标题："It makes us really look inferior to outsiders": Coping with psychosocial experiences associated with the lack of access to safe water and sanitation.
摘要：Much of the existing literature on the impacts of lack of access to safe water and adequate sanitation has been influenced by biomedical models of health and illness, with strong emphasis on morbidity and mortality outcomes. For example, effects of the lack of access on water-related disease have received significant attention, with a number of systematic reviews focused on diarrheoal diseases, (1-3) schistosomiasis, (4) and child and maternal health outcomes. (5) Although water-related diseases account for a significant portion (10%) of the global burden of illness, (6) other social impacts significantly affect the well-being of individuals and communities. (7,8) In recent years, there has been growing interest in the effects of lack of safe water and adequate sanitation on psychosocial well-being. For example, a number of anthropological studies have drawn attention to links between water and sanitation and various dimensions of psychosocial concerns, including feelings of embarrassment, shame, fear, anxiety, frustration and enhanced vulnerability. (9-11) These concerns are thought to manifest through a complex process of perceiving, coping with and adapting to threats and risks posed by stressors (i.e., lack of access to safe water and adequate sanitation) in the environment. (12)
Drawing on stress theory, Lazarus and Folkman (1984) (13) proposed that individual response to an environmental stressor (e.g., contaminated water) is an interactive and iterative process involving two stages: primary appraisal, whereby the individual evaluates the stressor as a threat or risk that can cause harm; and secondary appraisal, which involves the evaluation or appraisal of coping resources, mechanisms and strategies to deal with the stressor. Thus, resources are important in the secondary appraisal process for assessing one's capability to cope and/or adapt. (13) Resource appraisal becomes an even higher priority in vulnerable settings where (perceived) lack of coping resources and adequate behavioural and social responses may exacerbate psychosocial concerns. For example, a study by Sahoo et al. (2015) (9) found that coping with undesirable sanitation conditions, within the context of low resources and lack of agency to solve sanitation challenges, leads to a rise in sanitation-related stress among women in Odisha, India. Further, diverting limited household resources into coping (e.g., buying water from vendors) may result in opportunity costs in terms of reduced savings or resources for other household needs, such as food. (14)
