Structural Vulnerability and Epidemiology of COVID-19 in India- A Socio-epidemiological Approach for Health Promotion

Abstract

Introduction: COVID-19 (2019 Novel Coronavirus) pandemic is an outcome of a “complex system” of interactions occurring within and between individuals and their environments. The individual-level models, which give sole or primary emphasis to individual choice with their “victim blaming” tendency is insufficient as determinants of risk and risk behaviour. There are ‘structural vulnerabilities’ that are likely to lead to increased exposure to the contagion, risk of basic human needs not being met, insufficient support, or inadequate treatment Objective: To explore various structural vulnerabilities affecting spread and responses to COVID-19 pandemic. Method: We have conducted a scoping review of secondary data and statistics on COVID-19 from January 2020 to July 2020 in context of various structural vulnerability across various states and Union Territories of India. Result: It was observed that individuals had dynamic and reciprocal association with their physical social, political and economic environments significantly modifying their vulnerabilities to the disease. We classified the various social vulnerabilities majorly faced by individuals into three domains: a) Socio demographic composition b) Spatial distribution across various States and Union territories and c) Migration. It was observed that elderly and male gender were more prone to death by COVID-19 whereas children were found to be less susceptible to the disease. Individuals with underlying illnesses such as cardiovascular diseases (death rate 13.2%), diabetes (death rate 9.2%), high blood pressure (death rate 8.4%), and chronic respiratory diseases (death rate 8%) were at significantly higher risk of mortality. Though the states and cities with maximum connectivity and population density (like Mumbai, Delhi) were afflicted most in the early days of pandemic, but with reverse migration the virus manged to reach even the deepest hinterlands of the country. Conclusion: For an efficient response towards the COVID-19 pandemic it is important for policy makers to look through the lens of structural vulnerability and formulate relevant Socio-epidemiological approach.