In combating social exclusion how are interventions on the 'excluded' related to interventions on the 'excluding society'?: A comparative analysis of leprosy rehabilitation and prevention in Bangladesh

Abstract

In this paper, the social exclusion framework is applied to explore the impact of leprosy on affected people in Bangladesh, and to investigate the effectiveness of interventions of health education and socio-economic rehabilitation. Leprosy, because of its political, social, economic and cultural implications, provides a useful self-contained micro-study to test the applicability of social exclusion as a working tool. Primary research carried out in two centres in Bangladesh showed that in the lifetime of present patients it is possible to trace marked trajectories of exclusion and inclusion. It is argued that in order to reverse situations of deprivation, it is crucial to investigate these processes at the individual and societal levels. Consequently, two means of intervention are compared: health education of society and rehabilitation of individual patients. These interventions commonly remain distinct, but it is concluded that only by integrating the two approaches can deep-seated prejudices be removed, facilitating early detection and elimination of leprosy. It was found that processes of inclusion are effective when they involve the same actors that promoted exclusion, and when they create bridges across the rigid divides separating the excluded from the excluding society or group. It is also suggested that lessons learnt in the context of leprosy can be usefully applied to contexts of HIV/AIDS or caste-ism