Skip to main content

Health Inequalities—An Embodiment of Caste-Based Inequalities

  • Chapter
  • First Online:
Mapping Identity-Induced Marginalisation in India

Abstract

Identity-induced marginalization has been important feature of Indian society. The identity-based marginalization leading to exclusion of significant sections of population from different social, economic and political spheres of life has been documented time and again across length and breadth of the country. The exclusion from and discrimination in socio-economic and political spheres of life has been so deeply entrenched that it has embodied itself and get reflected in the bodies of the excluded and discriminated communities. The health status indicators show the differential health status experienced by different social identity groups. Mortality, nutritional status and morbidity indicators from different all-India-level data sets, collected by different government agencies at different points of time, clearly indicate that the health status is reflective of socio-economic inequalities in the country. The state apparatus has failed to do justice, even after 70 years of freedom, to the marginalized and discriminated identity groups especially scheduled castes, Scheduled Tribes and Muslims. The data shows exclusion and differential access to healthcare services provided for these marginalized social groups. The nationally representative data sources like NSSO, 64th and 71st round, NFHS 1–4 rounds, NNMB surveys, DLHS survey, NHP report, National Health Accounts data have been analysed to show the health status inequalities and in-equal access and utilization of state-run health services and health-related schemes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Acharya, S. S. (2009). Caste and patterns of discrimination in rural public health care services. In S. Thorat & K. Newman (Eds.), Blocked by caste: Economic discrimination in modern India (pp. 208–229). Oxford University Press.

    Google Scholar 

  • Acharya, S. S. (2018). Health Equity in India: An examination through the lens of social exclusion. Journal of Social Inclusion Studies, 4(1), 104–130. https://doi.org/10.1177/2394481118774489

    Article  Google Scholar 

  • Bagga, A., & Kulkarni, S. (2000). Age at menarche and secular trend in Maharashtrian (Indian) girls. Acta Biologica Szegediensis, 44(1–4), 53–57.

    Google Scholar 

  • Barnes, L. L., De Leon, C. F. M., Lewis, T. T., Bienias, J. L., Wilson, R. S., & Evans, D. A. (2008). Perceived discrimination and mortality in a population-based study of older adults. American Journal of Public Health, 98(7), 1241–1247.

    Article  Google Scholar 

  • Borooah, V. K., Diwakar, D., Mishra, V. K., Naik, A. K., & Sabharwal, N. S. (2014). Caste, inequality, and poverty in India: A re-assessment. Development Studies Research, 1(1), 279–294. https://doi.org/10.1080/21665095.2014.967877

    Article  Google Scholar 

  • Buckley, T. M., & Schatzberg, A. F. (2005). On the interactions of the hypothalamic-pituitary-adrenal (HPA) axis and sleep: Normal HPA axis activity and circadian rhythm, exemplary sleep disorders. The Journal of Clinical Endocrinology & Metabolism, 90(5), 3106–3114.

    Article  Google Scholar 

  • Busse, D., Yim, I. S., Campos, B., & Marshburn, C. K. (2017). Discrimination and the HPA axis: Current evidence and future directions. Journal of Behavioral Medicine, 40(4), 539–552.

    Article  Google Scholar 

  • Cohen, S., Janicki-Deverts, D., Doyle, W. J., Miller, G. E., Frank, E., Rabin, B. S., & Turner, R. B. (2012). Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proceedings of the National Academy of Sciences, 109(16), 5995–5999.

    Article  Google Scholar 

  • Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health: final report of the commission on social determinants of health. World Health Organization.

    Google Scholar 

  • Das, S. (2016). Food insecurity among dalit communities in India: Searching the root causes and dimensions. Journal of Political Sciences & Public Affairs, 04(01). https://doi.org/10.4172/2332-0761.1000190

  • Deaton, A. (2013). The great escape: Health, wealth, and the origins of inequality. Princeton University Press.

    Book  Google Scholar 

  • Desai, S., & Vanneman, R. (2018). India Human Development Survey-II (IHDS-II), 2011–12. Inter-university consortium for political and social research ann arbor, MI. https://doi.org/10.3886/ICPSR36151.v6

  • Deshpande, A. (2000). Does caste still define disparity? A look at inequality in Kerala, India. American Economic Review, 90(2), 322–325. https://www.jstor.org/stable/117244

  • Dhabhar, F. S. (2009). A hassle a day may keep the pathogens away: The fight-or-flight stress response and the augmentation of immune function. Integrative and Comparative Biology, 49(3), 215–236.

    Article  Google Scholar 

  • Dreze, J., & Goyal, A. (2003). Future of mid-day meals. Economic and political weekly, 4673–4683.

    Google Scholar 

  • Du, X., & Pang, T. Y. (2015). Is dysregulation of the HPA-axis a core pathophysiology mediating co-morbid depression in neurodegenerative diseases? Frontiers in Psychiatry, 6, 32.

    Article  Google Scholar 

  • Fiscella, K., Franks, P., Gold, M. R., & Clancy, C. M. (2000). Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health care. JAMA, 283(19), 2579–2584.

    Article  Google Scholar 

  • Gallo, V., Mackenbach, J. P., Ezzati, M., Menvielle, G., Kunst, A. E., Rohrmann, S., Kaaks, R., Teucher, B., Boeing, H., & Bergmann, M. M. (2012). Social inequalities and mortality in Europe–results from a large multi-national cohort. PLoS ONE, 7(7), e39013.

    Article  Google Scholar 

  • Garg, A., Kumar, L., & Garg, N. (2016). Association of maternal height with delivery outcome: A prospective study. Int J Sci Stud, 3(10), 27–30.

    Google Scholar 

  • Gibbs, E. P. J. (2014). The evolution of one health: A decade of progress and challenges for the future. Veterinary Record, 174(4), 85–91.

    Article  Google Scholar 

  • Guntupalli, A. M., & Baten, J. (2006). The development and inequality of heights in North, West, and East India 1915–1944. Explorations in Economic History, 43(4), 578–608.

    Article  Google Scholar 

  • Gupta, A., & Sudharsanan, N. (2020). Large and persistent life expectancy disparities among India’s social groups.

    Google Scholar 

  • Hatzenbuehler, M. L., & McLaughlin, K. A. (2014). Structural stigma and hypothalamic–pituitary–adrenocortical axis reactivity in lesbian, gay, and bisexual young adults. Annals of Behavioral Medicine, 47(1), 39–47.

    Article  Google Scholar 

  • Hindwan, S. (2010). Caste and class of violence in India: Assertion among Dalits. Journal of Peace Studies, 17(4), 1.

    Google Scholar 

  • International Institute for Population Sciences. (1995). National Family Health Survey (NFHS-1), 1992–93. http://rchiips.org/NFHS/india1.shtml

  • International Institute for Population Sciences. (2000). National Family Health Survey (NFHS-2),1998–99. http://rchiips.org/NFHS/india2.shtml

  • International Institute for Population Sciences. (2007). National Family Health Survey (NFHS-3), 2005–06 (Vol. 1). International Institute for Population Sciences.

    Google Scholar 

  • International Institute for Population Sciences. (2017). National Family Health Survey (NFHS-4), 2015–16. In International Institute for Population Studies. http://rchiips.org/nfhs/NFHS-4Reports/India.pdf

  • International Institute for Population Sciences. (2021). National Family Health Survey (NFHS-5), 2019–20. http://rchiips.org/NFHS/factsheet_NFHS-5.shtml

  • Jadhav, P. (2008). Relative disparity in the implementation of reservation policy in India. In J. Karade (Ed.), The development of scheduled castes and scheduled tribes in India. Newcastle, UK: Cambridge Scholars Publishing.

    Google Scholar 

  • Jadhav, S., Mosse, D., & Dostaler, N. (2016). Minds of caste—Discrimination and its affects. Anthropology Today, 32(1), 1–2. https://doi.org/10.1111/1467-8322.12221

    Article  Google Scholar 

  • Krieger, N. (2001). Theories for social epidemiology in the 21st century: An ecosocial perspective. International Journal of Epidemiology, 30(4), 668–677.

    Article  Google Scholar 

  • Krieger, N. (2005). Embodiment: A conceptual glossary for epidemiology. Journal of Epidemiology & Community Health, 59(5), 350–355.

    Article  Google Scholar 

  • Krieger, N. (2014). Discrimination and health inequities. International Journal of Health Services, 44(4), 643–710.

    Article  Google Scholar 

  • Krieger, N., & Davey Smith, G. (2004). Bodies count, and body counts: social epidemiology and embodying inequality. Epidemiologic Reviews, 26(1), 92–103. https://doi.org/10.1093/epirev/mxh009

    Article  Google Scholar 

  • Kuh, D., Ben-Shlomo, Y., Lynch, J., Hallqvist, J., & Power, C. (2003). Life course epidemiology. Journal of Epidemiology and Community Health, 57(10), 778.

    Article  Google Scholar 

  • Kumari, M., & Mohanty, S. K. (2020). Caste, religion and regional differentials in life expectancy at birth in India: Cross-sectional estimates from recent national family health survey. British Medical Journal Open, 10(8), e035392.

    Google Scholar 

  • Kuzawa, C. W., & Bragg, J. M. (2012). Plasticity in human life history strategy: Implications for contemporary human variation and the evolution of genus Homo. Current Anthropology, 53(S6), S369–S382.

    Article  Google Scholar 

  • Laurell, A. C. (1989). Social analysis of collective health in Latin America. Social Science & Medicine, 28(11), 1183–1191.

    Article  Google Scholar 

  • Laxmaiah, A., Nair, M. K., Arlappa, N., Raghu, P., Balakrishna, N., Rao, K. M., Galreddy, C., Kumar, S., Ravindranath, M., & Rao, V. V. (2012). Prevalence of ocular signs and subclinical vitamin A deficiency and its determinants among rural pre-school children in India. Public Health Nutrition, 15(4), 568–577.

    Article  Google Scholar 

  • Lee, D. B., Peckins, M. K., Heinze, J. E., Miller, A. L., Assari, S., & Zimmerman, M. A. (2018). Psychological pathways from racial discrimination to cortisol in African American males and females. Journal of Behavioral Medicine, 41(2), 208–220.

    Article  Google Scholar 

  • Madheswaran, S., & Attewell, P. (2007). Caste discrimination in the Indian urban labour market: Evidence from the National Sample Survey. Economic and political weekly, 4146–4153.

    Google Scholar 

  • Marmot, M., Friel, S., Bell, R., Houweling, T. A. J., Taylor, S., & Commission on Social Determinants of Health. (2008). Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet, 372(9650), 1661–1669.

    Article  Google Scholar 

  • Martinac, M., Pehar, D., Karlović, D., Babić, D., Marčinko, D., & Jakovljević, M. (2014). Metabolic syndrome, activity of the hypothalamic-pituitary-adrenal axis and inflammatory mediators in depressive disorder. Acta Clinica Croatica, 53(1), 55–70.

    Google Scholar 

  • Migliorini, C., & Siahpush, M. (2006). Smoking, not smoking: How important is where you live? Health Promotion Journal of Australia, 17(3), 226–232.

    Article  Google Scholar 

  • Ministry of Statistics and Program Implementation. (2015). Social consumption: education and health (NSS 71st Round).

    Google Scholar 

  • Ministry of Statistics and Program Implementation. (2017). Disabled persons in India-A statistical profile 2016. http://mospi.nic.in/sites/default/files/publication_reports/Disabled_persons_in_India_2016.pdf

  • Mohanty, S. K., & Ram, F. (2010). Life expectancy at birth among social and economic groups in India. Mumbai: International institute for population science, Available at https://Www.Iipsindia.Org/Pdf/RB-13%20file%20for%20uploading.pdf (Accessed December 2012).

  • Nathan, C. (2002). Points of control in inflammation. Nature, 420(6917), 846–852.

    Article  Google Scholar 

  • National Commission for Scheduled Tribes. (2007). National Commission for scheduled tribes—A handbook. https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiz9Imi0aDxAhVPX30KHcHrAhIQFjAAegQIBBAF&url=https%3A%2F%2Fwww.aicte-india.org%2Fdownloads%2Fhandbook%2520for%2520Scheduled%2520Tribes.pdf&usg=AOvVaw2ZxNWrH_baOboVkBCzxWCi

    Google Scholar 

  • Pallikadavath, S., Ogollah, R., Singh, A., Dean, T., Dewey, A., & Stones, W. (2016). Natural menopause among women below 50 years in India: A population-based study. The Indian Journal of Medical Research, 144(3), 366.

    Article  Google Scholar 

  • Pathak, P. K., Tripathi, N., & Subramanian, S. V. (2014). Secular trends in menarcheal age in India-evidence from the Indian human development survey. PLoS ONE, 9(11), e111027.

    Article  Google Scholar 

  • Pierce, M. B., & Leon, D. A. (2005). Age at menarche and adult BMI in the Aberdeen children of the 1950s cohort study. The American Journal of Clinical Nutrition, 82(4), 733–739.

    Article  Google Scholar 

  • Rah, J. H., Shamim, A. A., Arju, U. T., Labrique, A. B., Rashid, M., & Christian, P. (2009). Age of onset, nutritional determinants, and seasonal variations in menarche in rural Bangladesh. Journal of Health, Population, and Nutrition, 27(6), 802.

    Google Scholar 

  • Records Bureau. (2019). prison statistics India. https://ncrb.gov.in/en/prison-statistics-india-2019

  • Reiche, E. M. V., Nunes, S. O. V., & Morimoto, H. K. (2004). Stress, depression, the immune system, and cancer. The Lancet Oncology, 5(10), 617–625.

    Article  Google Scholar 

  • Rokade, S. A., & Mane, A. K. (2009). A study of age at menarche, the secular trend and factors associated with it. Internet Journal of Biological Anthropology, 3(2).

    Google Scholar 

  • Sabharwal, N. S. (2011). Caste, religion and malnutrition linkages. Economic and Political Weekly, 16–18.

    Google Scholar 

  • Sachar, R., Hamid, S., Oommen, T. K., Basith, M. A., Basant, R., Majeed, A., & Shariff, A. (2006). Social, economic and educational status of the Muslim community of India. Cirrus Graphics Pvt. Ltd.

    Google Scholar 

  • Seeman, T. E., Singer, B. H., Rowe, J. W., Horwitz, R. I., & McEwen, B. S. (1997). Price of adaptation—allostatic load and its health consequences: MacArthur studies of successful aging. Archives of Internal Medicine, 157(19), 2259–2268.

    Article  Google Scholar 

  • Shah, G., Mander, H., Thorat, S., Deshpande, S., & Baviskar, A. (2006). Untouchability in rural India. Sage.

    Google Scholar 

  • Sharma, P. P., Kumar, A., & Singh, P. (2010). A study of gender differentials in the prevalence of tuberculosis based on NFHS-2 and NFHS-3 data. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 35(2), 230.

    Article  Google Scholar 

  • SJ, A. I., Mangubhai, J. P., & Lee, J. G. (2006). Dalit women speak out: caste, class and gender violence in India (Volume I a). National Council for Dalit Human Rights.

    Google Scholar 

  • Susser, M., & Susser, E. (1996). Choosing a future for epidemiology: I. Eras and paradigms. American Journal of Public Health, 86(5), 668–673.

    Google Scholar 

  • Talma, H., Schönbeck, Y., van Dommelen, P., Bakker, B., van Buuren, S., & HiraSing, R. A. (2013). Trends in menarcheal age between 1955 and 2009 in the Netherlands. PLoS ONE, 8(4), e60056.

    Article  Google Scholar 

  • Taylor, S. E., Repetti, R. L., & Seeman, T. (1997). Health psychology: What is an unhealthy environment and how does it get under the skin? Annual Review of Psychology, 48(1), 411–447.

    Article  Google Scholar 

  • Thorat, S., & Lee, J. (2006). Food Security Schemes and Caste Discrimination (No. 3; Vol. 1).

    Google Scholar 

  • Thorat, S., & Madheswaran, S. (2018). Graded caste inequality and poverty: Evidence on role of economic discrimination. Journal of Social Inclusion Studies, 4(1), 3–29. https://doi.org/10.1177/2394481118775873

    Article  Google Scholar 

  • UNICEF. (1998). The State of the World’s Children. Oxford University Press. https://www.unicef.org/sowc98/sowc98.pdf

  • VILLERMÉ, L. R. (1829). Mémoire sur la taille de l’homme en France. Annales d’Hygiène Publique et de Médicine Légale, 351–396.

    Google Scholar 

  • Wagstaff, A., Bredenkamp, C., & Buisman, L. R. (2014). Progress on global health goals: Are the poor being left behind? The World Bank Research Observer, 29(2), 137–162.

    Article  Google Scholar 

  • Walvoord, E. C. (2010). The timing of puberty: Is it changing? Does it matter? Journal of Adolescent Health, 47(5), 433–439.

    Article  Google Scholar 

  • Whitaker, K. M., Everson-Rose, S. A., Pankow, J. S., Rodriguez, C. J., Lewis, T. T., Kershaw, K. N., Diez Roux, A. V., & Lutsey, P. L. (2017). Experiences of discrimination and incident type 2 diabetes mellitus: The multi-ethnic study of atherosclerosis (MESA). American Journal of Epidemiology, 186(4), 445–455.

    Article  Google Scholar 

  • Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A. G., de Souza Dias, B. F., Ezeh, A., Frumkin, H., Gong, P., & Head, P. (2015). Safeguarding human health in the Anthropocene epoch: Report of the Rockefeller foundation-lancet commission on planetary health. The Lancet, 386(10007), 1973–2028.

    Article  Google Scholar 

  • Williams, D. R., Lawrence, J. A., Davis, B. A., & Vu, C. (2019). Understanding how discrimination can affect health. Health Services Research, 54, 1374–1388.

    Article  Google Scholar 

  • World Health Organization. (2008). Closing the gap in a generation: health equity through action on the social determinants of health: Commission on social determinants of health final report. World Health Organization.

    Google Scholar 

  • World Health Organization. (2020). Life expectancy and healthy life expectancy-data by country. WHO; World Health Organization. https://apps.who.int/gho/data/view.main.SDG2016LEXv?lang=en

  • Yang, Y. C., Li, T., & Ji, Y. (2013). Impact of social integration on metabolic functions: Evidence from a nationally representative longitudinal study of US older adults. BMC Public Health, 13(1), 1–11.

    Article  Google Scholar 

  • Zeiders, K. H., Doane, L. D., & Roosa, M. W. (2012). Perceived discrimination and diurnal cortisol: Examining relations among Mexican American adolescents. Hormones and Behavior, 61(4), 541–548.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Prachinkumar Ghodajkar .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ghodajkar, P., Choudhary, K.K. (2022). Health Inequalities—An Embodiment of Caste-Based Inequalities. In: Kale, R.K., Acharya, S.S. (eds) Mapping Identity-Induced Marginalisation in India . Springer, Singapore. https://doi.org/10.1007/978-981-19-3128-4_21

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-3128-4_21

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-3127-7

  • Online ISBN: 978-981-19-3128-4

  • eBook Packages: Social SciencesSocial Sciences (R0)

Publish with us

Policies and ethics