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Inequities in Health in India and Dalit and Adivasi Populations

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Health Inequities in India

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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.

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Notes

  1. 1.

    A note on terminologies is in order here. While we would prefer to use the terms Dalit and Adivasi, and have done so when we are referring to these population groups, where we cite data from published sources, we have maintained the terminologies used by the authors of the study. Thus in almost all places where studies are cited, the terms SC and ST, or as is often the case, SC/ST is used.

  2. 2.

    ST groups such as the Bodo in the North-East of India prefer to refer to themselves as “Tribal” because the term Adivasi is used to refer to migrant STs from other states.

  3. 3.

    Some such as Bodo in the North-Eastern states of India, however, prefer to be known as tribals, to distinguish themselves from the ‘Adivasis’, a term used in the North-Eastern states to refer to migrant tribal communities from neighbouring states.

  4. 4.

    Integrated Child Development Services (ICDS) is a welfare programme of the Government of India. It includes the provision of food, preschool education and primary health care to children under 6 years of age and their mothers.

  5. 5.

    Maternal And Perinatal Death Enquiry and Response (MAPEDIR) Project was implemented in 16 districts in six Indian states with high maternal mortality (West Bengal, Rajasthan, Jharkhand, Bihar, Orissa and Madhya Pradesh).

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  1. Institute of Community Medicine, Madras Medical College, Chennai, India

    Sudharshini Subramaniam

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  1. Sudharshini Subramaniam
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  1. Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

    T.K. Sundari Ravindran

  2. Centre for Technology and Policy (CTaP), Indian Institute of Technology Madras, Chennai, Tamil Nadu, India

    Rakhal Gaitonde

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Subramaniam, S. (2018). Inequities in Health in India and Dalit and Adivasi Populations. In: Ravindran, T., Gaitonde, R. (eds) Health Inequities in India. Springer, Singapore. https://doi.org/10.1007/978-981-10-5089-3_5

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  • DOI: https://doi.org/10.1007/978-981-10-5089-3_5

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