key: cord-0767762-bu5t8poy authors: Gul, Azeem title: Covid‐19 pandemic: Current scenario and public risk perception in Pakistan date: 2021-02-02 journal: J Public Aff DOI: 10.1002/pa.2617 sha: d048b96efb62d2f7616fa049ab1d0d111c60b2dd doc_id: 767762 cord_uid: bu5t8poy Covid‐19 is a Severe Acute Respiratory Syndrome Corona Virus‐2 (SARS‐CoV‐2), which has exposed the issue of public risk perception among people in Pakistan. Previous research about public risk perception among people in Pakistan has been a neglected area till the writing of the current paper. The study aims to determine the level of public risk perception among people in Pakistan about the Covid‐19 pandemic. Why and how public risk perception among health professionals and literate is more than the illiterate people in Pakistan? Data were collected through questionnaires and interviews of populations sampling from five districts through visits in KPK and other provinces via phone calls and online through internet. Theory of Health Belief Model (HBM) was utilized to explain public health risk perception in Pakistan. The lack of public health risk perception has more in illiterate people than literate among people in Pakistan, which has caused the Coronavirus to multiply rapidly in Pakistan. The findings have indicated that both health professionals and other literate people have different health behaviors than those who are illiterate in Pakistan about the Covid‐19 pandemic. Covid-19 is a Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2), which has exposed health-related risk perception of both literate and illiterate people in Pakistan. Health related behaviors have significant role to prevent the spread of infectious diseases. When the Covid-19 virus was identified in Wuhan city in Hubei Province of China, many strategies were followed to contain the spread of the virus with little focus on public health perception to prevent further spread of Covid-19. Researchers are busy on many aspects of the infection to stop its further damage. This however again raises the question about why the Covid-19 virus spread very fast, which has brought a significant mark on the generation of the 21st century. Why there is negligence on the part of researchers and governments to consider health behaviors of the general public who are the main agents to spread the virus from one country to another such as from China to the rest of the world. While the virus is spreading among the comity of nations, particularly in developing nations such as Pakistan, it has become catastrophic in terms of health related behaviors despite the enactment of governments standard operating procedures (SOPs). The current paper is associated with the issues of Covid-19 pandemic by highlighting risk percpetion in Pakistan. The study has chosen the population sampling of Pakistan and these issues related to risk identification is worldwide, such as the previous infectious diseases, HIV/AIDS, TB. To resolve public health related issues, researchers in the 1950s introduced Health Belief Model (HBM) to increase and Sharpen public sensitivity toward the infectious diseases. Wthin this context, sociologist and psychologist introduced the HBM theory. This attempt was successful. Similarly, the current paper has reconsidered the utility of HBM in the case of Pakistan where there is a significant gap in terms of public health risk perception. The paper first has highlighted what is HBM theory and how it is applicable in the current paper. Second, what is health and its role as a social indicator has been examined briefly in a theoretical context. Third, the current epidemiological situation of Covid-19 both globally and in the context of Pakistan has been highlighted to map the study further. Fourth, while reviewing the spread of the virus in the country, the study has identified major issues related to the health behaviors among illiterate people. Fifth, the findings identified that there is negligence in health related behaviors, particularly risk identification among the illiterate people nationwide. Finally, the current study is based to highlight one of the seminal roles of perception, which can improve public health perception toward risk management. 5. Cues to action, which explain a stimulus needed to trigger the decision-making process to accept a recommended health action. 6. Self-efficacy is the last assumption, which has explained the level of an individual's confidence in his or her ability to perform a health-related behavior (Janz, 1984) . The current study is based on the theoretical construct of HBM that why Covid-19 has hit hard the population of Pakistan and other nations despite they knew from the established fact of the spread of the virus in China; however, states including Pakistan failed to stop the outbreak in their national domains. This study has found that it largely lacks public risk perception to give space to the virus to multiply in Pakistan (see Figure 1 ). Health is wealth. In this regard, Mehbooul-Haq and his colleague introduced Human Development Index in 1990, which has examined human capabilities such as leading a long life, being knowledgeable, and enjoying a decent standard of living. These are represented as health, education, and income. Health has been a valued passion (Alleyne & Cohen, 2002) . Economic thinkers have found health as one of human capitals contributing to economic growth and positively impacts on the GDP of the country (Sushant, 2020) . According to endogenous growth theories, good health increases human capital, leading to productivity. People with good health are more productive, learn more in schools, they live longer, and thus it causes long-run economic growth of a country (Hanushek & Wobamann, 2010) . The available literature on health and economy has shown that the level of per capita income is affected by the level of population health. The economic approaches have recognized that education and health are interlinked in their contribution to economic growth and human capital accumulation of a country. The government polices to increase spending on health might impact the economic growth (Bucci, 2019) . Besides, economic approaches to health both theoretically and empirically the sociological approaches to health have identified it as an important part of society. The functionalist approach, also known as consensus paradigm, dated to the work of August Comte, Emile Durkheim has important contribution to understand health. The functionalist approach has considered society as a living organism. The society functions like a social organism with interrelated and interdependent parts such as political institution that regulates the affairs of society, the economic institution serves to provide goods and services, and the health institutions as a subsystem to provide health care to the ill people. Any institution when does not function properly becomes dysfunctional. Functionalists have viewed health as a prerequisite for the smooth conduct of a society. They consider health as a social value and it is vital for survival and development for society (Amzat & Razum, 2014) . Similarly, cultural theory identifies the impact of values and cultural settings on the perception of risk. Cultural context shape an individual perception of risk. In this context, values frame the interpretation of information. For example, individuals with health values will interpret the probability of risks to their lives (Rippl, 2002) . In a number of reported cases, many patients have not shown symptoms. Due to the lack of proper testing, the number of Covid-19 patients is more than the existing data (Hoffman, 2020 with mortality rate of 9% in a total of 26 countries; however, the current Covid-19 outbreak began in December 2019 and is moving upward to infect and kill millions to date across the world (Shereen, 2020) . The Covid-19 virus soon spread in February 26, 2020 in Karachi city in Sindh Province of Pakistan. The estimated population of Karachi is 204.65 million. The virus easily swept across the country and has currently become an epidemic (Abid, 2020) . The total number of confirmed cases are indicated below, which show that the virus multiplied more from April 2020 to the month of July 2, 2020 (see Figures 2-5). Viewing the health institution in Pakistan, it has many challenges both at the economic, functional, cultural context and lack of public health perception. The health institution ranks lower than the global level in Pakistan. The funds for health sector have been only 2% against the 10% of the global level (Pradhan & Mistry, 2020) . However, due to the lack of public health related behaviors among the provinces, the virus killed and infected more people every day. The province wise breakdown of the infection is shown in Figure 6 and Table 1 . For this, to fill the very gap, I studied the available books, journal articles, newspaper articles, and news channels, which enlightened me about many aspects of the Covid-19 pandemic, however, what is largely missing in these sources is what is public risk perception in the case of Pakistan and why it is helpful to make the part of public health policy at state level to minimize the risk associated with the current pandemic and the upcoming infectious disease, both viral and bacterial. Thus, the present study is based on my own observation, distributing questionnaires and interviews among literate people while using interview solely as means of collecting data from the field to prove and test my hypothesis. In addition, secondary sources were utilized to analyze and interpret to know what other researchers have examined. Prior to the results of the current paper, it would be not useless to understand what perception is and why its role is important to contain infectious diseases in Pakistan. In the current study, perception is understood based on the HBM theory. To apply HBM on the current F I G U R E 6 Regional breakdown of confirmed coronavirus cases in Pakistan. Source: https://www.newsweekpakistan. com/pakistan-reports-4339-new-covid- Source: https://www.newsweekpakistan.com/pakistan-reports- 4339new-covid-19-infections-in-24-hours/. study, I studied the research conducted by Rosenstock, Stretcher, and Becker on HIV and earlier research studies in the 1950s to prevent TB in the US. Their studies based on HBM identified that people change their health related behaviors when they think risk is imminent. Similarly, to determine public perception of Covid-19, the current study applied the theory of HBM. Questionnaires were distributed among the prospective respondents such as health professionals and literate non-health professionals in the initial phase-one of the research studies. A total of five respondents were sampled among health professionals. All of the respondents were local physicians. The results showed greater awareness among health professional about the Covid-19 virus (see Table 2 ). showing that perception depends on the knowledge about the risk of the disease. Within this context, HBM is applicable, which has already postulated that health-related behaviors depend on when people perceive that the condition is serious; however, it fairly falls down even among the health professional when the condition is not serious. The study in the second phase collected samples from literate people who were nonprofessional. The findings of this phase revealed similar results in terms of perceiving the Covid-19 pandemic (see Table 3 ). In the second round of the study, samples were collected from literate people who have indicated that fair level of risk perception prevails among them. This is largely because of where they work and the type of Table 4 ). The current paper has used the HBM theory to understand risk percep- The study further recommends more research to highlight public health perception as an integral part of the preventive strategy currently and for upcoming epidemics and pandemics. This would give the field of epidemiology to flourish in Pakistan in order to provide the governments full preparedness to combat the microbes, which will reduce both mortality and morbidity among public. The current study has created novel insights in the current literature, which were previously not considered properly due to the lack of both state and public level attention. Public health behaviors are not specialized in Pakistan; however, the current paper has just advanced theoretical and empirical findings to recommend for policy formulation in the health sector to reduce further loss to the economy of Pakistan. All the available data in the article is permitted to be published as deemed appropriate. Azeem Gul https://orcid.org/0000-0003-0760-7772 Progress of Covid-19 pandemic in Pakistan The Covid-19 emergency and prioritizing public health in Pakistan Economic growth and poverty reduction. World Health Organization Human capital and economic growth: The impact of health, education and demographic change Education and economic growth Evaluation of Covid-10 IgM and IgG rapid test: An efficient tool for assessment of past exposure to SARS-CoV-2 The health belief model: A decade later An opportunity for Pakistan strengthen health system Cultural theory and risk perception: A proposal for better management Covid-19 pandemic: Origin, transmission, and characteristics of human corona virus Covid-19 and Pakistan: The economic fallout, observer research foundation Global Covid-19 deaths top 500,000. NPR News Islamabad and PhD scholar at Quaid-i-Azam University, Islamabad. How to cite this article: Gul A. Covid-19 pandemic: Current scenario and public risk perception in Pakistan Yes Source: Field data (May-June 2020).