Inequities in health in India and Dalit and Adivasi populations

Abstract

Caste in modern India is no longer just a social phenomenon but an indivisible part of the political process. This chapter summarises the recent literature on health inequities in India by Dalit or Scheduled Caste (SC) and Adivasi or Scheduled Tribe (ST) status. Through a synthesis across the various papers, the chapter also attempts to discern the possible mechanisms and processes underlying the observed health inequities, and changes in these over time. All studies consistently reported that the Scheduled Tribe and Scheduled Caste populations had worse health as compared to other sections of the population. The poor health of this disadvantaged group is evident in the higher levels of morbidity and undernutrition, higher rates of mortality and early onset of death. They also have relatively lower utilisation of both preventive and curative services, and receive poor quality of services when they do access services. In many instances, Dalit and Adivasi status-based health inequities are found even after adjusting for education and income. These health inequities have persisted over the time period under review (2000-2014). A reading across the studies suggests that three possible sets of mechanisms may underlie Dalit/Adivasi status-based inequities in health. The first set consists of disadvantages experienced by members of these population groups because of their historical social exclusion or isolation and their marginalisation. The second includes intermediary factors such as education, occupation and income, access to which is limited or constrained by the social location of SC and ST populations; and the third mechanism consists of differences in the way the institutions such as health and education and social welfare systems behave towards them. From the synthesis, it is evident that the current body of evidence affords only a superficial understanding on how Dalit and Adivasi status leads to health inequities. We need to ask the why and how questions, and explore the hypotheses emerging about possible mechanisms if we are to make meaningful contribution to policy and social action.