Role of Inequality and Inequity in Chronic Arsenicosis and Its Consequences

Abstract

TM5-O-10 Introduction: Millions of people living in the eastern part of India are exposed to arsenic by consuming arsenic-contaminated groundwater. The existing literature has revealed the adverse health impact of chronic arsenic poisoning. However, there is little information regarding the role of inequality and inequity on occurrence of chronic arsenicosis and its consequences, which are thought to be very important in policy formulation and its effective implementation. The present study explores the role of social-cultural factors and present development paradigm on the occurrence of the disease and its physical and social consequences in the form of disability and handicap. Methods: A cross-sectional survey was conducted in 5 arsenic-affected villages, and the population exhibiting arsenical dermatologic manifestation was taken as cases. In addition to researching effects at the individual level, in-depth analysis regarding the role of social security, governance, and development policy (water agriculture, health care) on arsenic exposure and people's suffering was also conducted. The World Health Organization's International Classification of Impairment, Disability and Handicap (ICIDH) was also used, as the guiding tool to define the consequences of disease. Results: Our data showed that modern agriculture practice and drinking water policy has made people more dependent on groundwater and hence more exposure to arsenic. Occurrence and severity of manifestation was significantly associated (P < 0.05) with arsenic exposure level, gender, occupation, socioeconomic status, nutrition, and access to health care. The poor population suffered more due to malnutrition, occupation, access to healthcare services as well as social services, and economic constraint, thereby impacting their ability to seek safer and alternative sources of water. The impairments due to chronic arsenicosis caused 4 major disabilities: personal care (75.8%), locomotor (62.9%), gripping (62.9%), and growing intolerance to heat and cold (30%). Three varieties of handicaps were found: physical independence (29.5%), occupational (38%), and social integration (42.8%). The magnitude of disabilities depended on the severity of impairment and socio-cultural and physical environmental factors. The severity of handicaps was found to be dependent on the magnitude of disability, socioeconomic status, social and family support, occupation, and gender relation. Discussion and Conclusions: The present study established the role of social, economic, and cultural disparities, governance, policy, and their complex relationships on the incidence and magnitude of chronic arsenicosis and its consequences. The study shows that it is imperative to address the existing disparities and people's perception in mitigation strategy to make it more effective and sustainable.