What is the connection between caste and health status in India? This paper, published by the Institute of Development Studies Bulletin, argues that discrimination and exclusion associated with “untouchability” may play a role in the poor health of lower caste individuals. Particularly in the nutrition domain, lower caste children have significantly lower indicators of health and well-being. Proactively inclusive measures are needed to reverse current trends, beginning with antipoverty and education programmes. Equally necessary is a major campaign to raise awareness among rural people, including the scheduled castes (SC) and scheduled tribes (ST), encouraging them to access healthcare services.
Data from the National Family Planning and Health Survey (NFHS-3) demonstrate that the SC/ST group is faring worse in terms of mortality, morbidity and undernutrition, and access to health services. A number of studies indicate the role of discrimination in unequal access – areas identified include the dispensing of medicine, diagnostic visits to the doctor and the conduct of pathological tests. A perception exists that public healthcare services discriminate more than private providers.
The following findings emerge from a review of health and discrimination among lower caste Indians:
- Health and nutrition status are much worse for SC and ST children in nearly all respects.
- Low caste health problems may be partly related to low income and low levels of education, but inability or unwillingness to access public health service is clearly a factor.
- Even when controlling for standard of living and education, SC and ST children have a significantly lower health status than their higher caste counterparts.
- However, “untouchability” is clearly not an absolute barrier to health care provision. The National Family Household Survey (2005–06) found that SC/ST women were more likely than others to utilise surgical forms of family planning.
The following recommendations provide a way of addressing these issues, and specifically for improving nutrition among ST and SC children:
- A national public awareness campaign is necessary to communicate the high cost of discrimination on individual children.
- Health officials and NGOs should give priority to the construction of new and improved Integrated Child Development Services (ICDS) centres that can help underserved SC and ST communities.
- ICDS staff should include more SC and ST women. Girls in these communities should be encouraged to complete basic and higher education in order to fill these roles. All ICDS staff training initiatives should include modules on the negative effects of gender and caste discrimination.
- ICDS staff and health workers should receive rewards when their work benefits SC/ST communities.
- Those NGOs which are more inclusive and recruit from underserved communities should be preferred for the subcontracting of health outreach services.
- Monitoring and evaluation systems should be disaggregated by social group, so that data can lead to better service delivery and the unblocking of “bottlenecks” in the system. The data should be made publicly available, and SC/ST organisations trained to make use of it.
