Social Determinants of Health in Understanding the Socio-Economic Impacts of Covid-19 Pandemic in Bangladesh

Social determinants of health are some indicating factors such as income, education, class, gender, and race that influence the socio-economic status of people living in a society. Coronavirus affects the social, economic, and also political sectors of people all over the world. In Bangladesh, during the Co-vid-19 pandemic, people of all ages and classes have faced social and economic crises based on the social determinants of health. Higher-class families had the facility of advanced medical services rather than the lower and low-er-middle classes. This article aims to show the relationship between the social determinants of health and the socio-economic impact of the Covid-19 pandemic in Bangladesh. This paper presents some secondary data to describe the socio-economic impact of Covid-19 and the functions of the social determinants of health in this case.

urban and rural populations have experienced the impact of the Covid-19 pandemic. Social determinants of health (SDOH) are important to understand the socio-economic impacts and implications of this pandemic in Bangladesh. The perspective of 'Social Determinants of Health' is adopted by epidemiologists and others who are engaged in the field of social medicine. There are different socio-economic factors such as income, wealth, and education as the fundamental causes of a wide range of health outcomes in a society that are considered as SDH [2]. Social determinants of health are income, education, social class, gender, race, environment, health status, etc. The non-medical elements that influence health outcomes are known as social determinants of health (SDH).
They are the circumstances in which people are born, grow, work, live, and age, as well as the larger set of factors and institutions that influence daily life conditions. Economic systems and practices, development objectives, social norms, social policies, and democratic structures are examples of these forces and systems. The aim of this study is to understand the socio-economic conditions of Bangladesh during Covid-19 pandemic in the context of the social determinants of health in Bangladesh. In fact, there are several social and economic breakdowns have occurred during the pandemic and the study will focus exploring the causes of these breakdown on the basis of social determinants of health such as education, employment and access to healthcare etc. In this study, secondary data have been used to explore the socio-economic condition of the people of Bangladesh during Covid-19 pandemic. The secondary data were gathered from a variety of sources including books, articles, and websites including Google Scholar, JSTOR etc. The websites have been explored with the main keywords. This is mainly a review article where secondary data have been used and analyzed according to the theme such as educational breakdown, challenges in livelihood, challenges in the healthcare system etc. The non-medical elements that influence health outcomes are known as social determinants of health (SDH). The impact and implications of Covid-19 are prominent in people of all ages and all classes. In Bangladesh, the elderly population has been increasing over the past few decades. They have suffered a lot due to poor socio-economic conditions, and inadequate access to healthcare services is another reason for their suffering [3].

Literature Review
The impact and implications of Covid-19 remain everywhere in society. In Bangladesh, the social and economic impacts of this pandemic are extreme due to being a developing country. Using secondary data, a study assessed the impact of Covid-19 on the social and economic realms in Bangladesh at the very first stage of this outbreak. The study focuses on social impacts like social interaction, religious overviews about coronavirus, violence against women, etc. They have recommended that the Government should take necessary steps to increase productivity and should invest more in the health care and education sector [4]. well-known to around 90% of the people in Bangladesh. The study claimed that the education system has seriously been broken due to the long shutdown [7].
Research using both quantitative and qualitative data. The aim of this study was to understand the impact of Covid-19 on the psychology and livelihood of people who are dependent on their daily income for their survival. The study found that 94.1% of respondents are affected by coronavirus [8]. A study has revealed the economic impacts of Covid-19 on the South-Asian countries (Bangladesh, India, Pakistan, Nepal, and Srilanka) and explored how Covid-19 affects the GDP growth of these countries and also suggested some policies that should be implemented by the governments of these countries in some important economic sectors such as agriculture, service, and manufacturing [9].

SDOH and the Socio-Economic Impacts and Implications of Covid-19 in Bangladesh
Social determinants of health are associated with the socio-economic impacts in Bangladesh including economic, healthcare, education, and livelihood impact.

Healthcare Challenges Faced by Doctors and Patients
Access to healthcare services is considered the most important social determi- sometimes avoided by many hospitals and doctors as well. It also disrupts the relationship between the doctor and patient or the doctor-patient relationship in the healthcare system. There are some factors that affect much of the healthcare system during this pandemic including poor administration, increased rate of corruption, and fragmented public health communication [10]. Although doctors feel at high risk for themselves and their families and there is a lack of medical facilities in the hospitals, they are trying to serve the people as much as they can [11]. If we want to be precise about the effects of this virus on a patient, then we must say that it affects both the public and private self of a patient.

Challenges in Economic Sector
The Covid-19 pandemic has affected the economic sectors of the life of people in Bangladesh. During this pandemic, many people have lost their jobs, especially those who worked in the informal sectors. Bangladesh Institute of Development Studies has reported that during this pandemic 13% of people have lost their job and as a result, 16% of new people are now living under the poverty line 3 . Because they are not able to pay them. As a result, the total production system has decreased at an alarming rate that affects the whole economic body of the country. Moreover, 42.9% of people strongly agreed that there will be a reduced supply of basic products. For daily use and 50.8% of respondents strongly agreed that there will be increased prices for basic products [12]. As there is a reduction in supply of the daily products in the market, the price of the products has also chanized technology, which causes shortages in agricultural production and they face risk in terms of harvesting [13]. The village people in Bangladesh also face the same problem because they are not getting proper profit from agricultural products. People from urban areas are unable to produce due to the lockdowns and therefore, are impacted economically. Many families have broken down because of the Covid-19 pandemic and social classes are also transforming every day.

Educational Breakdown
Apart from the healthcare and economic sectors, Covid-19 has also exerted an influence on the educational sectors in Bangladesh. Students from primary to the graduate level are going through great trouble because of the discontinuation of the study. All the educational institutions have been closed since March 2020. Income and social class are the two determinants of health that are also related to the educational impact in Bangladesh. Lower and lower-middle-class families face discrimination in both the healthcare and education system. Students from lower-class families feel much mental pressure during the lockdown as they spend minimal time on social sites compared to higher-class students [14]. In July 2020 the government of Bangladesh and the education minister decided to start a program called "distance learning". In this program, many students cannot take part, especially those who live in the rural and hill areas of Bangladesh due to electricity and network problems. Students living in rural areas (45%) reported not getting any direction from their schools about how to continue their education at home 4 . The primary level students are affected much during this pandemic, especially in rural areas. Their economic condition has created a barrier to accessing education through using electronic devices. It has been found that many students claimed that online education is not helpful due to poor lectures, shortages of class materials, and most importantly many students are not skilled enough to run electronic gadgets [15]. Students living in rural areas have also suffered from a lack of food and other services as their family has fallen down the poverty line due to the lockdown and shutdown. On the other hand, students from public and private universities have also gone through session delays and many of them become mentally ill due to depression and anxiety. A study has predicted that people from lower-income deciles cannot bear educational expenditures due to a fall in income in a widespread way in Bangladesh [16].

Challenges in Livelihood
The main prerequisite of protecting our body from coronavirus is keeping ourselves clean and leading a healthy life. Agriculture in the South-Asian region is labor-intensive, employing more than half of the workforce in each country.
Agriculture-based rural industries and livelihoods are affected by COVID-19 and the subsequent quarantine because of its large labour intensity [17]. Many people cannot manage their daily necessities like food, and clothing and suffer from a lack of nutrition. These categories of people are not able to maintain healthy food and proper safety. Income is the social determinant of health that is the main causative factor behind poor livelihood during the covid-19 pandemic.
During the Covid-19 pandemic, many people who worked in the informal sectors had to leave their workplaces. It has been reported that, because of the lockdown and shutdown, a large number of people have moved to their hometowns. We know that a large portion of the people living in rural areas is engaged in many informal jobs in urban areas such as Dhaka, Chittagong, Rajshahi. These people are becoming helpless when they are losing their jobs and as a result, they decide to leave their working place. 60.5% people strongly agreed that "most of the poor people living in urban areas have to leave the city due to not having any options for income [12].

Conclusions
Bangladesh is experiencing several social and economic impacts of

Limitations and Future Directions
The authors have faced some problems for conducting this study. Among them lack of funding is one of the most important issues. The authors have conducted this study by their own, there was no support of funding in this research.
Another one is the overall pandemic situation. Due to lockdown and shutdown, it was quite impossible for the authors to collect field data for better understanding of the topic. So, the study has been conducted by collecting secondary data from different journals, newspapers and other authorized sources. Although our review does not fill up the gaps that we mentioned above, collecting field data, quantitative and qualitative analysis and more review of the literature may contribute more for exploring the socio-economic condition in the context of social determinants of health in Bangladesh.