Health and social challenges faced by rickshaw pullers in South Asia: a narrative review

Introduction

Regardless of their origin, rickshaw pullers face significant health challenges due to their socio-economic conditions and occupational risks, making them a vulnerable population. Most migrant health issues are linked to their frequent mobility, harmful sexual practices, incapacity to manage psychological stress, relocating often, and relocation to metropolitan regions. Food insecurity, the weather, and other environmental dangers are further variables. In metropolitan regions, a significant share of the population is made up of migrants. They also have a great deal of health issues. They are also unable to make use of the current health services. By teaching people about the resources available for their health, some of their issues can be resolved.

Although riding a rickshaw requires no formal schooling, it is a very physically demanding job. It appeals to the impoverished and destitute who lack a formal education or source of income; therefore, they enter the profession to make ends meet. A person with poor chances for financial advancement might receive compensation for an accident with this type of income. A popular form of public transportation in Southeast Asia is the rickshaw. Its minimal operating costs and straightforward technology make it popular. Passengers may travel comfortably and easily through congested, small streets. Hand-pulled rickshaws are possible, albeit these variants are limited to Kolkata, India, and a few other places like Singapore and Manila. Rickshaw drivers must struggle with a few environmental, social, mental, and physical health issues in accumulation of their persistent poverty. Additionally, their kind of work poses several health risks (1).

As they age, rickshaw pullers experience physical weakness and collapse, which makes it impossible for them to continue working, according to a study on the lives of rickshaw pullers in Dhaka (2). Because of the vigorous effort needed for the job, the majority rickshaw drivers who worked 5 to 7 days in a week were told they were unable to endure the daily rigors of the job (2). Deprived rickshaw pullers may have poor health-related quality of life (HRQoL) because of living in congested conditions, having low incomes, carrying heavy family responsibilities, living in uncertainty, and lacking access to clean water and sanitary facilities (3).

While much of the work currently in published focuses on discrete aspects of rickshaw pullers’ life, such occupational health hazards, very few studies examine how these difficulties relate to more general societal variables, like mental health disorders, social marginalization, and insufficient access to healthcare.

A significant gap in the research is addressed by this review, which provides a comprehensive analysis of the social and health effects that South Asian rickshaw pullers confront. Prior analyses frequently fail to consider the collective effects of these troubles on the welfare of rickshaw pullers, especially when considering the distinct socioeconomic and environmental circumstances of South Asia. The impact of climate change on the lives and health of this vulnerable group is one of the new issues that this evaluation considers. By integrating these many aspects, we seek to offer a thorough knowledge that may guide focused interventions and guide policies tailored to the distinctive needs of rickshaw pullers, eventually promoting social justice and better health outcomes for this underprivileged population.

The objective of this review is to synthesize existing studies on the health, social, and economic challenges faced by rickshaw pullers in South Asia, providing a comprehensive understanding of their living conditions and identifying areas for policy intervention and future research. We present this article in accordance with the Narrative Review reporting checklist (available at https://jxym.amegroups.com/article/view/10.21037/jxym-24-49/rc).

Methods

Searching criteria

Studies were selected based on their relevance to the health, social, and economic aspects of rickshaw pullers in South Asia. Only peer-reviewed articles and studies published in reputable journals were included. Databases such as PubMed, Google Scholar, and other academic databases were searched using keywords like “rickshaw pullers”, “health challenges”, “social security”, “occupational hazards”, and “South Asia” (Table 1).

Participant’s selection criteria

Inclusion criteria

• Population: research using rickshaw pullers as the main subject group. This covers rickshaw pullers of all genders and ages who work in both urban and rural environments. The research was conducted in South Asian nations, including in Bangladesh, India, and other pertinent areas where pulling rickshaws is a prevalent profession.
• Health outcomes: it includes studies on mental health (such as stress and substance misuse), physical health (such as injury, chronic illness, and morbidity), and occupational health risks.
• Socio-economic factors: research on socio-economic aspects such as living standards, health insurance, and access to HealthCare. This study examines the coping strategies used by rickshaw pullers to address health and work-related issues.
• Study type: both qualitative and quantitative studies, including observational studies, cross-sectional surveys, cohort studies, and case studies, published in peer-reviewed journals.
• Time limit: studies published between 1999 and 2023, considering the evolving socio-economic and health landscapes in South Asia.

Exclusion criteria

• Research on unclassified transportation workers or other types of informal labor is not particularly related to rickshaw pullers.
• Research is undertaken outside of South Asia, unless it is specifically pertinent to the context of rickshaw pulling in the area.
• Studies on general urban health that is not occupation-specific, or studies that do not specifically address the health or socioeconomic circumstances of rickshaw pullers.
• Non-peer-reviewed sources like opinion pieces, editorials, non-scholarly reports, and other documents that are not subjected to peer review.
• Studies published in languages other than English are classified as non-English language publications, unless pertinent and readily available translations are provided.

Results

Methodological overview of studies

Using specific keywords, we found fourteen studies that have been conducted so far from 1999 to 2024.

Examining the methodological strategies used in the reviewed research is essential to assessing the social and health issues that rickshaw pullers in South Asia confront. The efficacy of any suggested interventions is impacted by the reliability and validity of study findings, which are ensured by methodological rigor.

The methodological overview table summarizes important findings from research on rickshaw pullers conducted in diverse geographic settings. This table provides readers with a clear understanding of how various aspects of the lives of the rickshaw pullers have been investigated by highlighting the various research designs, populations, data collection methods, and analytical techniques used in these studies.

The study designs used by the studies that are part of the review are diverse; they include observational studies, cross-sectional surveys, qualitative investigations, and simulation models. The inclination towards cross-sectional surveys is evident in the research conducted by Rahman et al. [2007] and Hoque et al. [2009], wherein the focus is on determining the incidence of health and socio-economic problems among rickshaw pullers at intervals (4,5). On the other hand, incorporating qualitative research like Rahman et al. [2022] facilitates a more profound investigation of individual encounters and viewpoints concerning healthcare accessibility (6).

In line with the geographic focus on South Asia, where rickshaw pulling is a popular job among low-income urban workers, the study covers rickshaw pullers from several locations, in Bangladesh and India. Sample sizes differ between studies; Lal et al. [2022] use bigger cohorts to assure statistical power, whereas Kumar et al. [2016]’s qualitative study uses smaller, more detailed samples to collect more nuanced information (7,8).

Table 2 shows the variety of methods used to collect data, from physiological measurements and simulation models to structured surveys and in-depth interviews. For example, Ahmed et al. [2016] conducted structured questionnaires to assess willingness-to-pay for health insurance, whereas Pradhan et al. [2008] used physiological measurements to estimate the physical burden of rickshaw pullers (10,13). These methodological variations draw attention to the studies’ diverse focal areas, which range from behavioral hazards and health effects to economic situations and policy implications.

A similar range of analysis techniques, such as thematic analysis, logistic regression, descriptive statistics, and econometric modeling, are used in these studies. For example, Sarker et al. [2016] employed econometric research to examine the socioeconomic impact of occupational sickness on labor productivity, whereas Hoque et al. [2009] used logistic regression to identify risk variables for human immunodeficiency virus (HIV) among rickshaw pullers (5,14). Robust analytical procedures are employed to augment the validity and dependability of the results, guaranteeing that the research makes significant contributions to the current corpus of knowledge.

Table 2 facilitates an integrated knowledge of the ways in which methodological decisions impact the research outcomes and interpretations by showing the methodology in addition to the results. The assessment of each study’s strengths and limitations, as well as the identification of areas that may require additional methodological innovation or rigor, depends on the alignment of techniques with findings.

This table aids in contextualizing the findings within the larger research landscape by methodically comparing the designs, populations, data collection methods, and analytical techniques. This makes it easier to have a more informed discussion about the implications and potential directions for future research in this area.

Thematic summary of the studies

Table 3 presents the main conclusions from a variety of studies on rickshaw pullers, organizing them into thematic groups that represent the multifaceted difficulties that this vulnerable group faces. The table provides a thorough synthesis that emphasizes the breadth and depth of current research by grouping the studies under various themes, including health status, socioeconomic conditions, occupational risks, dietary and lifestyle factors, healthcare access and utilization, and environmental and socioeconomic vulnerability.

Health status

Research in this area highlights the serious health issues that rickshaw pullers deal with, such as high rates of morbidity, the frequency of chronic illnesses, and the effects of work-related stressors. For instance, Carrin et al. [1999] underlined the vital role that tuberculosis management plays in household well-being, whereas Lal et al. [2022] revealed significant levels of illness and hypertension among Indian rickshaw pullers (8,9).

Socioeconomic conditions

This theme emphasizes the relationship between poverty, income instability, and social security access by focusing on the financial reality of rickshaw pullers. Research like that of Kumar et al. [2015] and the most current analysis of COVID-19’s [2023] effects demonstrate how financial instability affects health outcomes and service accessibility (12,17).

Occupational dangers

The research included in this category draws attention to the environmental and physical dangers that come with pulling rickshaws, such as the extreme workloads mentioned by Pradhan et al. [2010] and the increased risk of HIV because of specific behaviors mentioned by Hoque et al. [2009] (5,11). The necessity of ergonomic adjustments and focused health education initiatives is highlighted by these findings.

Nutritional and lifestyle factors

Studies in this area, like the 2023 study on Dhaka rickshaw pullers, shed light on the unhealthy lifestyle choices and low nutritional status that are common among rickshaw pullers. These include high rates of smoking and insufficient food intake, which increase their susceptibility to health issues (17).

Healthcare access and utilization

This theme illustrates the difficulties that rickshaw pullers encounter in obtaining healthcare services, such as their lack of resources and mistrust of established healthcare institutions. As demonstrated by Ahmed’s [2016] research, the studies also consider the possibility of community-based health insurance programs as a remedy (13).

Environmental and socioeconomic factors

Vulnerability: the last subject discusses how rickshaw pullers’ resilience and vulnerability are impacted by outside variables like climate change and occupational ailments. Important insights into how these variables lower production and increase socioeconomic insecurity are offered by Paul et al. [2019] and Sarker et al. [2016] (14,15).

These studies’ theme arrangement helps to clarify the intricate interactions between the several elements affecting rickshaw pullers. This methodology not only enables a more sophisticated discourse on the results but also aids in pinpointing significant lacunae in the body of literature, directing subsequent investigations and policy formulations with the objective of enhancing the welfare of rickshaw pullers.

Discussion

The migrant population in South Asia faces numerous health issues due to their frequent mobility, harmful sexual practices, psychological stress, and relocation to metropolitan regions. Rickshaw pulling, a popular form of public transportation in Southeast Asia, is a physically demanding job that appeals to the impoverished and destitute who lack a formal education or source of income. As they age, rickshaw pullers experience physical weakness and collapse, making it impossible for them to continue working. Deprived rickshaw pullers may have poor HRQoL due to living in congested conditions, having low incomes, carrying heavy family responsibilities, living in uncertainty, and lacking access to clean water and sanitary facilities.

This review synthesizes existing studies on the health, social, and economic challenges faced by rickshaw pullers in South Asia, providing a comprehensive understanding of their living conditions and identifying areas for policy intervention and future research. The study designs used by the reviewed research are diverse, including observational studies, cross-sectional surveys, qualitative investigations, and simulation models. Sample sizes differ between studies, with larger cohorts ensuring statistical power.

The variety of methods used to collect data, such as physiological measurements and simulation models, structured surveys and in-depth interviews, and various analysis techniques, such as thematic analysis, logistic regression, descriptive statistics, and econometric modeling, are employed in these studies. Robust analytical procedures are employed to augment the validity and dependability of the results.

Most rickshaw pullers are rural immigrants who have moved to city region from their previous occupations. They live in rented houses, with electricity usage depending on usage. Rickshaw pullers are backward in education due to lower income, poverty, and lack of proper accessibility of educational institutions.

Livelihood is due to illiteracy and lack of skill, as they started pulling rickshaws through known sources such as peers, other villagers, or father’s occupation. They often spend 10–12 hours a day pulling rickshaws and working in other fields. Health problems among rickshaw pullers include gastritis, tiredness, cough, body pain, fever, and chronic illnesses. They consume beedi, gutkha, or alcohol to cope with stress and resort to drinking habits, which can lead to mental problems and domestic violence.

As a close-knit group, the rickshaw pullers share their joys and sorrows with one another. They talk about their personal lives, careers, families, and the different obstacles they encounter, such as financial difficulties, police harassment, health problems, and future uncertainties. According to studies, migrants in this group face more challenges than native rickshaw pullers, including relocation and the difficulty of acclimating to new surroundings.

For example, traditional pedal rickshaw pullers in Southeast Asia experience serious physical strain and health issues because of their manual labor, whereas Qing-qi auto rickshaw drivers in Pakistan deal with concerns related to vehicle overloading and road safety (18). Notwithstanding these variations, the general vulnerabilities that rickshaw pullers, whether local or migrant, share underscore the pressing need for all-encompassing regulations that address their occupational safety and health in various settings.

Rickshaw pullers wish for better rickshaw structure, fixed payment, government housing, and modernization. They are victims of exorbitant daily rentals and the mafia that does not allow them to own the rickshaws. Many rickshaw pullers live on pavements, exploited by the police, municipal bodies, and unscrupulous money lenders. Association for Mobile Business Opportunity, and Rickshaw Bank can help improve daily earnings and provide health and hygiene programs. Individual and family wellness can be achieved through awareness camps, programs regarding family planning, and creating common information centers (CICs) to provide information about government-sponsored insurance and other financial assistance programs. Medical camps can also help reduce illness and increase earning capacity. Unionization and self-help groups can help create a sense of community and reduce interpersonal issues. Cooperative banks can reduce financial burden and allow the community to own and employ rickshaws.

Respect for human diversity can be fostered by collaborating with people from diverse backgrounds for cooperative banks, which facilitates greater interaction and increases respect for diversity. Social justice can be achieved by distributing voter identity (ID) cards and workshops on voting importance. Governments and unions should actively reach out to the community and ask for basic amenities like food and other resources. Empowerment and citizen participation can be improved by targeting rated charges and improving the socio-economic structure of rickshaw pulling.

Conclusions

Rickshaw pullers in South Asia face significant health, social, and economic challenges, including high smoking rates, occupational disorders, and HIV risk behaviors. Physical workloads and lack of health insurance impact their well-being. Policymakers need to develop comprehensive strategies to address occupational health hazards, improve healthcare access, and compensate wage losses.

In conclusion, the health, social, and economic challenges faced by rickshaw pullers in South Asia are significant and require further research and policy interventions. By understanding the unique challenges faced by these workers and implementing effective policies, we can better support their well-being and overall well-being of the community across the world.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://jxym.amegroups.com/article/view/10.21037/jxym-24-49/rc

Peer Review File: Available at https://jxym.amegroups.com/article/view/10.21037/jxym-24-49/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jxym.amegroups.com/article/view/10.21037/jxym-24-49/coif). The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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