support from governmental and non-governmental agencies, prejudice and discrimination by the dominant majority ethnic group and so on. Finally, policy implications of this research are also addressed.