Attacking social exclusion: combining rehabilitative and preventive approaches to leprosy in Bangladesh

From the earliest times, leprosy has been a disease set apart, and in a great many communities its sufferers continue to be rejected by society (Nicholls 2000). Leprosy remains a health challenge; of the 620,672 cases detected during 2002 alone, the overwhelming majority were in SE Asia, with countries such as Nepal having registered prevalence rates of 3 cases per 10,000 of the population (WHO 2004). In Bangladesh, national averages are now below 1 per 10,000 (the threshold below which leprosy is likely to be eliminated by natural means), but owing to a concentration of cases the incidence remains higher in the districts in which the research reported on in this article was carried out. Interventions to counter social exclusion are generally aimed either at the ‘excluded individual’ or at the ‘excluding society’ as a whole. This article compares these two means of intervention through a focus on socio-economic rehabilitation (SER) and health education (HE). Results are drawn from primary research undertaken in two projects in Bangladesh, one run by the Danish Bangladesh Leprosy Mission (DBLM) and the other by the development NGO Health Education Environment Development (HEED), involving individual interviews (55 respondents), focus-group discussions, and key-informant interviews. A social exclusion framework is used to present and analyse findings.