Caste as a social determinant of health inequalities in India

Dr. Sandip Medhe

sandip medheIntroduction

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).


'Educate, Agitate, Organize' - Is it a Sequence or a Parallel Process?

Birendra Nag

birendra nagI could remember the early days of my engagement with Ambedkarite activism; I used to hear this quotation “Educate, Agitate and Organize” on Bhim Jayanti that my community in the Balangir district of the Odisha state used to celebrate every year on 14th April. At that time, I didn't even know the source  of this quotation: who might have said this, what it means so on and so forth. Further, when I ventured into different spaces of Ambedkarite engagement, both within the state and outside, most notably in Maharashtra, I came to understand different intricacies of the movement, people, and its deployment of language in understanding and fighting caste. One of the many intricacies was the concept of Educate, Agitate and Organize.


Spectacle of Crisis: Coronavirus pandemic and the disease of Casteism-Brahmanism in India


Subodh Kunwer

subodh kunwerHas the Corona virus pandemic become something other than a medical subject/disease? The handling of this pandemic brought many crises, events and spectacles to the fore. While on one side lives of people are being lost, on the other we are witnessing the theatrical, performative aspect of the pandemic. Jennifer Cooke in her book Legacies of Plague in Literature, Theory and Film, drawing from Antonin Artaud's 'The Theatre and the Plague',and Albert Camus' 'The State of Siege', focuses on the fact that the effect of plague [pandemic] has an inherent theatricality, a fact that has not gone unnoticed by many playwrights. This write up sure will be called as audacious, perverted and insolent. Let it be called so. We have the example of Antonin Artaud who viewed plague in his essay 'Theatre and the Plague' as a theatrical and, theatre as plaguelike in its spectacle and its physical effect. Albert Camus's play "The State of Siege" as a companion to his novel The Plague presents an analogy for dictatorship and fascism.


കോവിഡ്-19 പകർച്ചവ്യാധിയും ലോക്ഡൗണും : കേരള സമൂഹത്തിന്റെ മുന്നിലെ വെല്ലുവിളികൾ

രഘു ഇരവിപേരൂർ

(Round Table India is doing a series to put together the Bahujan perspective on the Coronavirus pandemic)

raghu eraviperurരാകേഷ് റാം എസ്: ഇന്ത്യയിൽ കോവിഡ്-19 ആദ്യ കേസ് തിരിച്ചറിഞ്ഞത് കേരളത്തിലാണ്. അതിനെതിരെ ഏറ്റവും കാര്യക്ഷമതയോടെ പ്രതികരിച്ചതും കേരളമാണ്. ആദ്യം തൊട്ടു ബോധവത്കരണമുണ്ടായിട്ടും പ്രവാസികളിൽ ചിലർ(കൂടുതലും അധികാരം കൈയ്യേറുന്നവരും അത് കൊണ്ട് തന്നെ നിയന്ത്രണങ്ങൾ ഒരിക്കലും പാലിക്കാൻ താല്പര്യമില്ലാത്തവരും) മുന്നറിയിപ്പുകൾ അവഗണിക്കുകയും ഹോം ക്വാറന്റൈന്‍ പാലിക്കാതെ സമൂഹത്തിൽ ഇറങ്ങി നടക്കുകയും അതിലൂടെ അസുഖം കൂടുതൽ പേർക്ക് പിടിപെടാൻ സാഹചര്യമുണ്ടാക്കുകയും ചെയ്തു. പക്ഷെ ആദ്യ ഘട്ടത്തിൽ തന്നെ പൊതു സമൂഹത്തിൽ കൂടുതൽ നന്നായി ഇതിനെ പറ്റി ബോധ്യമുണ്ടായി എന്ന് തോന്നുന്നു. ഇതിനെ പറ്റി താങ്കളുടെ നിരീക്ഷണങ്ങൾ എങ്ങനെയാണു?

രഘു ഇരവിപേരൂർ: ഒന്നാമത്, തലമുറകൾക്കു ശേഷമാണ് ലോകം ഇത്തരം അപ്രതീക്ഷിതവും മരണകരവുമായ സാംക്രമികരോഗാവസ്ഥയെ നേരിടുന്നത്. പ്രതിരോധത്തിനായി വാക്സിൻ പോലും കണ്ടു പിടിക്കാൻ കഴിയാത്ത ഒരു രോഗത്തിന്റെ മുന്നിൽ മരണത്തെ നിസ്സഹായതയോടെ നോക്കി നിൽക്കുന്ന ഒരു അപൂർവ്വ സന്ദർഭത്തെ ആണല്ലോ ലോകം നേരിടുന്നത്. ചൈനയിലും യൂറോപ്പിലും അടക്കം ലോകത്തെ പല രാജ്യങ്ങളിലും കൊറോണ വൈറസ് ഡിസീസ് (കോവിഡ്-19) പ്രത്യക്ഷപ്പെടുകയും വലിയ തോതിൽ മരണങ്ങൾ ഉണ്ടാവുകയും ചെയ്ത ആദ്യ ഘട്ടത്തിൽ ഇന്ത്യയിൽ ഈ രോഗം കടന്നു വന്നിട്ടുണ്ടായിരുന്നില്ല. ഇവിടെ സൂചിപ്പിച്ചപോലെ കേരളത്തിലാണ്, ഇന്ത്യയിൽ ആദ്യമായി കോവിഡ് പ്രത്യക്ഷപ്പെട്ടത്. വിദേശത്തു നിന്ന് എത്തിയ മലയാളികളിലാണ് അത് ആദ്യം കാണപ്പെടുന്നത്. അവരുമായി സമ്പർക്കത്തിൽ വന്നവരിലൂടെയാണ് സംസ്ഥാനത്തു പിന്നീടത് വ്യാപിച്ചത്.


Philosopher Beyond Caste: An Understanding of Ambedkar’s Idea of Environment and Nature



The entire human civilization is passing through the most painful and catastrophic tragedy of the 21st century. The pandemic ‘COVID-19’ has spread across the world and millions of human beings are suffering for their survival. This global health crisis has compelled us to think about the future of human civilization. Competitive capitalism and blind exploitation of nature have brought the world to the brink of danger. Globalization and modernization are rapidly capturing human emotions under their control. The hegemonic capitalist ideology is solely responsible for this crisis. In such a civilizational crisis, B.R. Ambedkar’s idea of humanity becomes highly relevant for the world.

In the academic discourses, Ambedkar has rarely been seen in the framework of the environment, as much as Gandhi and Nehru have drawn the attention of scholars. In a broader sense, this article explains why Ambedkar has not found a place in the contemporary canon of Indian environmentalists and nature writers. Though, Ambedkar has immensely contributed to the domain of environment and nature through his scholarly writings. Mukul Sharma argues that ‘Ambedkar’s engagement with the environment question has been relatively unexplored, even when his thoughts and interventions on nature, village, land, agriculture, water, community, industry, technology and science are some of the enduring issues of India’s environmental and political traditions.’


The COVID19 crisis: the perils of separating environmental health from human health


Pradnya Mangala 

(SAVARI and Round Table India are doing a series to put together the Bahujan perspective on the Coronavirus pandemic)

pradnya mangala ore Anu RamdasWhat is the global conversation about the climate/weather change as a result of the lockdown in most of the heavily industrialized countries?

Pradnya Mangala: Broadly there are two kinds of narratives around climate change/environment related to the coronavirus outbreak: Marxist and Western liberal perspectives.

1. From a Marxist environmental sociology perspective, economy and ecology are entangled in complex ways in capitalist social relations. Thus, the origin and spread of the virus is connected to the larger question of the political economy of the intensive agribusiness which has led to intrusion and exploitation of natural systems and wilderness in a manner in which the emergence of harmful pathogens has become a recurring phenomenon (Wallace, 2020; Foster, 2020). In other words, we can say that capitalism, through the rearing of animals on a large scale for profitmaking, has altered ecological conditions in ways that have contributed to the development of new forms of pathogenic diseases. This perspective helps us to situate the pandemic on a broader systemic level.


Covid-19 plus Ramayan: Adding insult to injury


Amarnath Sandipamu & Deepu Myneni 

(Round Table India is doing a series to put together the Bahujan perspective on the Coronavirus pandemic)

Anu Ramdas: It is well known that pandemics can and do facilitate totalitarian regimes to accelerate their ideologies when society is under the threat of the disease. We wanted to document the conversation that Amar initiated on Facebook regarding the timing of retelecasting the Ramayan serial during the Covid19 lockdown. Amar, Deepu and Kuffir give a layered reading of the myths and their mass dissemination. Enjoy!

amaretal ramayana

Amarnath Sandipamu: The Govt's proposal or idea to retelecast Ramayan serial is not a smart or even an intelligent one.

Kuffir: … Darwin says that it is not the most powerful or the most intelligent species which survive, but those which adapt. So, brahmins are like that.


The need to revisit conversion as a tool for fighting caste

Srutheesh Kannadi

srutheeshThe issue of caste faced by Dalits is too complex to explain in the context of post-colonial modernity. The structural existence of caste has attained much flexibility and transformed into the behaviour of an amoeba where it appears to not follow any pre-defined principles. This illusion of caste made it invisible but at the same time it informs all kind of inhuman and discriminatory practices. The post-colonial modernity has paved the way for the ruling castes/class to maintain their hierarchies and Hindu social order by covering up themselves with the liberal/progressive masks. By creating an illusion of flexibility over caste discourses the structural position still appears to be more rigid as defined in the Hindu social order. So it is in this context that the idea of conversion needs to be revisited as a tool against the caste inequalities.

Many anti-caste philosophers and intellectuals, including Ambedkar, have suggested conversion as a method to resolve the humiliations and atrocities of the caste structured Hindu society. Ambedkar talks about both the social and spiritual aspects of conversion, especially to Buddhism, by imagining the idea of liberty, equality and fraternity. He argues in favour of conversion from Hinduism since it negates the identity of an individual and recognizes only the privileges of caste/class groups. But to talk about conversion or to get converted, the primordial state demands the Dalits to be accepted as Hindu in the beginning. So how have the Dalits become Hindu is the primary question that needs to be addressed.


Hindu religion is the real culprit: Why do people avoid talking about it?


Vaishali Khandekar

vaishali khandekar

"In spite of what others say the Hindu will not admit that there is anything evil in the Caste System and from one point he is right. There is love, unity and mutual aid among members of a family. There is honour among theives. A band of robbers have common interests as respects to its members. Gangs are marked by fraternal feelings and intense loyalty to their own ends however opposed they may be to the other gangs. Following this up one can say that a Caste has got all the praiseworthy characteristics which a society is supposed to have. It has got the virtues of a family inasmuch as there is love, unity and mutual aid. It has got the honour known to prevail among thieves. It has got loyalty and fraternal feeling we meet within gangs and it also possesses that sense of common interests which is found among robbers." ~ Babasaheb Ambedkar in "Triumph of Brahminism"

Yesterday, India witnessed a Diwali ahead of Diwali. What was different about this Diwali was that instead of celebrating just Ram's homecoming, it celebrated the supreme leader PM Narendra Modi. It was rather a celebration of Hindu Religion, marking its presence and a decalaration of victory through this Hindu orchestra, directed by their king. While I was witnessing this mayhem, I was enraged by the diyas and the sound of conches being blown. People went to the extent of chanting Jai Shri Ram and Bharat Mata ki Jai.


The Supreme Court’s decision on reservations in promotion is a step back in the fight against social injustice

Tanishque Gedam

tanishque gedamReservations in promotion for people belonging to the Scheduled Castes(SCs) & Scheduled Tribes(STs) in public services and government employment has been subject to intense debate and severe criticism ever since it first came into effect. However the issue was in the limelight again after the apex court in February ruled that reservation in promotions isn’t a fundamental right, meaning that the states are not legally bound to grant reservations to SCs & STs in government jobs and services.

The ruling reiterated that under Article 16(4) of the Indian Constitution, the government is empowered to undertake such legislation at its discretion.


This lockdown is completely against the Dalit-Bahujans

Pradnya Jadhav

(SAVARI and Round Table India are doing a series to put together the Bahujan perspective on the Coronavirus pandemic)

pradnyaj 2020Anu: How are the people at home and the neighbourhood responding, and preparing for the prolonged lockdown due to the pandemic?

Pradnya: I would say, uncertainty prevails. First of all, there is no clear communication between the authorities and the people. It is neither about the gravity nor about how the authorities themselves are preparing to respond to the needs of the people. It is no different than what we are witnessing at the pan-India level. The lockdown was abruptly announced giving no window for us to prepare ourselves.

In fact, the preparation is a lot more about having the capacity to afford it, with the majority of the people in my neighbourhood working as daily wage labourers. A few of them work at the sawmills, and a few as domestic helpers, security guards, sweepers, etc. The foremost concern, to survive during this lockdown, is to have enough groceries at home which not many of them have been able to purchase. The supermarkets are unaffordable, in each lane of the locality there are small kirana shops, and the owners keep daily essentials at their homes, from milk to the grains. As of now, most of them are buying groceries on credit from these kirana shops, this is an adjustment for the time being and not a long term solution. The PDS shops are far from here, going outside is risky since the police will beat them up and later the long queue waits at the shop.


Why Dr. Devi Shetty’s 25 (or 2500) ‘ways to manage Covid-19’ should be rejected outright


Dr. Sylvia Karpagam

Sylvia pixFor far too long, Dr. Devi Shetty has been giving advice on a range of things, the most recent being the Covid-19 pandemic. This is a crucial public health period for India, laying bare all the strengths and weaknesses of the system, and offering a significant window of opportunity to reimagine India's public health system in a more comprehensive and holistic manner. Dr. Devi Shetty, a cardiothoracic surgeon and Chairman of one of the largest chain of corporate hospitals in Karnataka has become, and projected as, the singular advisor on all types of healthcare issues - a veritable one man army!

However, one little fact that gets sidelined is that, being a cardiothoracic surgeon by training, he is unlikely to have expertise in public health, epidemiology, statistics, planning, management etc. Secondly, being the Chairman of a corporate chain of hospitals, he has a terribly strong conflict of interest. Given a chance to 'plan' crucial budgets with public money, what are the chances that he will give up a wonderful opportunity to further the cause of the private healthcare sector? What are the chances that he won't?


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