Exploring Health Inequalities within the Indian Caste System

This essay examines the significant health and social care inequalities in India, primarily focusing on the influence of the caste system. It explores how caste affects access to healthcare, health outcomes, and the overall well-being of various social groups, including Scheduled Castes (SCs), Scheduled Tribes (STs), and Other Backward Classes (OBCs). The essay discusses the impact of caste on infant mortality, malnutrition, underweight and overweight issues, and the prevalence of diseases like anemia, as well as the role of education and economic status in exacerbating these disparities. It highlights the practice of untouchability, its effects on healthcare, and the influence of government policies and reservations aimed at uplifting marginalized communities. Additionally, the essay touches upon mental health issues, population growth, and the historical context of health inequalities, emphasizing the need for addressing these disparities to improve public health outcomes in India. The essay also references various studies and research papers to support its arguments, providing a comprehensive overview of the complex relationship between caste and health in India.

Health and Social Care Inequalities

Topic: Inequalities in health and Caste System in India
In India, caste is a widely practised factor that carries the power to influence the other
segment of society. The significance of caste in India can be considered to be equivalent to
the significance of race plays in the U.S. and the social class in Great Britain. The national
health of the country is one of those segments that receive significant influence from the
status and caste of people. The issue of inequalities in the system of Health and Caste has
been increasing day by day. Several challenges are being shaped due to this issue. In many
cases, the health-related issues are being influenced by the caste and religion of the person. In
this essay, it is demonstrated how the Health and Caste issues in India are being affected by
inequalities.
In this regard first, it requires mentioning the health status of the Tribal people of the country.
According to the Census of 2011, as opined by Jungari and Chauhan (2017), ST people are
8.6% of the total population of India, which is equivalent to about 100 million people. Again
the SC population is more than that of ST people. It is 16.6% of the total population of the
country which is equivalent to about 201 million people. Mostly the tribal people live in the
locations or the villages that are extremely remote to the city areas or the other developed
areas of the country. Therefore, according to Jungari and Chauhan (2017), it is obvious that
those areas, being extreme remote, are mostly out of the range of any kind of modern
facilities such as, communication and connection, etc. the tribal people or the lower caste
group including STs, SCs and OBC are kept entirely excluded from the modern society or the
mainstream of the facilitated locality from the origin of caste and creed. Therefore, those
people are mostly deprived in almost all fields in the health sector. In this regard, as opined
by Jungari and Chauhan (2017), their lower economic status and the lack of knowledge and
awareness due to not being adequately educated play a significant role play. On the other
hand, it has been argued by Patel et al. (2015) that nowadays, in India, there are several
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beneficial reservations for the people of STs, SCs and OBC background both in education
and social segments which are significantly influencing in uplifting those people to the
mainstream of life and society. It can be stated that by the help of Government in several
segments, these people are being able to gain enough awareness.
In case of infant mortality and neonatal examples, as opined by Goudar et al. (2015), there
are defences between the other castes and the people of ST and SC background. This
tendency is higher among the lower cast people than the people from higher castes. It can be
mentioned in numbers which shows 4.5 for the ST people and 3.9 for the SC people where,
on the other hand, it is 3.6 for other castes. As it is already mentioned that the lower caste
people are mostly from a poor economic background, it is obvious that they would face the
issues of being underweight. This issue, most of the time, appears to be a severe threat to
them. In respect of the caste issue, which indirectly determines the social and economic
status, the risks in underweight, stunting and suffer wasting are spreading with sheer
inequalities among people. Though, on the other hand, Gouda and Prusty (2014) have argued
that several incidents in the case of underweight, stunting and suffer wasting are there that
shows people from higher castes suffering from this health issues. However, if the
underweight is a threat, overweight, on the other hand, is also a big threat for the people of
high economic background who are mainly from higher castes.
Again, according to Jungari and Chauhan (2017), the discriminations in the people in respect
of caste in the intensity of anaemia shows that it is widely found in the lower caste people,
especially lower caste women than the higher castes. Here, again, the lack of nutrition and
needful food cause can be considered to be the reason. Though, Arlappa et al. (2014) argued
that not only the lack of nutrition, there are several other issues are there behind this disease
and it is common in the higher caste as well.
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Untouchability is one of the major issues caused by the discriminations in the castes and
creed in the country like India. It is so commonly seen in the rural areas of the country.
People, influenced by the superstitions of castes, don’t think twice to treat the people from
lower castes as animals. The practice of untouchability is the ones of most significant
example of it. The higher cast people hate the lower caste people so much that they don’t
even want to touch them. This discrimination also badly affects the treatment of the lower
castes. Nevertheless, in this respect, Cháirez-Garza (2014) has argued that in the modern
days, people, being educated has been able to remove such social superstitions among them.
In this regard, it is required to mention B. R. Ambedkar, who, in spite of belonging to the
Dalit community has become the pride for India.
Education, on the other hand, is also responsible for many inequalities in Indian society in
respect of caste and heath. According to Jungari and Chauhan (2017), because of lack of
education among the lower cast people, they remain unaware of several needful information
and knowledge regarding the diseases. That results in making them more sufferers in health
issues than the higher caste people, who get ample opportunities to make themselves
educated. In addition, the lack of education also creates discrimination of sex among them.
This results in raising several risk factors among the women in the society. The case of infant
mortality is widely seen among them mostly. However, on the other hand, Ranjan, Dwivedi
and Mishra (2018) have opposed this saying the infant mortality is not less in the higher cast
at all in spite of the education and awareness they get.
There are significant discriminations in different castes in respect of the effect of BMI among
the Indian women. It is been seen that most of the women having significantly and
abnormally thin boy, belong to the lower caste people. As per the Jungari and Chauhan
(2017), one-fifth of the lower caste women are seen to be severely thin and one-fourth of the
lower caste women are seen to be moderately thin. Where, on the other hand, the women
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from the higher caste and economic background are much more in shape or rather
overweight. In this regard as well, the discriminations in castes are being one of the
significant influence.
Malnutrition is another two major issues in the health segment. As per the Jungari and
Chauhan (2017), it is been seen that the risk factor regarding malnutrition is much more
prominent among the Muslim and Hindu religions in India. The other castes people,
especially the children are less in count than the children of Muslim and Hindu religions to
make any significant example in this regard. Again, on the other hand, the children from the
lower caste and lower economic background are more exposed to be suffering from lack of
nutrition. Nevertheless, it has been argued by Kulkarni et al. (2014) who criticised the trend
of excessive dieting, which is so common among the young people irrespective of the castes
and creed. This trend is, however, being another threat to the health status of the youth of
India.
However, it this regard, it requires to be mention here regarding the mental health status of
the Indian people and how it is being affected by the discriminations in castes. According to
Morgan and Olsen (2015), people, who are engaged in high accountable job roles in their
career, are more likely to be affected by several health issues resulted in creating, stress,
anxiety, pressure and depression. It is an undeniable fact that mostly those kinds of jobs are
done by the people who are from a higher social background. Though, on the other hand,
Pattanayak and Sagar (2014) argued that nowadays the Government of India is encouraging
lowers social background in that scale that they are now equally establishing themselves in
the society. Again, the struggle, stress and anxiety, that the lowers cast people from a lower
economic background, have to face every day are enough to create some sort of frustration
and pressure that a person doing high accountable job faces.
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Uncontrolled growth in Indian population is also another significant point to mention in this
regard, that shows prominent discrimination between the though and culture among different
castes in the country (Cassen 2016). It is the lower caste people of significantly lower
economic status, who are mostly making examples of uncontrolled growth in Indian
population. In this regard, however, the lack of adequate education appears to be the most
significant reason. This is much less among the higher cast people who are being able to
make themselves enough educated and aware of the ill effects of Uncontrolled growth in
population. In addition, according to Cassen (2016), when, by uncontrolled birth, a poor and
needy family is increasing more family pressure regarding keeping household of a large
family, it appears to be more critical and tough. Though, in this regard, the discrimination of
sex is also an important example to be mentioned.
India is the nation that occupies large part of South Asia and has been roughly one-sixth of
the global population. The nation over last few decades has noted to enjoy rapid economic
growth, however, have charged ineffectively in human progress indicators and health
outcome. The population average of health eminence indicators as maternal mortality and
child health observed to remain unacceptably higher compared to nations in the east and
south Asian regions. Christian (2015) opined that the health inequalities in India coincide
with several axes of class, gender, regional and cast differences. In the nation, a crucial
determinant of socio-economic inequalities has been in near spheres of health and well-being
is cast. Chotia and Rao (2015) argued that irrespective of nation's impressive economic
development the growth in the health status of the Indians have been uneven and slow. The
health inequalities can be seen across states between urban, communities and rural regions.
Walton (2015) supported that historical inequalities that have rooted in the practices and
policies of British colonial India, several of them have been constant to pursued even after
independence. The socio-economic stratify that noted as shackles have contributed towards
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holding back India from modernizations. In context to particular geographical areas, the
health outcome has differed systematically by economic class and gender.
In India, two of socially depresses groups Dalits and Adivasis observed to have worse health
outcome. It is noted that approximately 16% of Dalits and 29% of Adivasis have nil access to
clinics or doctors and only 58% of Dalit and 43% of Adivasi has been immunised (Galanter
2018). On the other hand, Niranjan (2015) argues that it can be possible that relatively poor
health status of India has less to do with low social position however it is more related weak
economic status and poor living environment. With a series of national and global events
contributing to the health inequalities on policy radar, poverty and gender have been
considered as structural determinants of health inequalities in child and maternal health. The
major of factors adding to the health inequalities comprise the largest portion of non-
communicable, communication diseases along with higher rates of malnutrition. For many
years, Dalits have been out-casted from the community and tagged as untouchable. There
have been several laws formulated since 1850, yet they somewhat failed to safeguard Dalits
and end-status inequality (Ramaiah 2015). The respective discriminated colonies are enforced
to utilize water amenities that are not shared by high-status individuals. With 20% of Dalits
not having access to clean and safe drinking water noted to result in fatal diseases and illness
like cholera, diarrhoea and malaria that harshly impacts child mortality causing child death
(Maruthi and Busenna 2015). With half of the inequality referred to health concerns related to
children and women, the income factor has also been a common measure of equity in health
disproportion, followed by education. The issues of poor water facilities have impacted Dalit
women further than men, as traditionally role of girls and women in families have been to
collect water, even at cost of education. It has adversely contributed to health risks, as process
burn a large number of calories and amount of water is collected may be little to consume as
per daily basis. Pink (2016) examined that in India the lack of proper sanitation and education
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has been donors to illness. The limited access to higher education causes little employment
prospects and thus low economic empowerment to be capable to spend on transport to health
clinics or healthcare facilities (Maruthi and Busenna 2015). In India, some worker belonging
to economically backward castes, particularly working with human wastes have been
deprived of types of equipment to safeguard their skin from excrement. As a consequence
they suffer from jaundice, trachoma, vomiting and diarrhoea, where carbon-monoxide
poisoning leads to adverse health consequences. Vallabhaneni (2015) argues that irrespective
of danger, labours are trapped in adverse degrading jobs and often threaten with violence to
continue their working. The workers that tried to leave respective jobs encountered faced
barrier in access to employment, housing and government programs support. As opined by
Begum et al. (2015), the caste system in India that is an integral part of Indian society is
practised in such extents that often pregnant women of backwards-class left to give birth in
absence of trained birth attendants. These have been dangerous for both baby and the mother,
specifically with respect to a complication during labour pain.
It can be deduced that the socio-economic gradient have broadly established health disparities
in growth discourse in India. On the contrary, it is not the Indian government that not only
blamed for the existence of health inequalities. There are several health programs and policy
to support well-being of the society irrespective of caste category (Gupta et al. 2015). The
majority of the poor and low-casts migrating different part of the nation in hunt of work or
employment lose several benefits that are offered to the poorer section of society. The
migrants noted to face hard-time to register to National Tuberculosis Programme at
workplaces, leading to expensive treatments, discontinuation of medication at
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Barik and Thorat (2015) discussed that developing public health system irrespective of caste
in India increases scope of health equalities. The local government have taken initiative to
spend on health-related and public goods, after controlling for several elements, lower in a
region with high caste fragmentation rather than ethically more homogeneous areas. The
enhancement of health education, specifically setting departments of social medicines and
prevention in health electives and medical schools in several courses as social work has been
somewhat helpful to establish health equality. The course development and training in such
streams developed capability for undertaking field epidemiological studies. Bhagat (2016)
added that NSSO or National Sample Survey Organization undertook a national level
examination of self-reported health care and health data across a section of the policy and
social themes. The Indian government needs to emphasize on ending manual-scavenging,
cleaning human wastes by low-caste individuals in the communities. It is important to ensure
that officials at the local level enforce the regulations that prohibit particular discriminatory
practices. On the other hand, the government of India has taken adequate initiatives to
enforce existing legislation in assisting manual scavenging society members to have
alternative towards sustainable livelihoods.
As per the report of National Family Health Survey-III (2005-06), there is clearly mentioned
about the discrimination in the cast in the Indian society. This report also stressed on the
significantly lower tendency of using contraceptive among the people of Scheduled Tribes
and Scheduled Castes in compare to the other castes in India (Nielsen and Nilsen 2015).
Again in the lower caste people, access to the child health care and maternal is decreasing.
Institutional deliveries, antenatal care, and vaccination coverage are also significantly less
among the people of lower castes in the country. Not only the adults in the lower castes but
also the children belonging to this minority suffer from diseases like Stunting, underweight,
wasting and anaemia much more than the children from the higher caste. The issues they face
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in availing health care, are the most effective reasons behind this discriminations. It should be
mentioned that The National Family Health Survey-II (1998-99) as well, the report
documented the same thing which shows no growth in removing this discrimination created
by caste and creed in India, at least from the year 1998 to 2006.
As per the social health status of the Indian people is concerned, there as well, it can be seen
that the lower caste people most commonly suffer from the issues related to social exclusion
& discrimination and several communal violence (Sharma 2015). It is, mostly, the upper
castes, who commit the assault, murder and rape and the people from lower cast are
victimised. Not only that, in most of the cases, they don’t even get the proper justification and
the guiltiest remain unpunished in spite of the presence of Indian law and the system of
protection. The Khairlanji massacre can be mentioned in this regard as example where
investigate on received significant delay in spite of all the legal statutes.
The link between human rights and health status is undeniable factor which demands to be
mentioned (Wronka 2016). The violations that are related to human rights can be considered
to be significant health consequences. However, in order to reduce the intensity of ill-health
status among the lower caste people, protecting and preserving such right are highly
necessary. Freedom from inequality and the right to get an education, health and housing can
be mentioned as an example of such rights (Decker et al. 2015). There is a strong argument
from The World Health Organisation, demanding for the needful omission of discrimination
and abuses of human rights.
It is an undeniable fact that inequality and discrimination in health are more economic and
social instead of being medical. The unequal distribution of income, power, services and
goods play significantly strong threat in establishing a balance in the Indian society which
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results in making the lower caste people suffer. Thus, the socio-economic status of Indian
people is linked with the health status of them.
Among all the barriers that affect the mainstreaming process of health care, caste
discrimination that is based on several issues of the socio-cultural phenomenon is the most
significant barrier (Singh, Verma and Rao 2016). In order to make the intervention work
properly, it is highly essential to tackle the inequity castes related to culture, religion and
tradition with a strict hand. In this regard, it should be mentioned that there is a short time-lag
between the medical intervention’s absence and health outcomes. It appears to be causal. It,
however, states a significant relationship between culture and caste resulting in severe
impacts on its outcome.
In this regard, the development of awareness and health education is highly beneficial in
order to prevent that discrimination (Chu 2016). Setting up of needful preventive departments
and medicine department in several Indian health electives and medical schools are important to
be mentioned. In several other coerces, inclusion of the Training and development course,
conducting several field epidemiological courses are also important to be mentioned (Galanter
2018). However, it this regard it should be mentioned that The Indian Association of Preventive
and Social Medicine of 1974 and Indian Journal of Community Medicine helped a lot to
encourage several discussion publications and discussion of research on the health issues and
several needful researches and trainings.
The commission of WHO on health-related social determinants gave a recommendation of 3
principles that include ensuring the improvement of daily life’s condition, tackling the
discriminations in the distribution in case of power, resources and money and enriching the
public aware by the help of proper measurement and evaluation (Nagarajan 2015). It has
focused on several other needful sides like supplying psychosocial stimulation and
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supplemental nutrition in order to improve the mental and physical growth of the
underprivileged people, encouraging the secondary and primary education, provision of
accessible healthcare facilities, taking initiatives in the development of the urban people in
respect of providing clean water and affordable housing, provision of continuous and fair
employment etc are necessary in this regard.
The government interventions aiming at reducing the inequalities in the area of health policy
are highly important to mention here. ‘Health Survey and Development Committee Report’
of 1946 which was conducted by Sir Joseph Bhore aimed at providing a vast a wide coverage
to the entire population of the country (Debroy and Kumar 2015). In order to determine this
mission, the Government of India has established the National Rural Health Mission
(NRHM) in the year 2005 (Nagarajan 2015). This initiative was made in order to reposition
and rejuvenate the system of public health. However, it is important to mention here that the
initiatives taken by NRHM have been proven to be highly beneficial to the common people
of India and its services are irrespective of caste and crew (Nagarajan 2015). In the year
2009, another significant step was made by the government of India. A National Health Bill
was drafted by the government that proposed a legal framework in order to identify the ‘right
to health care’ and ‘right to health’ (Shidhaye 2016). However, it addressed several
determinants of the social health of the country. The Indian government has also contributed
in case of Utilization of several preventive services. In the period of 2005 to 2006, 44%
Indian population was covered by several governmental health care services. During that
time, the inequality in the minor castes which was caused by the household education and
wealth and other factors was started to show the signs of its gradual reduction with the flow
of time. In the period of 2005 to 2006, 39.7% of scheduled castes and 31.3% of scheduled
tribes were covered by several governmental health care services (Downey 2017). This
coverage rate was significantly higher than the other casts which were 53.8% for the entire
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