Dr. Sandip Medhe
The gross disparities in health that are conspicuous at the interface of different social orders in India are not new, but had been neglected in the discourse on Indian public health. These disparities in provision of health services driven by social forces result in unequal health outcomes among different social groups within the society(Adams et al., 2018), particularly with regards to the vulnerable, marginalized and socially excluded castes and tribes in the Indian society. According to the Commission on Social Determinants of Health brought together by the World Health Organization, factors such as social exclusion, food, transport, and stress are accepted as important social determinants of health (Marmot, 2017). Thus, unequal distribution of privileges and resources between different social classes results in differential opportunities to access health services.
National Family Health Survey (NFHS) is a national five-yearly survey conducted in India, and is analogous to the Demographic Health Survey (DHS) done in other middle/low income countries. Analysis of disaggregated data procured from the NFHS has established that caste in India has been persistently acting as a pivotal determinant of inequalities in health outcomes, especially for the Scheduled Castes (SC), Scheduled Tribes (ST), and Other Backward Classes (OBC) (Krishnan, 2000). Social exclusion, marginalization and discriminatory practices such as untouchability have become significant barriers to ensuring equitable access to essential health services such as primary healthcare, food security programs, maternal and reproductive health services, access to immunization. Such inequalities in health outcomes are the result of apathetic socio-political arrangements leading to avoidable but embodied inequalities in society (Krieger, 2012).