The West Bengal University of Health Sciences

Social and Behavioral Health

MPH (1st Semester) Examination, February–March 2022 | Detailed Answers

Question 1: Structural Violence (Amartya Sen & Paul Farmer)

Introduction

Paul Farmer coined "structural violence" to describe how social structures, institutions, and unequal systems harm people by preventing them from meeting basic needs. Amartya Sen emphasized that human suffering results from social inequality, poverty, discrimination, and unequal distribution of power – built into society's political, economic, and cultural systems.

Main Features of Structural Violence

  • Embedded in social systems
  • Preventable but persistent
  • Unequal distribution of resources and power
  • Causes avoidable suffering and death
  • Affects marginalized populations most

Examples

  • Poverty and malnutrition
  • Unequal healthcare access (rural vs urban)
  • Gender inequality (domestic violence, poor nutrition)
  • Caste-based discrimination
  • COVID-19 migrant worker crisis

Health Effects: Poor nutrition, unsafe environment, mental stress, limited treatment access, increased disease burden → high IMR, MMR, infectious diseases, mental illness.
Measures to reduce structural violence: Poverty reduction, universal healthcare, education for all, gender equality, employment opportunities, social welfare policies, human rights protection.

Question 2: Health Problems of Migrant Workers During COVID-19

Main Health Problems

  • Food insecurity & malnutrition
  • Mental health problems (anxiety, depression, stress)
  • COVID-19 infection risk (overcrowding, poor hygiene)
  • Lack of healthcare access (no insurance, no ID)
  • Exhaustion during reverse migration (dehydration, heat stroke, death)
  • Occupational health problems (construction injuries, chemical exposure)
  • Maternal & child health problems (lack of ANC, unsafe delivery)
  • Social stigma & discrimination
  • Poor living conditions (congested housing, unsafe water)
  • Interruption of chronic disease treatment (diabetes, TB, hypertension)

Government Measures: Free ration schemes, shelter homes, Shramik special trains, cash assistance, vaccination programs.
Long-term measures: Social security for migrants, portable health benefits, better housing, employment protection, universal healthcare access, mental health support.

Question 3: NFHS-5 Comparison – West Bengal vs Tamil Nadu

IndicatorWest BengalTamil NaduBetter State
Women literacy (%)72.984.0Tamil Nadu
Men literacy (%)80.290.7Tamil Nadu
Anaemia among women (%)71.753.6Tamil Nadu
Anaemia among men (%)38.915.2Tamil Nadu
Underweight children under 5 (%)32.222.0Tamil Nadu
Overweight children under 5 (%)~4.3~4.3Similar

Key Observations

  • Tamil Nadu has significantly higher literacy (male & female)
  • Anaemia is extremely high in West Bengal (71.7% women)
  • Child underweight higher in West Bengal (32.2% vs 22.0%)
  • Both states show ~4.3% overweight children (nutrition transition)
  • Rural populations perform worse in both states

Recommendations

  • Improve nutrition programs
  • Strengthen anaemia control
  • Promote female education
  • Improve sanitation & healthcare access
  • Strengthen maternal-child health services

Question 4: Social Dimensions of Climate Change

Key Social Dimensions

  • Health impact: Heat stroke, respiratory diseases, vector-borne diseases, malnutrition
  • Poverty & inequality: Poor populations most vulnerable
  • Food security: Droughts/floods reduce production → shortage, price rise
  • Migration & displacement: Coastal erosion, floods, drought → slums, unemployment
  • Gender dimension: Women disproportionately affected (resource management, workload)
  • Impact on livelihood: Farmers, fishermen suffer income loss
  • Mental health: Anxiety, depression, trauma
  • Social conflict: Water/resource scarcity → community conflicts
  • Urbanization problems: Overcrowding, poor sanitation
  • Impact on vulnerable groups: Children, elderly, tribal populations, disabled persons

Public Health Response: Disaster preparedness, climate-resilient healthcare systems, sustainable development, environmental protection, awareness programs.

Question 5: Healthcare Deficit in Tribal Areas (PHC, CHC, Sub-Centres)

Causes

  • Geographical inaccessibility (remote, forested, hilly)
  • Lack of infrastructure (poor roads, electricity, internet)
  • Shortage of healthcare workers (doctors/nurses avoid tribal postings)
  • Poverty and underdevelopment
  • Administrative neglect (insufficient investment, weak monitoring)
  • Cultural and language barriers

Consequences

  • High maternal and infant mortality
  • High disease burden (malaria, TB, malnutrition, diarrhoea)
  • Delayed treatment → complications, mortality
  • Poor immunization coverage
  • Malnutrition among children and women
  • Increased out-of-pocket expenditure
  • Mental and social stress
📌 Measures to Improve Tribal Healthcare: Increase healthcare funding, recruit and incentivize rural doctors, improve roads and communication, mobile health services, community health workers, telemedicine services, tribal-sensitive healthcare policies.