Social exclusion, caste & health: a review based on the social determinants framework

Poverty and social exclusion are important socio-economic variables which are often taken for granted while considering ill-health effects. Social exclusion mainly refers to the inability of our society to keep all groups and individuals within reach of what we expect as society to realize their full potential. Marginalization of certain groups or classes occurs in most societies including developed countries and perhaps it is more pronounced in underdeveloped countries. In the Indian context, caste may be considered broadly as a proxy for socio-economic status and poverty. In the identification of the poor, scheduled caste and scheduled tribes and in some cases the other backward castes are considered as socially disadvantaged groups and such groups have a higher probability of living under adverse conditions and poverty. The health status and utilization patterns of such groups give an indication of their social exclusion as well as an idea of the linkages between poverty and health. In this review, we examined broad linkages between caste and some select health/health utilization indicators. We examined data on prevalence of anaemia, treatment of diarrhoea, infant mortality rate, utilization of maternal health care and childhood vaccinations among different caste groups in India. The data based on the National Family Health Survey II (NFHS II) highlight considerable caste differentials in health. The linkages between caste and some health indicators show that poverty is a complex issue which needs to be addressed with a multi-dimensional paradigm. Minimizing the suffering from poverty and ill-health necessitates recognizing the complexity and adopting a perspective such as holistic epidemiology which can challenge pure technocentric approaches to achieve health status.